Al-Aweel I, Pursley D M, Rubin L P, Shah B, Weisberger S, Richardson D K
Harvard Newborn Medicine, Beth Israel Deaconess Medical Center, Brigham, and Women's Hospital, Children's Hospital, and Harvard Medical School, Boston, MA, USA.
J Perinatol. 2001 Jul-Aug;21(5):272-8. doi: 10.1038/sj.jp.7210563.
Very low birth weight infants are vulnerable to hypotension and its associated complications. Vasopressors are used to raise blood pressure (BP), but indications for use are uncertain. Our objectives were (1) to study variations in BP stability among NICUs, (2) to investigate inter-NICU differences in vasopressor use, and (3) to address the association between intraventricular hemorrhage (IVH) and abnormal BPs.
A total of 1288 infants with birth weight <1500 g were admitted to six NICUs in Massachusetts and Rhode Island over 21 months. The lowest and highest mean BPs were collected within the first 12 hours. Also recorded were the use of vasopressors within the first 24 hours and the occurrence of IVH. Logistic regressions were used to model outcomes, controlling for gestational age and illness severity using the Score for Neonatal Acute Physiology.
Two of the six NICUs had significantly higher percentages of infants with at least one hypotensive BP, with prevalences of 24% to 45%. Percentages of infants treated with vasopressors ranged from 4% to 39%. This range of vasopressor use could not be explained by inter-NICU differences in birth weight, illness severity, or rates of hypotension. We found a borderline association between severe IVH and hypotension (odds ratio 1.6, p=0.055), but not between severe IVH and hypertension.
Wide differences exist in the prevalence of hypotension, hypertension, and vasopressor use among NICUs. We also found an association between hypotension and IVH, but not between hypertension and IVH.
极低出生体重儿易发生低血压及其相关并发症。血管升压药用于升高血压（BP），但使用指征尚不确定。我们的目标是：（1）研究新生儿重症监护病房（NICU）之间血压稳定性的差异；（2）调查NICU之间血管升压药使用的差异；（3）探讨脑室内出血（IVH）与异常血压之间的关联。
在21个月内，共有1288例出生体重<1500 g的婴儿被收治于马萨诸塞州和罗德岛的6个NICU。在出生后的前12小时内收集最低和最高平均血压。还记录了出生后24小时内血管升压药的使用情况以及IVH的发生情况。使用逻辑回归对结果进行建模，并使用新生儿急性生理学评分来控制胎龄和疾病严重程度。
6个NICU中有2个NICU中至少有一次低血压的婴儿比例明显更高，患病率为24%至45%。使用血管升压药的婴儿比例在4%至39%之间。这种血管升压药使用范围的差异无法用NICU之间出生体重、疾病严重程度或低血压发生率的差异来解释。我们发现重度IVH与低血压之间存在临界关联（优势比1.6，p=0.055），但重度IVH与高血压之间无关联。
NICU之间低血压、高血压和血管升压药使用的患病率存在很大差异。我们还发现低血压与IVH之间存在关联，但高血压与IVH之间无关联。
