Use of antihypotensive therapies in extremely preterm infants

Beau Batton, 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, Seetha Shankaran & 3 others Kurt Schibler, Rosemary D. Higgins, Michele C. Walsh

Research output: Contribution to journalArticle

49 Citations (Scopus)

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 230/7to 26 6/7weeks' 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.

Original languageEnglish
JournalPediatrics
Volume131
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Extremely Premature Infants
Hypotension
Blood Pressure
Therapeutics
Gestational Age
Regression Analysis
Retinopathy of Prematurity
Therapy
Observational Studies
Prospective Studies
Hemorrhage
Morbidity

Keywords

  • Antihypotensive therapy
  • Blood pressure
  • Extremely preterm infant
  • Hypotension

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Batton, B., Li, L., Newman, N. S., Das, A., Watterberg, K. L., Yoder, B. A., ... Walsh, M. C. (2013). Use of antihypotensive therapies in extremely preterm infants. Pediatrics, 131(6). https://doi.org/10.1542/peds.2012-2779

Use of antihypotensive therapies in extremely preterm infants. / Batton, Beau; Li, Lei; Newman, Nancy S.; Das, Abhik; Watterberg, Kristi L.; Yoder, Bradley A.; Faix, Roger G.; Laughon, Matthew M.; Stoll, Barbara J.; Van Meurs, Krisa P.; Carlo, Waldemar A.; Poindexter, Brenda B.; Bell, Edward F.; Sánchez, Pablo J.; Ehrenkranz, Richard A.; Goldberg, Ronald N.; Laptook, Abbot R.; Kennedy, Kathleen A.; Frantz, Ivan D.; Shankaran, Seetha; Schibler, Kurt; Higgins, Rosemary D.; Walsh, Michele C.

In: Pediatrics, Vol. 131, No. 6, 06.2013.

Research output: Contribution to journalArticle

Batton, B, Li, L, Newman, NS, Das, A, Watterberg, KL, Yoder, BA, Faix, RG, Laughon, MM, Stoll, BJ, Van Meurs, KP, Carlo, WA, Poindexter, BB, Bell, EF, Sánchez, PJ, Ehrenkranz, RA, Goldberg, RN, Laptook, AR, Kennedy, KA, Frantz, ID, Shankaran, S, Schibler, K, Higgins, RD & Walsh, MC 2013, 'Use of antihypotensive therapies in extremely preterm infants', Pediatrics, vol. 131, no. 6. https://doi.org/10.1542/peds.2012-2779
Batton B, Li L, Newman NS, Das A, Watterberg KL, Yoder BA et al. Use of antihypotensive therapies in extremely preterm infants. Pediatrics. 2013 Jun;131(6). https://doi.org/10.1542/peds.2012-2779
Batton, Beau ; Li, Lei ; Newman, Nancy S. ; Das, Abhik ; Watterberg, Kristi L. ; Yoder, Bradley A. ; Faix, Roger G. ; Laughon, Matthew M. ; Stoll, Barbara J. ; Van Meurs, Krisa P. ; Carlo, Waldemar A. ; Poindexter, Brenda B. ; Bell, Edward F. ; Sánchez, Pablo J. ; Ehrenkranz, Richard A. ; Goldberg, Ronald N. ; Laptook, Abbot R. ; Kennedy, Kathleen A. ; Frantz, Ivan D. ; Shankaran, Seetha ; Schibler, Kurt ; Higgins, Rosemary D. ; Walsh, Michele C. / Use of antihypotensive therapies in extremely preterm infants. In: Pediatrics. 2013 ; Vol. 131, No. 6.
@article{94697c9094fa45309b079446fbc2b4cd,
title = "Use of antihypotensive therapies in extremely preterm infants",
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 230/7to 26 6/7weeks' 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.",
keywords = "Antihypotensive therapy, Blood pressure, Extremely preterm infant, Hypotension",
author = "Beau Batton and Lei Li and Newman, {Nancy S.} and Abhik Das and Watterberg, {Kristi L.} and Yoder, {Bradley A.} and Faix, {Roger G.} and Laughon, {Matthew M.} and Stoll, {Barbara J.} and {Van Meurs}, {Krisa P.} and Carlo, {Waldemar A.} and Poindexter, {Brenda B.} and Bell, {Edward F.} and S{\'a}nchez, {Pablo J.} and Ehrenkranz, {Richard A.} and Goldberg, {Ronald N.} and Laptook, {Abbot R.} and Kennedy, {Kathleen A.} and Frantz, {Ivan D.} and Seetha Shankaran and Kurt Schibler and Higgins, {Rosemary D.} and Walsh, {Michele C.}",
year = "2013",
month = "6",
doi = "10.1542/peds.2012-2779",
language = "English",
volume = "131",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "6",

}

TY - JOUR

T1 - Use of antihypotensive therapies in extremely preterm infants

AU - Batton, Beau

AU - Li, Lei

AU - Newman, Nancy S.

AU - Das, Abhik

AU - Watterberg, Kristi L.

AU - Yoder, Bradley A.

AU - Faix, Roger G.

AU - Laughon, Matthew M.

AU - Stoll, Barbara J.

AU - Van Meurs, Krisa P.

AU - Carlo, Waldemar A.

AU - Poindexter, Brenda B.

AU - Bell, Edward F.

AU - Sánchez, Pablo J.

AU - Ehrenkranz, Richard A.

AU - Goldberg, Ronald N.

AU - Laptook, Abbot R.

AU - Kennedy, Kathleen A.

AU - Frantz, Ivan D.

AU - Shankaran, Seetha

AU - Schibler, Kurt

AU - Higgins, Rosemary D.

AU - Walsh, Michele C.

PY - 2013/6

Y1 - 2013/6

N2 - 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 230/7to 26 6/7weeks' 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.

AB - 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 230/7to 26 6/7weeks' 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.

KW - Antihypotensive therapy

KW - Blood pressure

KW - Extremely preterm infant

KW - Hypotension

UR - http://www.scopus.com/inward/record.url?scp=84878708778&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878708778&partnerID=8YFLogxK

U2 - 10.1542/peds.2012-2779

DO - 10.1542/peds.2012-2779

M3 - Article

VL - 131

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 6

ER -