Am J Perinatol 2014; 31(11): 947-956
DOI: 10.1055/s-0034-1368089
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Incidence, Management, and Outcomes of Cardiovascular Insufficiency in Critically Ill Term and Late Preterm Newborn Infants

Erika Fernandez
1  Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
,
Kristi L. Watterberg
1  Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
,
Roger G. Faix
2  Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
,
Bradley A. Yoder
3  Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
,
Michele C. Walsh
3  Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
,
Conra Backstrom Lacy
1  Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
,
Karen A. Osborne
3  Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
,
Abhik Das
4  Statistics and Epidemiology Unit, RTI International, Rockville, Maryland
,
Douglas E. Kendrick
5  Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
,
Barbara J. Stoll
6  Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
,
Brenda B. Poindexter
7  Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
,
Abbot R. Laptook
8  Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
,
Kathleen A. Kennedy
9  Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas
,
Kurt Schibler
10  Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Edward F. Bell
11  Department of Pediatrics, University of Iowa, Iowa City, Iowa
,
Krisa P. Van Meurs
12  Division of Neonatal and Developmental Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
,
Ivan D. Frantz III
13  Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
,
Ronald N. Goldberg
14  Department of Pediatrics, Duke University, Durham, North Carolina
,
Seetha Shankaran
15  Department of Pediatrics, Wayne State University, Detroit, Michigan
,
Waldemar A. Carlo
16  Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama
,
Richard A. Ehrenkranz
17  Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Pablo J. Sanchez
18  Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Rosemary D. Higgins
19  Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, Maryland
› Author Affiliations
Further Information

Publication History

11 November 2013

18 December 2013

Publication Date:
10 February 2014 (eFirst)

Abstract

Objective The objective of this study was to characterize the incidence, management, and short-term outcomes of cardiovascular insufficiency (CVI) in mechanically ventilated newborns, evaluating four separate prespecified definitions.

Study Design Multicenter, prospective cohort study of infants ≥34 weeks gestational age (GA) and on mechanical ventilation during the first 72 hours. CVI was prospectively defined as either (1) mean arterial pressure (MAP) < GA; (2) MAP < GA + signs of inadequate perfusion; (3) any therapy for CVI; or (4) inotropic therapy. Short-term outcomes included death, days on ventilation, oxygen, and to full feedings and discharge.

Results Of 647 who met inclusion criteria, 419 (65%) met ≥1 definition of CVI. Of these, 98% received fluid boluses, 36% inotropes, and 17% corticosteroids. Of treated infants, 46% did not have CVI as defined by a MAP < GA ± signs of inadequate perfusion. Inotropic therapy was associated with increased mortality (11.1 vs. 1.3%; p < 0.05).

Conclusion More than half of the infants met at least one definition of CVI. However, almost half of the treated infants met none of the definitions. Inotropic therapy was associated with increased mortality. These findings can help guide the design of future studies of CVI in newborns.