Objective To investigate the influence of early-stage hypotension defined as mean arterial pressure (MAP)<gestational age (weeks) or MAP<30 mmHg on the short-term prognosis of preterm infants with a gestational age of <32 weeks. Methods A total of 320 preterm infants who were admitted to Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology from April 2020 to August 2021 and met the inclusion criteria were enrolled in this prospective study. Blood pressure within 72 hours was monitored. The definition of hypotension and grouping were as follows: (1) Of the 320 preterm infants, those with MAP<gestational age in 2 consecutive measurements served as the hypotension group (n=104), and the others (n=216) served as the control group; (2) Of the 320 preterm infants, those with MAP<30 mmHg in 2 consecutive measurements served as the hypotension group (n=114), and the others served as the control group (n=206). Perinatal data and clinical data during hospitalization were collected.Poor short-term prognosis was defined as death during hospitalization and/or grade Ⅲ-Ⅳ periventricular-intraventricular hemorrhage identified within 1 week after birth. The multivariate logistic regression analysis was used to investigate the influence of hypotension based on the above two definitions on the short-term prognosis of preterm infants. Results Compared with the control group, the hypotension group based on the above two definitions had higher incidence rates of the clinical manifestations of hypoperfusion, poor prognosis, hemodynamically significant patent ductus arteriosus, and pulmonary hemorrhage (P<0.05). In addition, compared with the control group, the hypotension group defined by MAP<30 mmHg had higher incidence rates of periventricular-intraventricular hemorrhage and bronchopulmonary dysplasia and mortality rate during hospitalization (P<0.05). The incidence of poor short-term prognosis in the hypotension group defined by MAP<30 mmHg was higher than that in the hypotension group defined by MAP<gestational age (18.4% vs 12.5%), but the difference was not statistically significant (P>0.05).The univariate analysis showed that the poor short-term prognosis was related to birth of cesarean section, gestational age, an Apgar score of ≤ 5 at 5 minutes, use of vasoactive drugs within 72 hours, mechanical ventilation within 72 hours, and hypotension under the two definitions (P<0.05).The multivariate logistic regression showed that hypotension based on either definition was not an independent risk factor for poor prognosis (P>0.05). Conclusions Hypotension based on either definition is not an independent risk factor for short-term poor prognosis in preterm infants with a gestational age of <32 weeks. Hypotension defined by MAP<30 mmHg might be more sensitive than that defined by MAP<gestational age in predicting short-term adverse outcomes, which needs further analysis by large sample studies.
Key words
Hypotension /
Vasoactive agent /
Short-term prognosis /
Preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 Sortica da Costa C, Cardim D, Molnar Z, et al. Changes in hemodynamics, cerebral oxygenation and cerebrovascular reactivity during the early transitional circulation in preterm infants[J]. Pediatr Res, 2019, 86(2): 247-253. PMID: 31029059. DOI: 10.1038/s41390-019-0410-z.
2 Aldana-Aguirre JC, Deshpande P, Jain A, et al. Physiology of low blood pressure during the first day after birth among extremely preterm neonates[J]. J Pediatr, 2021, 236: 40-46.e3. PMID: 34019882. DOI: 10.1016/j.jpeds.2021.05.026.
3 Dempsey EM. What should we do about low blood pressure in preterm infants[J]. Neonatology, 2017, 111(4): 402-407. PMID: 28538235. DOI: 10.1159/000460603.
4 Vesoulis ZA, Flower AA, Zanelli S, et al. Blood pressure extremes and severe IVH in preterm infants[J]. Pediatr Res, 2020, 87(1): 69-73. PMID: 31578033. PMCID: PMC6962547. DOI: 10.1038/s41390-019-0585-3.
5 Al-Mouqdad MM, Abdelrahim A, Abdalgader AT, et al. Risk factors for intraventricular hemorrhage in premature infants in the central region of Saudi Arabia[J]. Int J Pediatr Adolesc Med, 2021, 8(2): 76-81. PMID: 34084876. PMCID: PMC8144857. DOI: 10.1016/j.ijpam.2019.11.005.
6 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
7 Bahmani T, Karimi A, Rezaei N, et al. Retinopathy prematurity: a systematic review and meta-analysis study based on neonatal and maternal risk factors[J]. J Matern Fetal Neonatal Med, 2021. Epub ahead of print. PMID: 34256661. DOI: 10.1080/14767058.2021.1940938.
