Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions

Peter, Deidre St; Gandy, Christiana; Hoffman, Suma B

doi:10.1159/000452616

Cited by 36 publications

(31 citation statements)

References 37 publications

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“…It is unlikely that hypotension alone has definite causal effects on the severity of BPD because hypotension sometimes reflects multifactorial poor medical conditions. However, even apart from BPD, other studies have shown the significance of hypotension as a risk factor for mortality and adverse outcomes in VLBWIs [21]. For this reason, hypotension was not significantly different for the 24-week GA group in this study, since we excluded deaths before BPD diagnosis.…”

Section: Discussionmentioning

confidence: 70%

Risk factors that affect the degree of bronchopulmonary dysplasia: Comparison by severity in the same gestational age

et al. 2020

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Objective To investigate the risk factors for BPD severity by gestational age (GA) and identify a way to reduce the incidence of moderate-to-severe BPD Study design This was a retrospective cohort study of very-low-birth-weight-infants (VLBWIs) delivered at 24 to 28 weeks GA from Korean Neonatal Network registry between 2013 and 2016. BPD was defined using the National Institutes of Health criteria. Study populations were divided by GA and subdivided into no/mild BPD and moderate/severe BPD. The initial statuses of all infants, including those who died before BPD diagnosis and the maternal and neonatal factors of the live infants were compared. Statistical methods included descriptive statistics, comparative tests, and logistic regression.

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Section: Discussionmentioning

confidence: 70%

Risk factors that affect the degree of bronchopulmonary dysplasia: Comparison by severity in the same gestational age

et al. 2020

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“…Thirty-six percent of subjects were treated with dopamine, which is similar to what has been reported in the literature. 1,2,5 Infants treated with dopamine did not differ in demographic characteristics such as BW, GA, and sex from the neonates not exposed to dopamine. However, these subjects were significantly more likely to have a higher SNAPPE-II illness severity score, were exposed to high-frequency ventilation, had severe (grades 3 and 4) IVH, and have increased mortality, suggesting a higher acuity in this population.…”

Section: Discussionmentioning

confidence: 87%

“…Up to 50% of premature infants will be diagnosed with hypotension during the first 4 days of life, and of those up to half will be treated with vasopressor therapy. [1][2][3] Hypotension, although not well defined in this population, is known to be associated with increased morbidity (intraventricular hemorrhage (IVH) and neurologic impairments) and mortality, especially when requiring vasopressor therapy. [4][5][6][7][8] Dopamine is the most commonly used vasopressor in neonatal care because of its ability to effectively increase mean arterial pressure (MAP), but its effect on cerebral blood flow is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Association between dopamine and cerebral autoregulation in preterm neonates

Solanki

Hoffman

2020

Pediatr Res

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BACKGROUND: To test the hypothesis that dopamine is associated with impaired cerebral autoregulation (ICA) in a dosedependent fashion. METHODS: Non a priori designed secondary analysis of a prospectively enrolled cohort study subjects <12 h of life between 24 0 and 29 6 weeks gestation. Cerebral saturations (rScO2) and mean arterial blood pressure (MAP) were continuously monitored every 30 s for 96 h. ICA was defined by a 10 min epoch rScO2-MAP correlation coefficient of >0.5. RESULTS: Twenty-three of 61 subjects (38%) required dopamine. Time spent with ICA was 23% in dopamine-exposed subjects vs. 14% in those not exposed (p = 0.0001). On the epoch level, time spent with ICA was 15%, 29%, 34%, 37%, and 23% in epochs with dopamine titration of 0, 1-5, 6-10, 11-15, and 16-20 μg/kg/min, respectively. Using mixed-effect modeling, ICA for each dopamine titration was significantly higher than unexposed times when controlling for gestation, presence of a patent ductus arteriosus, day of life, MAP less than gestational age, and illness severity score (p < 0.02). CONCLUSIONS: Dopamine exposure during the first 96 h was associated with ICA. Time periods with ICA increased with dopamine exposure in a dose-dependent fashion peaking at a concentration of 11-15 μg/kg/min.

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“…This also supports our research. There is no consensus regarding normal blood pressure in premature neonates [26][27][28]; however, some studies indicate that the neuroprotective mechanism of autoregulation is lost below MAP of 30 mmHg [26]. For example, infants who developed severe IVH have been shown as having substantially more unstable MAP, and therefore, spent significantly more time with extreme MAP values (< 23 mmHg or > 46 mmHg) as compared with those without severe IVH [27].…”

Section: Discussionmentioning

confidence: 99%

Assessing key clinical parameters before and after intraventricular hemorrhage in very preterm infants

et al. 2020

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Intraventricular cerebral hemorrhage (IVH) is one of the most severe complications of premature birth, potentially leading to lifelong disability. The purpose of this paper is the assessment of the evolution of three of the most relevant parameters, before and after IVH: mean arterial pressure (MAP), arterial carbon dioxide pressure (pCO 2), and cerebral blood flow (CBF). Clinical records of 254 preterm infants with a gestational age of 23-30 weeks, with and without a diagnosis of IVH, were reviewed for MAP and arterial pCO 2 in the period up to 7 days before and 3 days after IVH or during the first 10 days of life in cases without IVH. Conclusion: A statistically significant increase in pCO 2 and decrease in MAP in patients with IVH compared with those without were detected. Both the mean values and the mean absolute deviations of CBF were computed in this study, and the latter was significantly higher than in control group. High deviations of CBF, as well as hypercapnia and hypotension, are likely to contribute to the rupture of cerebral blood vessels in preterm infants, and consequently, to the development of IVH. What is Known: • The origin of IVH is multifactorial, but mean arterial pressure, carbon dioxide partial pressure, and cerebral blood flow are recognized as the most important parameters. • In premature infants, the autoregulation mechanisms are still underdeveloped and cannot compensate for cerebral blood flow fluctuations. What is New: • The numerical simulation of CBF is shown to be a promising approach that may be useful in the care of preterm infants. • The mean values of CBF before and after IVH in the affected group were similar to those in the control group, but the mean absolute deviations of CBF in the affected group before and after IVH were significantly higher than that in the control group. Keywords Intraventricular cerebral hemorrhage. Preterm infants. Immature brain. Mean arterial pressure. Arterial carbon dioxide pressure. Cerebral blood flow

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Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions

Cited by 36 publications

References 37 publications

Risk factors that affect the degree of bronchopulmonary dysplasia: Comparison by severity in the same gestational age

Risk factors that affect the degree of bronchopulmonary dysplasia: Comparison by severity in the same gestational age

Association between dopamine and cerebral autoregulation in preterm neonates

Assessing key clinical parameters before and after intraventricular hemorrhage in very preterm infants

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