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Published on: October 11, 2011
Short- and long-term consequences of hypotension in ELBW infants
Avroy A Fanaroff1, Jonathan M Fanaroff
1Department of Pediatrics, Case Western Reserve University School of Medicine, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA. aaf2@cwru.edu
Insights
Symptomatic hypotension in extremely low birth weight (ELBW) infants is linked to increased mortality, severe brain bleeds, and developmental issues. Early blood pressure management is crucial for better neurodevelopmental outcomes in ELBW infants.
Area of Science:
- Neonatal intensive care
- Pediatric neurology
- Perinatal medicine
Background:
- Hypotension is common in extremely low birth weight (ELBW) infants, yet definitions vary.
- Neonatal hypotension may be a risk factor for neurologic impairment.
- Limited data exists on the neurodevelopmental impact of low blood pressure in ELBW infants (<1000g).
Purpose of the Study:
- To explore the relationship between early blood pressure, perinatal factors, morbidity, and mortality in ELBW infants.
- To compare neurosensory outcomes in ELBW infants with and without symptomatic hypotension.
Main Methods:
- Retrospective review of 156 ELBW infants (<1000g) from 1998-1999.
- Categorized infants into "treated" (received BP support) and "non-treated" groups within the first 72 hours.
- Follow-up at 20 months corrected age included neurologic, motor, mental, vision, and hearing evaluations.
Main Results:
- 59 infants required blood pressure support; 97 did not. Treated infants had higher rates of severe IVH (19% vs 2%) and mortality (34% vs 16%).
- Multivariate analysis indicated symptomatic hypotension is associated with delayed motor development (–6.0) and hearing loss (O.R. 8.9).
Conclusions:
- Symptomatic hypotension in ELBW infants during the first 72 hours is linked to significant short-term and long-term morbidity.
- Infants experiencing symptomatic hypotension face higher risks of delayed motor development, hearing loss, and death.
Background:
Hypotension affects close to half of all ELBW infants, yet an agreement on its definition is still lacking. Despite the fact that neonatal hypotension may be a risk factor for neurologic impairment, there is a paucity of data on the impact of low blood pressure (BP) in extremely low birth weight (ELBW) infants weighing below 1000 g on neuro-developmental outcome.
Objectives:
Explore the relationship between blood pressure in the first 72 hours of life, perinatal factors, morbidity, and mortality in ELBW infants. Compare neuro-sensory outcome in ELBW infants with and without symptomatic hypotension.
Methods:
We reviewed the outcome for all 156 infants with a birth weight <1000 g admitted to the neonatal intensive care unit covering the time period 1998 to 1999. Infants who received fluid pushes and/or pressors during the first 72 hours of life in an attempt to increase blood pressure were regarded as "symptomatic" or "treated infants"; the others were designated "non-treated infants." Follow-up at 20 months corrected age included neurologic status, Bayley motor/mental evaluation, plus tests of vision and hearing. Statistical analysis was by SPSS 11.0. Univariate and multivariate analyses were conducted to determine morbidities associated with symptomatic hypotension.
Results:
A total of 59 infants (mean BW 714 +/- 154 g; GA 24.9 +/- 1.7 weeks) required BP support; 97 infants (mean BW 768 +/- 141 g; GA 26.1 +/- 1.9 weeks) received no BP support. The groups had similar race, gender, delivery mode, and maternal socioeconomic status. Thirty-five (22%) infants died, including 20 who received BP support. There were more infants with severe IVH (grade III/IV), 19% versus 2%, and the mortality was greater, 34% versus 16%, in those infants who received BP support. Of the 121 survivors, 110 (91%) had complete follow-up evaluations. Multivariate analysis controlling for SES and neonatal morbidity revealed that symptomatic hypotension is associated with delayed motor development (-6.0; SE 3.1) and hearing loss (O.R. 8.9; CI 0.92-86.3).
Conclusions:
Symptomatic hypotension in ELBW infants in the first 72 hours of life is associated with significant short-term and long-term morbidity. Infants with symptomatic hypotension are more likely to have delayed motor development, hearing loss, and death.
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