Blood pressure standards for very low birthweight infants during the first day of life

Lee, J; Rajadurai, Victor Samuel; Tan, K W

doi:10.1136/fn.81.3.f168

Cited by 113 publications

(69 citation statements)

References 6 publications

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“…In the absence of reliable normative data, clinicians have resorted to nonvalidated generalizations, such as assuming that MAP (in Torr) if equated numerically to GA (in weeks) represents the lower limit of normal. 29,30 Poor definition of GA, varying postnatal age at the time of MAP reading, and a wide range of values among infants never treated for hypotension weaken these assumptions.…”

Section: Discussionmentioning

confidence: 99%

“…21 -23,30 Our group of large discordant twins had higher MAPs than their small discordant counterparts. It has been noted 14,23,30 that among infants of the same birth weight, those with more advanced GA will have higher MAP. This observation is also validated by the fact that small concordants who had similar birth weight but younger GA had lower MAP than small discordant ELBW infants.…”

Section: Cordero and Johnsonmentioning

confidence: 99%

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Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Cordero

Johnson

2002

J Perinatol

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Section: Discussionmentioning

confidence: 99%

Section: Cordero and Johnsonmentioning

confidence: 99%

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Cordero

Johnson

2002

J Perinatol

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“…Many clinicians now consider a mean arterial pressure (in torr) less than the gestational age (in weeks) as an indication to treat for hypotension. 22,23 Our study focused only on singletons mainly because the arterial pressure is also complicated by several other factors associated with multiple gestations. 7,8 Previous studies have demonstrated that arterial blood pressure in newborns is influenced by birth weight, 3,24 -26 gestational age, antenatal steroid exposure, 4 multiple gestations, 7,8 postnatal age 27,28 and maternal age.…”

Section: Discussionmentioning

confidence: 99%

“…Arterial pressure was measured directly through an indwelling catheter or noninvasively by the oscillometric method. Under unit protocol, any recorded mean arterial pressure less than the gestational age in weeks in the first 24 h of life 22,23 requiring fluid therapy generated a 'hypotension' problem in an infant's NeoData medical record documentation system. Other demographic, diagnostic, therapeutic and outcome data were extracted from NeoData archives.…”

Section: Methodsmentioning

confidence: 99%

Early neonatal hypotension in premature infants born to preeclamptic mothers

Sharma

et al. 2006

J Perinatol

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Background: Early neonatal hypotension (ENH) is common in premature infants and has been claimed to occur more frequently in infants born to mothers with severe preeclampsia. Previous studies that showed a relationship between maternal preeclampsia and neonatal hypotension did not control for potential confounding factors such as birth weight and maternal treatment with magnesium sulfate (MgSO 4 ).Objective: To determine whether maternal preeclampsia is an independent risk factor for ENH.Study Design: We conducted a retrospective review of all viable singleton infants with gestational age of 23 to 30 weeks who were admitted to the neonatal intensive care unit over a 2-year period. ENH was defined as the persistence of the mean arterial pressure lower than the gestational age in weeks requiring volume expansion and inotropic support in the first 24 h of life.Results: One hundred and eighty four infants were enrolled. Seventy-five (41%) infants met the diagnostic criteria for ENH. Maternal preeclampsia, the presence of labor, maternal treatment with MgSO 4 , Apgar scores, birth weight, gestational age and respiratory distress syndrome were significantly associated with ENH by univariate analysis. Only gestational age and maternal preeclampsia were significantly associated with ENH by multiple logistic regression. Conclusion:Gestational age and maternal preeclampsia were independent risk factors for ENH in our population of premature infants.

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“…Both the definition and treatment of hypotension are controversial in ELBW infants, but we felt that this was the best available methodology at the time of study design. 28,29 Since blood pressure is dependent upon gestational and postnatal age, 30,31 defining normal blood pressure using distributions of values in populations is problematic. This is especially true when standards for all premature infants are applied to ELBW infants, because published studies generally include few infants at very early gestations and extremely low birth weights.…”

Section: Discussionmentioning

confidence: 99%

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

Efird

Heerens²,

Gordon

et al. 2004

J Perinatol

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Extremely low birth weight (ELBW) infants are at risk for hypotension. Abnormal adrenal function may play a role in the pathogenesis of hypotension, and therefore, the administration of hydrocortisone (HC) may be an effective treatment for hypotension in some infants. However, the efficacy of prophylactic HC to prevent the use of vasopressors for a defined hypotensive state has not been studied. We conducted a randomized-controlled trial to determine the potential role on adrenal insufficiency in early neonatal hypotension and to determine the effectiveness of prophylactic HC in reducing treatment of hypotension in ELBW infants. STUDY DESIGN:Infants were assigned to receive either HC or placebo within the first 3 hours of life. Therapy was continued for 5 days. The presence of hypotension was based on an operational definition and treatment with vasopressors (VP) was standardized based on an a priori protocol. RESULTS:A total of 34 patients were enrolled. Baseline characteristics were similar between groups. Of the HC group 25% received VP at 24 hours of age compared to 44% of the placebo group. On day of life 2, only 7% of the HC group received VP compared to 39% of the placebo group (p<0.05). CONCLUSION:Prophylactic treatment with HC reduces the incidence of hypotension, defined by treatment with VP, among ELBW infants during the first 2 days of life. However, the mounting evidence that prophylactic administration of glucocorticoids in the first days of life is harmful to ELBW infants makes HC prophylaxis unwise until the efficacy of treatment relative to safety can be clearly established.

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Blood pressure standards for very low birthweight infants during the first day of life

Cited by 113 publications

References 6 publications

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Mean Arterial Pressure in Extremely Low Birth Weight Concordant and Discordant Twins During the First Day of Life

Early neonatal hypotension in premature infants born to preeclamptic mothers

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

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