Faust Kirstin, Härtel Christoph, Preuß Michael, Rabe Heike, Roll Claudia, Emeis Michael, Wieg Christian, Szabo Miklos, Herting Egbert, Göpel Wolfgang
Department of Paediatrics, University of Lübeck, Lübeck, Germany.
Institute of Medical Biometrics and Statistics, University of Lübeck, Lübeck, Germany.
Arch Dis Child Fetal Neonatal Ed. 2015 Sep;100(5):F388-92. doi: 10.1136/archdischild-2014-306483. Epub 2015 Jul 21.
To evaluate lowest mean arterial blood pressure during the first 24 h of life (minMAP(24)) in very-low-birthweight (VLBW) infants and to identify associations between hypotension and short-term outcome.
Retrospective cohort analysis of the minMAP(24) of 4907 VLBW infants with a gestational age <32 weeks in correlation with clinical data. Hypotension was defined as minMAP(24) being lower than the median value of all patients of the same gestational age.
MinMAP(24) values correlated with gestational age. Median minMAP(24) values of VLBW infants ≤29 weeks' gestation were 1-2 mm Hg lower than gestational age in completed weeks. Hypotensive infants had a higher rate of intraventricular haemorrhage (IVH, 20.3% vs 15.9%, p<0.001), bronchopulmonary dysplasia (BPD, 19.2% vs 15.1%, p<0.001) and death (5.2% vs 3.0%, p<0.001). Multivariate logistic regression analyses, including potential confounders, confirmed these data. MinMAP(24) was an independent risk factor for IVH (OR 0.97/mm Hg, 95% CI 0.96 to 0.99, p=0.003), BPD (OR 0.96/mm Hg, 95% CI 0.94 to 0.98, p<0.001) and mortality (OR 0.94/mm Hg, 95% CI 0.90 to 0.98, p=0.003).
Hypotension during the first 24 h of life is associated with adverse outcomes in VLBW infants. This underlines the need for randomised controlled trials on the use of vasoactive drugs in this vulnerable patient cohort.
评估极低出生体重（VLBW）婴儿出生后最初24小时内的最低平均动脉血压（minMAP(24)），并确定低血压与短期预后之间的关联。
对4907例孕周<32周的VLBW婴儿的minMAP(24)进行回顾性队列分析，并与临床数据相关联。低血压定义为minMAP(24)低于同孕周所有患者的中位数。
minMAP(24)值与孕周相关。孕周≤29周的VLBW婴儿的minMAP(24)中位数比完整孕周的孕周低1 - 2 mmHg。低血压婴儿的脑室内出血（IVH，20.3%对15.9%，p<0.001）、支气管肺发育不良（BPD，19.2%对15.1%，p<0.001）和死亡（5.2%对3.0%，p<0.001）发生率更高。包括潜在混杂因素的多变量逻辑回归分析证实了这些数据。minMAP(24)是IVH（比值比0.97/mmHg，95%可信区间0.96至0.99，p = 0.003）、BPD（比值比0.96/mmHg，95%可信区间0.94至0.98，p<0.001）和死亡率（比值比0.94/mmHg，95%可信区间0.90至0.98，p = 0.003）的独立危险因素。
出生后最初24小时内的低血压与VLBW婴儿的不良预后相关。这突出了对这一脆弱患者群体使用血管活性药物进行随机对照试验的必要性。
