Hypotension in Preterm Neonates: Low Blood Pressure Alone Does Not Affect Neurodevelopmental Outcome

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• 作者：Thomas Alderliesten ; MD ; ^{t.alderliesten-2@umcutrecht.nl" class="auth_mail} ; Petra M.A. Lemmers ; MD ; PhD ; Ingrid C. van Haastert ; MA ; PhD ; Linda S. de Vries ; MD ; PhD ; Hilde J.C. Bonestroo ; MD ; Willem Baerts ; MD ; PhD ; Frank van Bel ; MD ; PhD
• 关键词：BSID-II-NL ; Bayley Scales of Infant Development ; Second (Dutch) Edition ; BSITD-III ; Bayley Scales of Infant and Toddler Development ; Third Edition ; DQ ; Developmental quotient ; GA ; Gestational age ; GMDS ; Griffiths Mental Development Scales ; MABP ; Mean arterial blood pressure ; NIRS ; Near-infrared spectroscopy ; rSco2 ; Regional cerebral oxygenation ; Sao2 ; Arterial oxygen saturation ; SVR ; Systemic vascular resistance
• 刊名：The Journal of Pediatrics
• 出版年：May, 2014
• 年：2014
• 卷：164
• 期：5
• 页码：986-991
• 全文大小：256 K

文摘

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Objective

To compare neurodevelopmental outcome, mean arterial blood pressure (MABP), and regional cerebral oxygenation (rSco₂) between preterm neonates treated for hypotension and controls.

Study design

Preterm neonates (N聽=聽66) with a gestational age (GA) 鈮?2聽weeks, without a patent ductus arteriosus, treated for hypotension (dopamine 鈮?聽渭g/kg/min) were included. Neonates were matched to controls for GA, birth weight, sex, and year of birth. The rSco₂ was determined by using near-infrared spectroscopy. Monitoring of MABP, rSco₂, and arterial saturation was started at admission and continued for at least 72聽hours. Neurodevelopmental outcome was assessed at 18 and 24聽months' corrected age by using the Griffiths Mental Development Scales or the Bayley Scales of Infant and Toddler Development, Third Edition.

Results

Infants treated for hypotension spent more time with an MABP less than GA (median 9% vs 0%, P聽<聽.001) and time with an MABP/rSco₂ correlation >0.5 (27% vs 17%, P聽<聽.001). Time spent with an rSco₂ <50% and neurodevelopmental outcome at 18 and 24聽months' corrected age were not significantly different between infants treated for hypotension and controls. The 26 neonates with an rSco₂ <50% for >10% of time had a lower neurodevelopmental outcome at 18聽months (median 99 vs 104, P聽=聽.02).

Conclusion

An MABP less than GA (in weeks) was not associated with lower rSco₂ or with lower neurodevelopmental outcome scores. However, regardless of MABP, low rSco₂ was associated with lower neurodevelopmental outcome scores. Perfusion/oxygenation variables could be of additional value in neonatal intensive care.