8 Development of audit measures and guidelines for good practice in the management of neonatal respiratory distress syndrome. Report of a Joint Working Group of the British Association of Perinatal Medicine and the Research Unit of the Royal College of Physicians[J]. Arch Dis Child, 1992, 67(10 Spec No): 1221-1227. PMID: 1444567. PMCID: PMC1590463. DOI: 10.1136/adc.67.10_spec_no.1221.
9 Miall-Allen VM, de Vries LS, Whitelaw AG. Mean arterial blood pressure and neonatal cerebral lesions[J]. Arch Dis Child, 1987, 62(10): 1068-1069. PMID: 3314723. PMCID: PMC1778679. DOI: 10.1136/adc.62.10.1068.
10 B?rch K, Lou HC, Greisen G. Cerebral white matter blood flow and arterial blood pressure in preterm infants[J]. Acta Paediatr, 2010, 99(10): 1489-1492. PMID: 20456278. PMCID: PMC3068289. DOI: 10.1111/j.1651-2227.2010.01856.x.
11 Elizondo LI, Rios DR, Vu E, et al. Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants[J]. Pediatr Res, 2019, 86(2): 242-246. PMID: 31003233. PMCID: PMC6658334. DOI: 10.1038/s41390-019-0403-y.
12 St Peter D, Gandy C, Hoffman SB. Hypotension and adverse outcomes in prematurity: comparing definitions[J]. Neonatology, 2017, 111(3): 228-233. PMID: 27898415. DOI: 10.1159/000452616.
13 Yeo KT, Thomas R, Chow SS, et al. Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort study[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 105(2): 145-150. PMID: 31201252. DOI: 10.1136/archdischild-2018-316664.
14 谢幸, 孔北华, 段涛, 等. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018.
15 Dionne JM. Determinants of blood pressure in neonates and infants: predictable variability[J]. Hypertension, 2021, 77(3): 781-787. PMID: 33566691. DOI: 10.1161/HYPERTENSIONAHA.120.14587.
16 农绍汉. 新生儿毛细血管渗漏综合征[J]. 中国当代儿科杂志, 2020, 22(10): 1056-1060. PMID: 33059800. PMCID: PMC7569001. DOI: 10.7499/j.issn.1008-8830.2004033.
17 Bischoff AR, Stanford AH, McNamara PJ. Short-term ventriculo-arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure[J]. Physiol Rep, 2021, 9(22): e15108. PMID: 34806325. PMCID: PMC8606853. DOI: 10.14814/phy2.15108.
18 Botkin ND, Turova VL, Kovtanyuk AE, et al. Extended model of impaired cerebral autoregulation in preterm infants: heuristic feedback control[J]. Math Biosci Eng, 2019, 16(4): 2334-2352. PMID: 31137216. DOI: 10.3934/mbe.2019117.
19 中国新生儿重症监护室协作性质量改进研究协作组. 极低和超低出生体重儿重度脑室内出血发生情况及其影响因素多中心研究[J]. 中华儿科杂志, 2019, 57(4): 258-264. PMID: 30934197. DOI: 10.3760/cma.j.issn.0578-1310.2019.04.006.
20 Dempsey EM, Al Hazzani F, Barrington KJ. Permissive hypotension in the extremely low birthweight infant with signs of good perfusion[J]. Arch Dis Child Fetal Neonatal Ed, 2009, 94(4): F241-F244. PMID: 19174413. DOI: 10.1136/adc.2007.124263.
21 Soo Yoon Ahn, Eun Sun Kim, Jin Kyu Kim, et al. Permissive hypotension in extremely low birth weight infants (≤1 000 gm) [J]. Yonsei Med J, 2012, 53(4): 765-771. PMID: 22665344. PMCID: PMC3381492. DOI: 10.3349/ymj.2012.53.4.765.
22 Alderliesten T, Lemmers PM, van Haastert IC, et al. Hypotension in preterm neonates: low blood pressure alone does not affect neurodevelopmental outcome[J]. J Pediatr, 2014, 164(5): 986-991. PMID: 24484771. DOI: 10.1016/j.jpeds.2013.12.042.
23 Batton B, Li L, Newman NS, et al. Use of antihypotensive therapies in extremely preterm infants[J]. Pediatrics, 2013, 131(6): e1865-1873. PMID: 23650301. PMCID: PMC3666108. DOI: 10.1542/peds.2012-2779.
PDF(586 KB)
