Permissive Hypotension in Extremely Low Birth Weight Infants (≤1000 gm)

Ahn, So Yoon; Kim, Eun Sun; Kim, Jin Kyu; Shin, Jeong Hee; Sung, Se In; Jung, Ji Mi; Chang, Yun Sil; Park, Won Soon

doi:10.3349/ymj.2012.53.4.765

Cited by 16 publications

(14 citation statements)

References 23 publications

(31 reference statements)

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“…In a retrospective cohort study by Dempsey et al, there were no significant short-term differences between ELBW infants with permissive hypotension and good perfusion and those who were normotensive (7). These findings were also shown in a study by Ahn et al, where they demonstrated that there were no significant differences in long-term neurological outcomes as evaluated by the incidence of cerebral palsy, hearing loss or developmental delay as assessed by Bayley scores (19). These studies showed worse outcomes in those infants who received treatment for hypotension; however, it is unclear whether this finding is due to the treatment itself or an underlying increased vulnerability of this treated population.…”

Section: Discussionsupporting

confidence: 66%

“…We have shown that an elevated diastolic effective perfusion pressure or closing margin (diastolic ABP minus CrCP) is associated with severe IVH in very low birth weight (VLBW) infants, whereas mean ABP alone was not associated with this outcome (3). While not the primary finding in the study by Ahn et al, they also did not detect an association between blood pressure and severe IVH (19). In addition, while measured ABP does not reflect the middle cerebral artery pressure directly, it does trend to the device used for clinical decision making, which is more useful than a direct middle cerebral artery pressure measurement.…”

Section: Discussionmentioning

confidence: 65%

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Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants

Elizondo

Rios

et al. 2019

Pediatr Res

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Introduction: Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. Preterm ABP is low and close to CrCP. The diastolic closing margin (diastolic ABP minus CrCP), has been associated with intraventricular hemorrhage in preterm infants. CrCP is estimated from middle cerebral artery cerebral blood flow velocity (CBFV) and ABP waveforms. However, these estimations have not been validated due to lack of gold standard. Direct observation of the CrCP in preterm infants with hypotension is an opportunity to validate synchronously estimated CrCP. Methods: ABP and CBFV tracings were obtained from 24 extremely low birthweight infants. Recordings where diastolic CBFV was zero were identified. The gold standard CrCP was delineated using piecewise regression of ABP and CBFV values paired by rank ordering and then estimated using a published formula. The measured and estimated values were compared using linear regression and Bland-Altman analysis. Results: Linear regression showed a high degree of correlation between measured and calculated CrCP (r 2 = 0.93). Conclusions: This is the first study to validate a calculated CrCP by comparing it to direct measurements of CrCP from preterm infants when ABP is lower than CrCP.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 65%

Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants

Elizondo

Rios

et al. 2019

Pediatr Res

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“…There are difficulties in extrapolating the findings of hypotensive premature infants in the neonatal intensive care unit to premature infants that become hypotensive intraoperatively. Hypotension in awake NICU patients may be a marker rather than a cause of subsequent neurologic deficits, and several studies found that isolated hypotension in very young premature infants who were otherwise well was not related to white matter neuronal damage . The authors of the ELGAN research study (extremely low gestational age newborns) were careful to point out that not finding an association between hypotension and later neurologic injury does not mean that hypotension is safe for very young and small premature infants.…”

Section: Definition Of Hypotensionmentioning

confidence: 99%

Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment

McCann

Schouten

2013

Pediatric Anesthesia

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Neonates have a higher perioperative mortality risk largely due to the degree of prior illness of the infants, the complexity of their surgeries, and infant physiology. It is important to consider contributing anesthetic factors during the perioperative period that may affect cerebral perfusion and neurocognitive outcome, such as alterations in hemodynamics and ventilation. Limitations of blood pressure as a marker for cerebral perfusion are discussed, as well as the effect of hypocapnia on the brain.

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“…Aggressive hypotension therapy may lead to worse outcomes (mortality and IVH) than allowing permissive hypotension in patients with no signs of systemic hypoperfusion [24,25]. Vasopressor therapy is also controversial as some studies indicate that it is independently associated with impaired cerebral autoregulation and brain injury [4,26,27].…”

Section: Introductionmentioning

confidence: 99%

Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions

Peter

Gandy

Hoffman³

2016

Neonatology

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Background: In the premature neonate, there is no consensus regarding normal blood pressure (BP). The most common definition used is a mean arterial BP (MAP) less than the gestational age (GA); however, studies indicate that the neuroprotective mechanism of autoregulation is lost below a MAP of 30 mm Hg. Objective: To determine whether hypotension defined as MAP <30 mm Hg or MAP less than the infant's GA better predicts adverse outcomes of intraventricular hemorrhage (IVH) and death. Study Design: For this retrospective study, demographic, clinical, and BP data in epochs of 12 h were collected during the first 72 h of life in 188 subjects 24-28 weeks of gestation. For each definition, outcomes of severe IVH (grade 3 or 4), death, or the composite outcome of either were evaluated using bivariate testing. Logistic regression determined independent predictors of composite outcome of death and/or grade 3 or 4 IVH. Results: Hypotension by either definition was significant for death and the composite outcome (p < 0.0001). Only the MAP <30 mm Hg definition was associated with severe IVH (p = 0.02). On logistic regression, significant predictors of the composite outcome were GA (OR 0.59, 95% CI 0.39-0.89) and vasopressor therapy (OR 5.5, 95% CI 2-17). Conclusions: Neither definition of hypotension independently predicts adverse outcome in multivariate logistic regression. Vasopressor therapy, however, is an independent predictor of IVH and death in premature infants.

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Permissive Hypotension in Extremely Low Birth Weight Infants (≤1000 gm)

Cited by 16 publications

References 23 publications

Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants

Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants

Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment

Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions

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