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

Erika Fernandez; Kristi L. Watterberg; Roger G. Faix; Bradley A. Yoder; Michele C. Walsh; Conra Backstrom Lacy; Karen A. Osborne; Abhik Das; Douglas E. Kendrick; Barbara J. Stoll; Brenda B. Poindexter; Abbot R. Laptook; Kathleen A. Kennedy; Kurt Schibler; Edward F. Bell; Krisa P. Van Meurs; Ivan D. Frantz III; Ronald N. Goldberg; Seetha Shankaran; Waldemar A. Carlo; Richard A. Ehrenkranz; Pablo J. Sanchez; Rosemary D. Higgins

doi:10.1055/s-0034-1368089

American Journal of Perinatology, Table of Contents

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

¹Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico

,

Kristi L. Watterberg

¹Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico

,

Roger G. Faix

²Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah

,

Bradley A. Yoder

³Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio

,

Michele C. Walsh

³Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio

,

Conra Backstrom Lacy

¹Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico

,

Karen A. Osborne

³Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio

,

Abhik Das

⁴Statistics and Epidemiology Unit, RTI International, Rockville, Maryland

,

Douglas E. Kendrick

⁵Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina

,

Barbara J. Stoll

⁶Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia

,

Brenda B. Poindexter

⁷Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana

,

Abbot R. Laptook

⁸Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island

,

Kathleen A. Kennedy

⁹Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas

,

Kurt Schibler

¹⁰Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

,

Edward F. Bell

¹¹Department of Pediatrics, University of Iowa, Iowa City, Iowa

,

Krisa P. Van Meurs

¹²Division 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

¹³Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts

,

Ronald N. Goldberg

¹⁴Department of Pediatrics, Duke University, Durham, North Carolina

,

Seetha Shankaran

¹⁵Department of Pediatrics, Wayne State University, Detroit, Michigan

,

Waldemar A. Carlo

¹⁶Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama

,

Richard A. Ehrenkranz

¹⁷Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut

,

Pablo J. Sanchez

¹⁸Department 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

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.

Keywords

blood pressure - cardiovascular insufficiency - mechanical ventilation - inotrope - fluid bolus - glucocorticoid - outcomes - newborn

Full Text

References

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