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Permissive hypotension in the extremely low birthweight infant with signs of good perfusion
E M Dempsey1, F Al Hazzani, K J Barrington
1Neonatology, Cork University Maternity Hospital, Cork, Ireland.
Insights
Many extremely low birthweight (ELBW) infants are treated for hypotension based on mean arterial blood pressure (BP) less than gestational age (GA). This study found that ELBW infants with hypotension but good perfusion had similar outcomes to normotensive infants, while treated hypotension was linked to adverse outcomes.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Perinatal Medicine
Background:
- Many practitioners routinely treat extremely low birthweight (ELBW) infants when mean arterial blood pressure (BP) is less than gestational age (GA).
- The current approach to managing hypotension in ELBW infants requires re-evaluation.
Purpose of the Study:
- To assess the effectiveness of a combined approach using clinical signs, metabolic acidosis, and absolute BP values for treating hypotension in ELBW infants.
- To determine optimal management strategies for hypotension in ELBW infants.
Main Methods:
- Retrospective cohort study of live-born ELBW infants over a 4-year period.
- Infants were categorized into normotensive, hypotensive with permissive hypotension (good perfusion), and hypotensive with poor perfusion (treated).
Main Results:
- 53% of ELBW infants experienced hypotension (BP < GA).
- Infants with permissive hypotension had similar outcomes to normotensive infants.
- Treated hypotension was independently associated with increased mortality (OR 8.0).
Conclusions:
- Blood pressure spontaneously improves in ELBW infants within the first 24 hours.
- Clinical assessment of perfusion is crucial in deciding hypotension treatment for ELBW infants.
- Treating hypotension based solely on BP < GA criteria without considering clinical signs may lead to adverse outcomes.
Introduction:
Many practitioners routinely treat infants whose mean arterial blood pressure in mm Hg is less than their gestational age in weeks (GA).
Objective:
To assess the effectiveness of utilising a combined approach of clinical signs, metabolic acidosis and absolute blood pressure (BP) values when deciding to treat hypotension in the extremely low birthweight (ELBW) infant.
Methods:
Retrospective cohort study of all live born ELBW infants admitted to our neonatal intensive care unit over a 4-year period. Patients were grouped as either normotensive (BP never less than GA), hypotensive and not treated (BP
Results:
118 patients were admitted during this period. Blood pressure data were available on 108 patients. 53% of patients were hypotensive (mean BP in mm Hg less than GA in weeks). Treated patients had lower birth weight and GA, and significantly lower blood pressure at 6, 12, 18 and 24 h. Normotensive patients and patients designated as having permissive hypotension had similar outcomes. Mean blood pressure in the permissive group increased from 26 mm Hg at 6 h to 31 mm Hg at 24 h. In a logistic regression model, treated hypotension is independently associated with mortality, odds ratio 8.0 (95% CI 2.3 to 28, p<0.001).
Conclusions:
Blood pressure spontaneously improves in ELBW infants during the first 24 h. Infants hypotensive on GA criteria but with clinical evidence of good perfusion had as good an outcome as normotensive patients. Treated low blood pressure was associated with adverse outcome.
