New Hanover Regional Medical Center, Wilmington, North Carolina, USA.
Arch Dis Child Fetal Neonatal Ed. 2011 Sep;96(5):F321-8. doi: 10.1136/adc.2010.183335. Epub 2010 Dec 7.
To evaluate in extremely low gestational age newborns, relationships between indicators of hypotension during the first 24 postnatal hours and developmental delay at 24 months of age.
The 945 infants in this prospective study were born at <28 weeks, were assessed for three indicators of hypotension in the first 24 postnatal hours, and were evaluated with the Bayley Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 24 months corrected age. Indicators of hypotension included: (1) mean arterial pressure in the lowest quartile for gestational age; (2) treatment with a vasopressor; and (3) blood pressure lability, defined as the upper quartile for the difference between the lowest and highest mean arterial pressure. Logistic regression was used to evaluate relationships between hypotension and developmental outcomes, adjusting for potential confounders.
78% of infants in this cohort received volume expansion or vasopressor; all who received a vasopressor were treated with volume expansion. 26% had an MDI <70 and 32% had a PDI <70. Low MDI and PDI were associated with low gestational age, which in turn, was associated with receipt of vasopressor treatment. Blood pressure in the lowest quartile for gestational age was associated with vasopressor treatment and labile blood pressure. After adjusting for potential confounders, none of the indicators of hypotension were associated with MDI <70 or PDI <70.
In this large cohort of extremely low gestational age newborns, we found little evidence that early postnatal hypotension indicators are associated with developmental delay at 24 months corrected gestational age.
评估极低胎龄新生儿出生后 24 小时内低血压的各项指标与 24 月龄时发育迟缓的关系。
本前瞻性研究共纳入 945 例胎龄<28 周的新生儿，评估其出生后 24 小时内的 3 项低血压指标，并在校正胎龄 24 个月时采用贝利婴幼儿发展量表（Bayley Mental Development Index，MDI）和精神运动发育指数（Psychomotor Development Index，PDI）进行评估。低血压的指标包括：（1）按胎龄所处四分位范围的最低值计算的平均动脉压；（2）使用血管加压药治疗；（3）血压波动，定义为最低与最高平均动脉压差值的四分位范围上限。采用 logistic 回归评估低血压与发育结局的关系，并对潜在混杂因素进行校正。
该队列中 78%的新生儿接受了扩容或血管加压药治疗；所有使用血管加压药的新生儿均接受了扩容治疗。26%的新生儿 MDI<70，32%的新生儿 PDI<70。较低的 MDI 和 PDI 与较低的胎龄相关，而较低的胎龄又与血管加压药的使用相关。胎龄所处四分位范围最低的血压与血管加压药治疗和血压波动相关。在校正潜在混杂因素后，低血压的各项指标均与 MDI<70 或 PDI<70 无关。
在本项大型极低胎龄新生儿队列研究中，我们几乎没有发现早期新生儿低血压指标与校正胎龄 24 个月时的发育迟缓相关的证据。
