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Evolving blood pressure dynamics for extremely preterm infants
B Batton1, L Li2, N S Newman3
11] Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA [2] Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USA.
Insights
Arterial blood pressure (ABP) in extremely preterm infants initially decreased after birth, then spontaneously rose over 24 hours. Antihypotensive therapies did not alter this natural rise in ABP.
Area of Science:
- Neonatal Physiology
- Perinatal Medicine
- Pediatric Cardiology
Background:
- Extremely preterm infants experience significant hemodynamic instability after birth.
- Understanding arterial blood pressure (ABP) trends is crucial for neonatal care.
Purpose of the Study:
- To investigate the dynamic changes in arterial blood pressure (ABP) during the first 24 hours of life in extremely preterm infants.
- To evaluate the effect of antihypotensive therapies on ABP trends.
Main Methods:
- Prospective observational study involving 367 infants with gestational age from 23 to 26 weeks.
- Recorded 18,709 arterial blood pressure (ABP) measurements over the initial 24 postnatal hours.
- Documented the use of antihypotensive therapies, including fluid boluses and dopamine.
Main Results:
- Arterial blood pressure (ABP) initially decreased for 3 hours, reaching a nadir between 4-5 hours post-birth.
- ABP then demonstrated a spontaneous increase at an average rate of 0.2 mmHg/hour from hour 4 to 24.
- The rate of ABP increase was consistent between infants receiving no therapy and those receiving antihypotensive interventions.
Conclusions:
- Arterial blood pressure (ABP) exhibits a spontaneous upward trend in extremely preterm infants within the first 24 postnatal hours.
- Antihypotensive therapies did not significantly alter the natural rate of ABP increase in this population.
Objective:
To examine changes in arterial blood pressure (ABP) after birth in extremely preterm infants.
Study Design:
Prospective observational study of infants 23(0/7) to 26(6/7) weeks gestational age (GA). Antihypotensive therapy use and ABP measurements were recorded for the first 24 h.
Result:
A cohort of 367 infants had 18 709 ABP measurements recorded. ABP decreased for the first 3 h, reached a nadir at 4 to 5 h and then increased at an average rate of 0.2 mm Hg h(-1). The rise in ABP from hour 4 to 24 was similar for untreated infants (n=164) and infants given any antihypotensive therapy (n=203), a fluid bolus (n=135) or dopamine (n=92). GA-specific trends were similar. ABP tended to be lower as GA decreased, but varied widely at each GA.
Conclusion:
ABP increased spontaneously over the first 24 postnatal hours for extremely preterm infants. The rate of rise in ABP did not change with antihypotensive therapy.
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