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Treating hypotension in the preterm infant: when and with what: a critical and systematic review
1Department of Pediatrics, McGill University, Montréal, QC, Canada.
Insights
Treatments for hypotension in extremely preterm infants vary widely. Current evidence does not define optimal blood pressure (BP) thresholds or effective interventions, highlighting a need for further research.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Clinical Pharmacology
Background:
- Hypotension is common in extremely preterm infants, leading to varied treatment approaches across neonatal intensive care units.
- Significant discrepancies exist in treatment indications and interventions for hypotension among neonatologists.
Purpose of the Study:
- To systematically review the literature on the benefits of blood pressure (BP) elevating interventions for preterm infants.
- To identify interventions that improve clinically important outcomes in hypotensive preterm infants.
Main Methods:
- Systematic literature review.
- Analysis of studies investigating interventions for hypotension in preterm infants.
Main Results:
- Unable to establish a definitive BP threshold predictive of poor outcomes.
- No clear evidence that interventions for hypotension improve infant outcomes.
- Lack of data to determine which interventions are most beneficial.
Conclusions:
- A significant gap in prospective research hinders optimal clinical management of hypotension in preterm infants.
- A simple BP threshold may not be sufficient; clinical status and blood flow measurements might be more informative.
- Future research should focus on these alternative indicators and require careful prospective study design.
Unlabelled:
A very large proportion of extremely preterm infants receive treatments for hypotension. There are, however, marked variations in indications for treatment, and in the interventions used, between neonatal intensive care units and between neonatologists.
Methods:
We performed systematic reviews of the literature in order to determine which preterm infants may benefit from treatment with interventions to elevate blood pressure (BP), and which interventions improve clinically important outcomes.
Results:
Our review was not able to define a threshold BP that was significantly predictive of a poor outcome, nor whether any interventions for hypotensive infants improved outcomes, nor which interventions were more likely to be beneficial.
Conclusions:
There is a distinct lack of prospective research of this issue, which prevents good clinical care. It is possible that a simple BP threshold that indicates the need for therapy does not exist, and other factors, such as the clinical status or systemic blood flow measurements, may be much more informative. Such a paradigm shift will also require careful prospective study.
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