Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013 Jun;131(6):e1865-73.
doi: 10.1542/peds.2012-2779. Epub 2013 May 6.

Use of antihypotensive therapies in extremely preterm infants

Beau Batton  1 , Lei Li, Nancy S Newman, Abhik Das, Kristi L Watterberg, Bradley A Yoder, Roger G Faix, Matthew M Laughon, Barbara J Stoll, Krisa P Van Meurs, Waldemar A Carlo, Brenda B Poindexter, Edward F Bell, Pablo J Sánchez, Richard A Ehrenkranz, Ronald N Goldberg, Abbot R Laptook, Kathleen A Kennedy, Ivan D Frantz 3rd, Seetha Shankaran, Kurt Schibler, Rosemary D Higgins, Michele C Walsh; Eunice Kennedy Shriver National Institute of Child Health & Human Development Neonatal Research Network
Affiliations
Randomized Controlled Trial

Use of antihypotensive therapies in extremely preterm infants

Beau Batton et al. Pediatrics. 2013 Jun.

Abstract

Objective: To investigate the relationships among blood pressure (BP) values, antihypotensive therapies, and in-hospital outcomes to identify a BP threshold below which antihypotensive therapies may be beneficial.

Methods: Prospective observational study of infants 23(0/7) to 26(6/7) weeks' gestational age. Hourly BP values and antihypotensive therapy use in the first 24 hours were recorded. Low BP was investigated by using 15 definitions. Outcomes were examined by using regression analysis controlling for gestational age, the number of low BP values, and illness severity.

Results: Of 367 infants enrolled, 203 (55%) received at least 1 antihypotensive therapy. Treated infants were more likely to have low BP by any definition (P < .001), but for the 15 definitions of low BP investigated, therapy was not prescribed to 3% to 49% of infants with low BP and, paradoxically, was administered to 28% to 41% of infants without low BP. Treated infants were more likely than untreated infants to develop severe retinopathy of prematurity (15% vs 8%, P = .03) or severe intraventricular hemorrhage (22% vs 11%, P < .01) and less likely to survive (67% vs 78%, P = .02). However, with regression analysis, there were no significant differences between groups in survival or in-hospital morbidity rates.

Conclusions: Factors other than BP contributed to the decision to use antihypotensive therapies. Infant outcomes were not improved with antihypotensive therapy for any of the 15 definitions of low BP investigated.

Trial registration: ClinicalTrials.gov NCT00874393.

Keywords: antihypotensive therapy; blood pressure; extremely preterm infant; hypotension.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Extremely preterm infant study enrollment including classification by study group.
FIGURE 2
FIGURE 2
Percentage of infants with stated definition of low BP who received at ≥1 antihypotensive therapy.
FIGURE 3
FIGURE 3
Center variation in the rate of antihypotensive therapy administration, frequency of low BP, and incidence of hospital survival.
See this image and copyright information in PMC

References

    1. Dempsey EM, Barrington KJ. Treating hypotension in the preterm infant: when and with what: a critical and systematic review. J Perinatol. 2007;27(8):469–478 - PubMed
    1. Evans N. Which inotrope for which baby? Arch Dis Child Fetal Neonatal Ed. 2006;91(3):F213–F220 - PMC - PubMed
    1. Laughon M, Bose C, Allred E, et al. ELGAN Study Investigators . Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week. Pediatrics. 2007;119(2):273–280 - PMC - PubMed
    1. Batton B, Batton D, Riggs T. Blood pressure during the first 7 days in premature infants born at postmenstrual age 23 to 25 weeks. Am J Perinatol. 2007;24(2):107–115 - PubMed
    1. Fanaroff JM, Wilson-Costello DE, Newman NS, Montpetite MM, Fanaroff AA. Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics. 2006;117(4):1131–1135 - PubMed

Publication types

Associated data