Low blood pressure in VLBW infants: to treat or not

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Very preterm infants have very low blood pressures relative to term infants or adults. A clear definition for what is a lower than normal blood pressure for these infants remains elusive. The next conundrum is what to do if a low blood pressure is identified by whatever (almost) arbitrary criteria. If the decision is to treat, then the next decision tree to negotiate is with what to treat. Finally, if treatment is given, what are the criteria for success? Against this insecure background, Batton et al report their experiences with identification and treatment of hypotension in very low birth weight infants. Not surprisingly, infants deemed to have normal blood pressure had better neurodevelopmental outcomes than infants with low blood pressure, but treatment of low blood pressure did not improve outcomes relative to not treating low blood pressure. The observations were more hypothesis-generating than conclusive because they were retrospective and the selection of patients for treatment of low blood pressure and the given treatments were not controlled. The results do suggest that although treatment may do no (further) harm, treatment of blood pressure in this population may also not do much good.