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Use of antihypotensive therapies in extremely preterm infants
Beau Batton1, Lei Li, Nancy S Newman
1Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA. bbatton@siumed.edu
Insights
Antihypotensive therapies in premature infants did not improve outcomes. Factors other than blood pressure influenced treatment decisions, suggesting current practices may not be beneficial for infant health.
Area of Science:
- Neonatal medicine
- Clinical pharmacology
- Pediatric critical care
Background:
- Low blood pressure (BP) is common in premature infants.
- Antihypotensive therapies are frequently used, but their efficacy is debated.
- Identifying optimal BP thresholds for treatment is crucial.
Purpose of the Study:
- To examine the relationship between blood pressure (BP) values, antihypotensive therapy use, and in-hospital outcomes in preterm infants.
- To determine if a specific BP threshold exists below which antihypotensive therapies demonstrate benefit.
Main Methods:
- Prospective observational study of infants born between 23 and 26 weeks' gestational age.
- Hourly BP monitoring and antihypotensive therapy use recorded in the first 24 hours.
- 15 definitions of low BP were analyzed; outcomes assessed via regression analysis.
Main Results:
- 55% of 367 infants received antihypotensive therapy, often inconsistently with low BP.
- Treated infants showed higher rates of severe retinopathy of prematurity and intraventricular hemorrhage.
- Regression analysis revealed no significant differences in survival or morbidity between treated and untreated groups.
Conclusions:
- Clinical decisions to use antihypotensive therapies were influenced by factors beyond BP.
- No significant improvement in infant outcomes was observed with antihypotensive therapy across 15 low BP definitions.
Objective:
To investigate the relationships among blood pressure (BP) values, antihypotensive therapies, and in-hospital outcomes to identify a BP threshold below which antihypotensive therapies may be beneficial.
Methods:
Prospective observational study of infants 23(0/7) to 26(6/7) weeks' gestational age. Hourly BP values and antihypotensive therapy use in the first 24 hours were recorded. Low BP was investigated by using 15 definitions. Outcomes were examined by using regression analysis controlling for gestational age, the number of low BP values, and illness severity.
Results:
Of 367 infants enrolled, 203 (55%) received at least 1 antihypotensive therapy. Treated infants were more likely to have low BP by any definition (P < .001), but for the 15 definitions of low BP investigated, therapy was not prescribed to 3% to 49% of infants with low BP and, paradoxically, was administered to 28% to 41% of infants without low BP. Treated infants were more likely than untreated infants to develop severe retinopathy of prematurity (15% vs 8%, P = .03) or severe intraventricular hemorrhage (22% vs 11%, P < .01) and less likely to survive (67% vs 78%, P = .02). However, with regression analysis, there were no significant differences between groups in survival or in-hospital morbidity rates.
Conclusions:
Factors other than BP contributed to the decision to use antihypotensive therapies. Infant outcomes were not improved with antihypotensive therapy for any of the 15 definitions of low BP investigated.
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