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Blood pressure values and hypotension management in extremely preterm infants: a multi-center study

Abstract

Objective

To describe high/low daily blood pressures (BP) and variability in BP management with vasoactive infusions (VI) and/or hydrocortisone (HC) in extremely preterm infants.

Study design

Analysis of data from 24–27 weeks’ gestation infants in the Preterm Erythropoietin Neuroprotection (PENUT) Trial. Daily high/low BPs, the use of VI and/or HC, and adverse outcomes were compared descriptively and using regression models.

Results

936 infants were included; 64% untreated, 20% VI, 3% HC, and 13% VI + HC. BP ranges are described for the 602 untreated infants. Considerable inter- and intra-center variability was demonstrated in the rate of VI and/or HC use and the lowest BP on the day of VI or HC initiation.

Conclusions

Despite published expert opinion guidance regarding BP management in extremely preterm infants, our results suggest a continued lack of consensus result in both inter- and intra-center variability in practice. Well-designed studies in the field are urgently needed.

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Fig. 1: Lowest and highest daily systolic, diastolic, and mean arterial blood pressures for infants who received no anti-hypotensive treatment within the first 14 days of life.
Fig. 2: Lowest daily mean arterial blood pressures for infants, stratified by gestational age and treatment/mortality.
Fig. 3: Variability in treatment thresholds and types of treatment by study site.
Fig. 4: Survival and time until weaning off of vasoactive infusions (VI), by treatment group.

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Funding

This project was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award numbers U01NS077953 and U01NS077955.

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ESP and BAC contributed to the design, analysis, and interpretation of the data, drafted the initial manuscript, and reviewed and critically revised the manuscript. PJH and SEJ contributed to the design, analysis, collection, and interpretation of the data, and reviewed and critically revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Eric S. Peeples.

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Peeples, E.S., Comstock, B.A., Heagerty, P.J. et al. Blood pressure values and hypotension management in extremely preterm infants: a multi-center study. J Perinatol 42, 1169–1175 (2022). https://doi.org/10.1038/s41372-022-01425-2

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