Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Early neonatal hypotension in premature infants born to preeclamptic mothers

Abstract

Background:

Early neonatal hypotension (ENH) is common in premature infants and has been claimed to occur more frequently in infants born to mothers with severe preeclampsia. Previous studies that showed a relationship between maternal preeclampsia and neonatal hypotension did not control for potential confounding factors such as birth weight and maternal treatment with magnesium sulfate (MgSO4).

Objective:

To determine whether maternal preeclampsia is an independent risk factor for ENH.

Study Design:

We conducted a retrospective review of all viable singleton infants with gestational age of 23 to 30 weeks who were admitted to the neonatal intensive care unit over a 2-year period. ENH was defined as the persistence of the mean arterial pressure lower than the gestational age in weeks requiring volume expansion and inotropic support in the first 24 h of life.

Results:

One hundred and eighty four infants were enrolled. Seventy-five (41%) infants met the diagnostic criteria for ENH. Maternal preeclampsia, the presence of labor, maternal treatment with MgSO4, Apgar scores, birth weight, gestational age and respiratory distress syndrome were significantly associated with ENH by univariate analysis. Only gestational age and maternal preeclampsia were significantly associated with ENH by multiple logistic regression.

Conclusion:

Gestational age and maternal preeclampsia were independent risk factors for ENH in our population of premature infants.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK . Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol 2001; 21: 272–278.

    Article  CAS  Google Scholar 

  2. Dasgupta SJ, Gill AB . Hypotension in the very low birthweight infant: the old, the new, and the uncertain. Arch Dis Child Fetal Neonat Ed 2003; 88: F450–F454.

    Article  CAS  Google Scholar 

  3. Spinazzola RM, Harper RG, de Soler M, Lesser M . Blood pressure values in 500- to 750-gram birthweight infants in the first week of life. J Perinatol 1991; 11: 147–151.

    CAS  PubMed  Google Scholar 

  4. Moise AA, Wearden ME, Kozinetz CA, Gest AL, Welty SE, Hansen TN . Antenatal steroids are associated with less need for blood pressure support in extremely premature infants. Pediatrics 1995; 95: 845–850.

    CAS  PubMed  Google Scholar 

  5. Zubrow AB, Hulman S, Kushner H, Falkner B . Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. J Perinatol 1995; 15: 470–479.

    CAS  Google Scholar 

  6. LeFlore JL, Engle WD, Rosenfeld CR . Determinants of blood pressure in very low birth weight neonates: lack of effect of antenatal steroids. Early Hum Dev 2000; 59: 37–50.

    Article  CAS  Google Scholar 

  7. Cordero L, Johnson JR . Mean arterial pressure in extremely low birth weight concordant and discordant twins during the first day of life. J Perinatol 2002; 22: 526–534.

    Article  Google Scholar 

  8. Cordero L, Giannone PJ, Ramirez CN, Joy SD . Mean arterial pressure in concordant and discordant triplets during the first week of life. J Perinatol 2005; 25: 198–204.

    Article  Google Scholar 

  9. Dimitriou G, Greenough A, Mattagos J, Skinner S . Metabolic acidosis, core–peripheral temperature difference and blood pressure response to albumin infusion in hypotensive, very premature infants. J Perinat Med 2001; 29: 442–445.

    Article  CAS  Google Scholar 

  10. Hegyi T, Carbone MT, Anwar M, Ostfeld B, Hiatt M, Koons A . Blood pressure ranges in premature infants: I. The first hours of life. J Pediatr 1994; 124: 627–633.

    Article  CAS  Google Scholar 

  11. Miall-Allen VM, De Vries LS, Whitelaw AGL . Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child 1987; 62: 1068–1069.

    Article  CAS  Google Scholar 

  12. Watkins AMC, West CR, Cooke RWI . Blood pressure and cerebral hemorrhage and ischemia in very low birthweight infants. Early Hum Dev 1989; 9: 103–110.

    Article  Google Scholar 

  13. Dammann O, Allred EN, Kuban KC, Van Marter LJ, Pagano M, Sanocka U . Systemic hypotension and white-matter damage in preterm infants. Dev Med Child Neurol 2002; 44: 82–90.

    Article  Google Scholar 

  14. Bada HS, Korones SB, Perry EH, Arbeart KL, Ray JD, Pourcyous M . Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage. J Pediatr 1990; 117: 607–614.

    Article  CAS  Google Scholar 

  15. Low JA, Froese AB, Galbraith RS, Smith JT, Sauerbrei EE, Derrick EJ . The association between preterm newborn hypotension and hypoxemia and outcome during the first year. Acta Paediatr 1993; 82: 433–437.

    Article  CAS  Google Scholar 

  16. Mizoguchi MB, Chu TG, Murphy FM, Willits N, Morse LS . Dopamine use is an indicator for the development of threshold retinopathy of prematurity. Br J Ophthalmol 1999; 83: 425–428.

