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Definitions of cardiovascular insufficiency and relation to outcomes in critically ill newborn infants
Erika Fernandez1, Kristi L Watterberg1, Roger G Faix2
1Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
Insights
Different definitions of cardiovascular insufficiency (CVI) in newborns impact outcomes. A definition based solely on blood pressure (BP) did not consistently predict adverse outcomes or death.
Area of Science:
- Neonatal Research
- Pediatric Cardiology
- Clinical Neonatology
Background:
- Cardiovascular insufficiency (CVI) incidence, management, and outcomes in infants were previously studied.
- Limited data exist on how different CVI definitions relate to short-term outcomes in term and late preterm newborns.
Purpose of the Study:
- To evaluate the relationship between four distinct CVI definitions and short-term outcomes, including mortality.
- To assess the predictive value of different CVI diagnostic criteria in a neonatal intensive care unit (NICU) population.
Main Methods:
- Analysis of a multicenter, prospective cohort study involving 647 infants (≥34 weeks gestation) admitted to a Neonatal Research Network (NRN) NICU.
- Mechanical ventilation (MV) use within the first 72 hours was a key inclusion criterion.
- Examination of the association between four CVI definitions and five short-term outcomes.
Main Results:
- All four CVI definitions correlated with increased days on mechanical ventilation (MV) and oxygen (O2).
- A definition relying solely on a threshold blood pressure (BP) was not linked to improved feeding, shorter NICU stays, or reduced mortality.
- The definition incorporating CVI treatment was associated with all evaluated outcomes, including death.
Conclusions:
- A CVI definition based exclusively on threshold BP measurements lacks consistent association with adverse short-term outcomes.
- Solely utilizing threshold BP for CVI diagnosis and guiding therapy may not lead to improved infant outcomes.
Background:
We previously reported on the overall incidence, management, and outcomes in infants with cardiovascular insufficiency (CVI). However, there are limited data on the relationship of the specific different definitions of CVI to short-term outcomes in term and late preterm newborn infants.
Objective:
This study aims to evaluate how four definitions of CVI relate to short-term outcomes and death.
Study Design:
The previously reported study was a multicenter, prospective cohort study of 647 infants ≥ 34 weeks gestation admitted to a Neonatal Research Network (NRN) newborn intensive care unit (NICU) and mechanically ventilated (MV) during their first 72 hours. The relationship of five short-term outcomes at discharge and four different definitions of CVI were further analyzed.
Results:
All the four definitions were associated with greater number of days on MV and days on O2. The definition using a threshold blood pressure (BP) measurement alone was not associated with days of full feeding, days in the NICU or death. The definition based on the treatment of CVI was associated with all the outcomes including death.
Conclusions:
The definition using a threshold BP alone was not consistently associated with adverse short-term outcomes. Using only a threshold BP to determine therapy may not improve outcomes.
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