Division of Neonatal-Perinatal Medicine, Betty H Cameron Women's and Children's Hospital, New Hanover Regional Medical Center, Wilmington, NC 28402, USA.
J Perinatol. 2011 Aug;31(8):524-34. doi: 10.1038/jp.2010.201. Epub 2011 Jan 27.
To evaluate, in extremely low gestational age newborns (ELGANs), relationships between indicators of early postnatal hypotension and cranial ultrasound indicators of cerebral white matter damage imaged in the nursery and cerebral palsy diagnoses at 24 months follow-up.
The 1041 infants in this prospective study were born at <28 weeks gestation, were assessed for three indicators of hypotension in the first 24 postnatal hours, had at least one set of protocol cranial ultrasound scans and were evaluated with a structured neurological exam at 24 months corrected age. Indicators of hypotension included: (1) lowest mean arterial pressure (MAP) in the lowest quartile for gestational age; (2) treatment with a vasopressor; and (3) blood pressure lability, defined as the upper quartile of the difference between each infant's lowest and highest MAP. Outcomes included indicators of cerebral white matter damage, that is, moderate/severe ventriculomegaly or an echolucent lesion on cranial ultrasound and cerebral palsy diagnoses at 24 months gestation. Logistic regression was used to evaluate relationships among hypotension indicators and outcomes, adjusting for potential confounders.
Twenty-one percent of surviving infants had a lowest blood pressure in the lowest quartile for gestational age, 24% were treated with vasopressors and 24% had labile blood pressure. Among infants with these hypotension indicators, 10% percent developed ventriculomegaly and 7% developed an echolucent lesion. At 24 months follow-up, 6% had developed quadriparesis, 4% diparesis and 2% hemiparesis. After adjusting for confounders, we found no association between indicators of hypotension, and indicators of cerebral white matter damage or a cerebral palsy diagnosis.
The absence of an association between indicators of hypotension and cerebral white matter damage and or cerebral palsy suggests that early hypotension may not be important in the pathogenesis of brain injury in ELGANs.
评估极低出生体重儿（ELGANs）中出生后早期低血压的指标与新生儿重症监护病房（NICU）中脑白质损伤的头颅超声指标以及 24 个月随访时脑瘫诊断之间的关系。
本前瞻性研究纳入了 1041 例出生时胎龄<28 周的婴儿，在出生后 24 小时内评估了 3 项低血压指标，至少进行了一组协议性头颅超声扫描，并在 24 个月校正年龄时进行了结构化神经检查。低血压的指标包括：（1）最低平均动脉压（MAP）处于胎龄最低四分位数；（2）使用血管加压药治疗；（3）血压波动，定义为每个婴儿最低和最高 MAP 之间差异的上四分位数。结局包括脑白质损伤的指标，即头颅超声中度/重度脑室扩大或脑实质内透亮区和 24 个月时脑瘫的诊断。采用逻辑回归评估低血压指标与结局之间的关系，并调整了潜在的混杂因素。
21%存活婴儿的最低血压处于胎龄最低四分位数，24%接受了血管加压药治疗，24%血压波动。在有这些低血压指标的婴儿中，10%出现脑室扩大，7%出现脑实质内透亮区。24 个月随访时，6%出现四肢瘫，4%出现双瘫，2%出现偏瘫。调整混杂因素后，我们发现低血压指标与脑白质损伤或脑瘫诊断之间没有关联。
低血压指标与脑白质损伤或脑瘫之间没有关联，提示早期低血压可能在 ELGANs 脑损伤的发病机制中并不重要。
