Abstract
Objective A significant variability exists for diagnosis and treatment of hypotension in extremely
preterm infants. Benefits of the use of vasopressors remain unclear. We wanted to
identify the risk factors associated with use of vasopressors in the first week of
life and their impact on outcomes of extremely preterm infants.
Study Design Retrospective review of all newborns ≤28 weeks of gestational age (GA) admitted in
neonatal intensive care unit from October 1, 2012, to October 31, 2015, done. Data
regarding antenatal and neonatal characteristics and outcomes were recorded. Study
infants were divided into two cohorts and compared based on vasopressor use. Chi-square,
t-test, and multiple logistic regression were performed as appropriate and significance
set at p <0.05.
Results Of 213 extremely preterm infants, 90 (42.3%) received vasopressors in first week
of life. The mean arterial pressure (MAP) at admission in these infants was significantly
lower than that of infants who did not require vasopressors (27 ± 8 vs. 30 ± 6 mm
Hg, p < 0.05). Vasopressors were initiated within 24 hours in 91% of babies. After controlling
for other variables, use of vasopressors was significantly higher in infants with
lower birth weight (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6–8.3),
5-minute Apgar's score ≤5 (OR: 1.8, 95% CI: 1.2–3.12), and admission hypothermia (OR:
2.7, 95% CI: 1.3–4.9). The use of vasopressors was significantly associated with severe
intraventricular hemorrhage (IVH), even after controlling for other significant variables
(OR: 5.9, 95% CI: 1.6–9.3).
Conclusion Lower birth weight, low 5-minute Apgar's score, and admission hypothermia are characteristics
associated with early use of vasopressors in extremely preterm infants. Infants treated
with vasopressors are at a higher risk of developing severe IVH.
Key Points
-
Low systemic blood pressure is a very common problem in the extremely preterm population.
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In clinical practice, mean arterial blood pressure (BP) less than the infants GA in
week is typically considered to be “low BP.”
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About 50% of infants born at <29 weeks of GA received very preterm in the first week
of life.
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Use of vasopressors is associated with a higher incidence of intraventricular hemorrhage
in extremely preterm population.
Keywords
extremely preterm infants - hypotension - vasopressors - dopamine