    Article  CAS  Google Scholar 

  17. Tantivit P, Subramanian N, Garg M, Ramanathan R, deLemos RA . Low serum cortisol in term newborns with refractory hypotension. J Perinatol 1999; 19: 352–357.

    Article  CAS  Google Scholar 

  18. Ng PC, Lam CW, Fok TF, Lee CH, Ma KC, Chan IH . Refractory hypotension in preterm infants with adrenocortical insufficiency. Arch Dis Child Fetal Neonat Ed 2001; 84: F122–F124.

    Article  CAS  Google Scholar 

  19. Szymonowicz W, Yu VY . Severe pre-eclampsia and infants of very low birth weight. Arch Dis Child 1987; 62: 712–716.

    Article  CAS  Google Scholar 

  20. Dotsch J, Hohmann M, Kuhl PG . Neonatal morbidity and mortality associated with maternal haemolysis elevated liver enzymes and low platelets syndrome. Eur J Pediatr 1997; 156: 389–391.

    Article  CAS  Google Scholar 

  21. Ali A, Walentik C, Mantych GJ, Sadiq HF, Keenan WJ, Noguchi A . Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome: two case reports. Pediatrics 2003; 112: e70–e72.

    Article  Google Scholar 

  22. Report of a Joint Working Group of the British Association of Perinatal Medicine and the Research Unit of the Royal College of Physicians. Development of audit measurements and guidelines for good practice in the management of neonatal respiratory distress syndrome. Arch Dis Child 1992; 67: 1221–1227.

  23. Lee J, Rajadurai VS, Tan KW . Blood pressure standards for very low birthweight infants during the first day of life. Arch Dis Child 1999; 81: F168–F170.

    Article  CAS  Google Scholar 

  24. Zinner SH, Lee YH, Rosner B, Oh W, Kass EH . Factors affecting blood pressures in newborn infants. Hypertension 1980; 2: 99–101.

    Article  CAS  Google Scholar 

  25. Launer LJ, Hoffman A, Grobbee DE . Relationship between birth weight and blood pressure: longitudinal study of infants and children. BMJ 1993; 307: 1451–1454.

    Article  CAS  Google Scholar 

  26. Alves JG, Vilarim JN, Figueiroa JN . Fetal influences on neonatal blood pressure. J Perinatol 1999; 19: 593–595.

    Article  CAS  Google Scholar 

  27. DeSwiet M, Fayers P, Shinebourne EA . Blood pressure survey in a population of newborn infancy. BMJ 1976; 2: 9–11.

    Article  CAS  Google Scholar 

  28. Gillman MW, Rich-Edwards JW, Rifas-Shiman SL, Lieberman ES, Klenman KP, Lipshultz SE . Maternal age and other predictors of newborn blood pressure. J Pediatr 2004; 144: 240–245.

    Article  Google Scholar 

  29. Krediet TG, Valk L, Hempenius I, Egberts J, van Bel F . Nitric oxide production and plasma cyclic guanosine monophosphate in premature infants with respiratory distress syndrome. Biol Neonate 2002; 82: 150–154.

    Article  CAS  Google Scholar 

  30. Rantone TH, Gronlund JU, Jalonen JO, Ekblad UU, Kaapa PO, Kero PH . Comparison of the effects of antenatal magnesium sulphate and ritodrine exposure on circulatory adaptation in preterm infants. Clin Physiol Funct Imag 2002; 22: 13–17.

    Article  CAS  Google Scholar 

  31. Cordero L, Giannone PJ, Rich JT . Mean arterial pressure in very low birth weight (801–1500 g) concordant and discordant twins during the first day of life. J Perinatol 2003; 23: 545–551.

    Article  Google Scholar 

  32. Steinert JR, Wyatt AW, Poston L, Jacob R, Mann GE . Preeclampsia is associated with altered Ca2+ regulation and NO production in human fetal venous endothelial cells. FASEB J 2002; 16: 721–723.

    Article  CAS  Google Scholar 

  33. Kajantie E, Dunkel L, Turpeinen U, Stenman U, Wood PJ, Nuutila M . Placental 11b-hydroxysteroid dehydrogenase-2 and fetal cortisol/cortisone shuttle in small preterm infants. J Clin Endocrinol Metab 2003; 88: 493–500.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R-J Teng.

Additional information

Premature infants born to preeclamptic mothers are more prone to develop hypotension requiring inotropes in the first day of life.Part of the study was presented in the 2004 SPR meeting.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Teng, RJ., Wu, TJ., Sharma, R. et al. Early neonatal hypotension in premature infants born to preeclamptic mothers. J Perinatol 26, 471–475 (2006). https://doi.org/10.1038/sj.jp.7211558

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211558

Keywords

This article is cited by

Search

Quick links