Hypotension in Preterm Neonates: Low Blood Pressure Alone Does Not Affect Neurodevelopmental Outcome

doi:10.1016/j.jpeds.2013.12.042

The Journal of Pediatrics

Volume 164, Issue 5, May 2014, Pages 986-991

https://doi.org/10.1016/j.jpeds.2013.12.042 Get rights and content

Objective

To compare neurodevelopmental outcome, mean arterial blood pressure (MABP), and regional cerebral oxygenation (rSco₂) between preterm neonates treated for hypotension and controls.

Study design

Preterm neonates (N = 66) with a gestational age (GA) ≤32 weeks, without a patent ductus arteriosus, treated for hypotension (dopamine ≥5 μg/kg/min) were included. Neonates were matched to controls for GA, birth weight, sex, and year of birth. The rSco₂ was determined by using near-infrared spectroscopy. Monitoring of MABP, rSco₂, and arterial saturation was started at admission and continued for at least 72 hours. Neurodevelopmental outcome was assessed at 18 and 24 months' corrected age by using the Griffiths Mental Development Scales or the Bayley Scales of Infant and Toddler Development, Third Edition.

Results

Infants treated for hypotension spent more time with an MABP less than GA (median 9% vs 0%, P < .001) and time with an MABP/rSco₂ correlation >0.5 (27% vs 17%, P < .001). Time spent with an rSco₂ <50% and neurodevelopmental outcome at 18 and 24 months' corrected age were not significantly different between infants treated for hypotension and controls. The 26 neonates with an rSco₂ <50% for >10% of time had a lower neurodevelopmental outcome at 18 months (median 99 vs 104, P = .02).

Conclusion

An MABP less than GA (in weeks) was not associated with lower rSco₂ or with lower neurodevelopmental outcome scores. However, regardless of MABP, low rSco₂ was associated with lower neurodevelopmental outcome scores. Perfusion/oxygenation variables could be of additional value in neonatal intensive care.

Section snippets

Methods

This case-control study is nested in a prospective observational cohort study conducted at the level 3 Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands. The aim is to monitor clinical, physiological, and NIRS data during the first 72 hours of life in all neonates admitted with a GA ≤32 weeks. Cranial ultrasound was performed daily, and peri-/intraventricular hemorrhage was graded according to Papile et al.¹⁶ The presence or absence of a

Results

Of the 549 neonates who were monitored between 2005 and 2010, 137 neonates received inotropes in addition to fluids as a treatment for systemic arterial hypotension (ie, MABP < GA). Of these 137 neonates, 67 were excluded because of a hemodynamic significant patent ductus arteriosus, 3 for having a congenital malformation, and 1 because of severe anemia. Therefore, 66 cases and 66 controls were included in this study. Clinical data are presented in the Table. Median duration of blood pressure

Discussion

In this observational study, neonates treated for hypotension spent more time with an MABP (mm Hg) below their GA (in weeks) than did controls despite treatment with fluids and inotropes. No differences were found between cases and controls regarding cerebral oxygenation and neurodevelopmental outcome. Interestingly, an rSco₂ <50% for >10% of the time was found to be associated with a lower neurodevelopmental outcome score. This observation was true regardless of whether the infant was treated

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On the contrary, in the BP group, the incidence rate of IVH in infants with successful intervention was greater than infants with normal BP. Recent studies have indicated that circulation management aiming to increase BP cannot improve the short- or long-term neonatal outcomes.18,19 Rather, the administration of vasopressors has worsened the neonatal outcomes in recent studies.20,21
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: The authors declare no conflicts of interest.

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Original ArticleHypotension in Preterm Neonates: Low Blood Pressure Alone Does Not Affect Neurodevelopmental Outcome

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

Clin Perinatol

Early Hum Dev

J Pediatr

Early Hum Dev

J Pediatr

J Pediatr

J Thorac Cardiovasc Surg

Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs

J Perinatol

Development of audit measures and guidelines for good practice in the management of neonatal respiratory distress syndrome. Report of a Joint Working Group of the British Association of Perinatal Medicine and the Research Unit of the Royal College of Physicians

Arch Dis Child

Mean arterial blood pressure and neonatal cerebral lesions

Arch Dis Child

Hypotensive extremely low birth weight infants have reduced cerebral blood flow

Pediatrics

Aetiological rôle of cerebral blood-flow alterations in development and extension of peri-intraventricular haemorrhage

Dev Med Child Neurol

Current definitions of hypotension do not predict abnormal cranial ultrasound findings in preterm infants

Pediatrics

Early systemic hypotension and vasopressor support in low birth weight infants: impact on neurodevelopment

Pediatrics

Permissive hypotension in the extremely low birthweight infant with signs of good perfusion

Arch Dis Child Fetal Neonatal Ed

Monitoring neonatal regional cerebral oxygen saturation in clinical practice: value and pitfalls

Neonatology

Original Article
Hypotension in Preterm Neonates: Low Blood Pressure Alone Does Not Affect Neurodevelopmental Outcome