Blood Pressure, Anti-Hypotensive Therapy, and Neurodevelopment in Extremely Preterm Infants

Objective

To compare neurodevelopment (ND) in 3 cohorts of extremely preterm infants: untreated with normal blood pressure (BP), untreated with low BP, and treated with low BP.

Study design

We conducted a retrospective study of infants 23 to 25 weeks gestation. Low BP was defined as ≥3 mean arterial pressures ≤25 mm Hg in the first 72 hours of life. Treatment included fluids, inotropes, and corticosteroids.

Results

We examined 67 infants with normal BP, 31 infants with untreated low BP, and 70 infants with treated low BP. A total of 75% survived to be discharged from the hospital, and 95% of survivors had ND assessment. Perinatal variables differed between treated infants with low BP and the other groups. Untreated infants with low BP had similar survival rates, but more cerebral palsy, deafness, or any ND impairment when compared with infants with normal BP. Treated infants with low BP had more mortality, worse ND, and less survival without ND impairment compared with infants who had normal BP. Results were unchanged after logistic regression adjusting for prenatal steroids, maternal education, race, sex, bronchopulmonary dysplasia, and postnatal dexamethasone exposure.

Conclusions

Infants with low BP—regardless of treatment—had worse ND than infants with normal BP. Early low BP may be independently associated with a poor outcome.

Abbreviations: BP, Blood pressure, BPD, Bronchopulmonary dysplasia, CP, Cerebral palsy, GA, Gestational age, IVH, Intraventricular hemorrhage, MAP, Mean arterial pressure, MDI, Mental developmental index, ND, Neurodevelopment, NDI, Neurodevelopmental impairment, NICU, Neonatal intensive care unit, PDA, Patent ductus arteriosus, PDI, Psychomotor developmental index, PMA, Postmenstrual age, PVL, Periventricular leukomalacia, SNAPPE II, Score for Neonatal Acute Physiology Perinatal Extension II, UAC, Umbilical arterial catheter