Short-term outcome of very-low-birthweight infants with arterial hypotension in the first 24 h of life. Issue 5 (21st July 2015) - Faust, Kirstin
Abstract : Objective: To evaluate lowest mean arterial blood pressure during the first 24 h of life (minMAP 24 ) in very-low-birthweight (VLBW) infants and to identify associations between hypotension and short-term outcome. Design: Retrospective cohort analysis of the minMAP 24 of 4907 VLBW infants with a gestational age <32 weeks in correlation with clinical data. Hypotension was defined as minMAP 24 being lower than the median value of all patients of the same gestational age. Results: MinMAP 24 values correlated with gestational age. Median minMAP 24 values of VLBW infants ≤29 weeks' gestation were 1–2 mm Hg lower than gestational age in completed weeks. Hypotensive infants had a higher rate of intraventricular haemorrhage (IVH, 20.3% vs 15.9%, p<0.001), bronchopulmonary dysplasia (BPD, 19.2% vs 15.1%, p<0.001) and death (5.2% vs 3.0%, p<0.001). Multivariate logistic regression analyses, including potential confounders, confirmed these data. MinMAP 24 was an independent risk factor for IVH (OR 0.97/mm Hg, 95% CI 0.96 to 0.99, p=0.003), BPD (OR 0.96/mm Hg, 95% CI 0.94 to 0.98, p<0.001) and mortality (OR 0.94/mm Hg, 95% CI 0.90 to 0.98, p=0.003). Conclusions: Hypotension during the first 24 h of life is associated with adverse outcomes in VLBW infants. This underlines the need for randomised controlled trials on the use of vasoactive drugs in this vulnerable patient cohort.