Admission Systolic Blood Pressure and Outcomes in Preterm Infants of ≤ 26 Weeks' Gestation

Yanyu Lyu; Xiang Y. Ye; Tetsuya Isayama; Ruben Alvaro; Chuks Nwaesei; Keith Barrington; Shoo K. Lee; Prakesh S. Shah; for the Canadian Neonatal Network Investigators

doi:10.1055/s-0037-1603342

American Journal of Perinatology, Table of Contents

Am J Perinatol 2017; 34(13): 1271-1278
DOI: 10.1055/s-0037-1603342

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Admission Systolic Blood Pressure and Outcomes in Preterm Infants of ≤ 26 Weeks' Gestation

Yanyu Lyu

¹Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada

²Department of Child Health Development, Capital Institute of Pediatrics, Beijing, China

,

Xiang Y. Ye

¹Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada

,

Tetsuya Isayama

¹Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada

³Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

,

Ruben Alvaro

⁴Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada

,

Chuks Nwaesei

⁵Department of Pediatrics, Windsor Regional Hospital, Windsor, Ontario, Canada

,

Keith Barrington

⁶Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada

,

Shoo K. Lee

¹Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada

⁷Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada

⁸Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

,

Prakesh S. Shah

¹Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada

⁷Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada

⁸Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

,

for the Canadian Neonatal Network Investigators

› Author Affiliations

Abstract

Objective To examine the relationship between admission systolic blood pressure (SBP) and adverse neonatal outcomes. Specifically, we aimed to identify the optimal SBP that is associated with the lowest rates of adverse outcomes in extremely preterm infants of ≤ 26 weeks' gestation.

Methods In this retrospective study, inborn neonates born at ≤ 26 weeks' gestational age and admitted to tertiary neonatal units participating in the Canadian Neonatal Network between 2003 and 2009 were included. The primary outcome was early mortality (≤ 7 days). Secondary outcomes included severe brain injury, late mortality, and a composite outcome defined as early mortality or severe brain injury. Nonlinear multivariable logistic regression models examined the relationship between admission SBP and outcomes.

Results Admission SBP demonstrated a U-shaped relationship with early mortality, severe brain injury, and composite outcome after adjustment for confounders (p < 0.01). The lowest risks of early mortality, severe brain injury, and composite outcome occurred at admission SBPs of 51, 55, and 54 mm Hg, respectively.

Conclusion In extremely preterm infants of ≤ 26 weeks' gestational age, the relationship between admission SBP, and early mortality and severe brain injury was “U-shaped.” The optimal admission SBP associated with lowest rates of adverse outcome was between 51 and 55 mm Hg.

Keywords

systolic blood pressure - small for gestational age - preterm - neonatal outcomes

Full Text

References

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Supplementary Material

Supplementary material