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Multicenter Study
. 2014 Nov;31(11):947-56.
doi: 10.1055/s-0034-1368089. Epub 2014 Feb 10.

Incidence, management, and outcomes of cardiovascular insufficiency in critically ill term and late preterm newborn infants

Erika Fernandez  1 , Kristi L Watterberg  1 , Roger G Faix  2 , Bradley A Yoder  3 , Michele C Walsh  3 , Conra Backstrom Lacy  1 , Karen A Osborne  3 , Abhik Das  4 , Douglas E Kendrick  5 , Barbara J Stoll  6 , Brenda B Poindexter  7 , Abbot R Laptook  8 , Kathleen A Kennedy  9 , Kurt Schibler  10 , Edward F Bell  11 , Krisa P Van Meurs  12 , Ivan D Frantz 3rd  13 , Ronald N Goldberg  14 , Seetha Shankaran  15 , Waldemar A Carlo  16 , Richard A Ehrenkranz  17 , Pablo J Sanchez  18 , Rosemary D Higgins
Affiliations
Multicenter Study

Incidence, management, and outcomes of cardiovascular insufficiency in critically ill term and late preterm newborn infants

Erika Fernandez et al. Am J Perinatol. 2014 Nov.

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.

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Figures

Figure 1
Figure 1
*Clinical sign: poor capillary refill (>3 seconds), oliguria (urine output <1ml/kg/hour over 6 hours) or serum bicarbonate <18 and/or base deficit >5
Figure 2
Figure 2
Percent (%) is number of infants with the each definition divided by total number of infants enrolled. Of the 112 infants who met criteria for Definition A, 36% (40) received no therapy. Of those who met either Definition A or B (low mean blood pressure ± clinical signs of low blood flow), 19% (48) were not treated. Of infants who received inotropic agents (Definition D), 30% (40) did not have CVI by Definition A and 47% (64) did not meet Definition B. Of the infants who received fluid expansion, 46% (166) did not have CVI by Definition A and 65% (237) did not meet definition B.
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References

    1. Cayabyab R, McLean CW, Seri I. Definition of hypotension and assessment of hemodynamics in the preterm neonate. Journal of perinatology : official journal of the California Perinatal Association. 2009;29(Suppl 2):S58–62. - PubMed
    1. Al-Aweel I, Pursley DM, Rubin LP, et al. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. Journal of perinatology : official journal of the California Perinatal Association. 2001;21(5):272–278. - PubMed
    1. Clark RH. The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. Journal of perinatology : official journal of the California Perinatal Association. 2005;25(4):251–257. - PubMed
    1. Brierley J, Choong K, Cornell T, et al. 2007 American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock*. Crit Care Med. 2008 - PubMed
    1. Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update. Neonatology. 2010;97(4):402–417. - PubMed

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