Al Balushi Asim, Barbosa Vargas Stephanie, Maluorni Julie, Sanon Priscille-Nice, Rampakakis Emmanouil, Saint-Martin Christine, Wintermark Pia
Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Canada.
JSS Medical Research, Montreal, Québec, Canada.
Am J Perinatol. 2018 Jan;35(1):31-38. doi: 10.1055/s-0037-1604392. Epub 2017 Jul 31.
This study aimed to assess the incidence of hypotension in asphyxiated newborns treated with hypothermia, the variability in treatments for hypotension, and the impact of hypotension on the pattern of brain injury.
We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. Mean blood pressures, lactate levels, and inotropic support medications were recorded during the hospitalization. Presence and severity of brain injury were scored using the brain magnetic resonance imaging (MRI) obtained after the hypothermia treatment was completed.
One hundred and ninety term asphyxiated newborns were treated with hypothermia. Eighty-one percent developed hypotension. Fifty-five percent of the newborns in the hypotensive group developed brain injury compared with 35% of the newborns in the normotensive group ( = 004). Twenty-nine percent of the newborns in the hypotensive group developed severe brain injury, compared with only 15% in the normotensive group. Nineteen percent of the newborns presenting with volume- and/or catecholamine-resistant hypotension had near-total injury, compared with 6% in the normotensive group and 8% in the group responding to volume and/or catecholamines.
Hypotension was common in asphyxiated newborns treated with hypothermia and was associated with an increased risk of (severe) brain injury in these newborns.
本研究旨在评估接受低温治疗的窒息新生儿低血压的发生率、低血压治疗方法的变异性，以及低血压对脑损伤模式的影响。
我们对接受低温治疗的窒息新生儿进行了一项回顾性队列研究。住院期间记录平均血压、乳酸水平和使用的血管活性药物。在低温治疗结束后，通过脑磁共振成像（MRI）对脑损伤的存在情况和严重程度进行评分。
190名足月窒息新生儿接受了低温治疗。81%的患儿出现低血压。低血压组中55%的新生儿发生脑损伤，而血压正常组这一比例为35%（P = 0.04）。低血压组中29%的新生儿发生严重脑损伤，而血压正常组仅为15%。出现容量和/或儿茶酚胺抵抗性低血压的新生儿中有19%发生近乎完全性损伤，而血压正常组为6%，对容量和/或儿茶酚胺有反应的组为8%。
在接受低温治疗的窒息新生儿中，低血压很常见，并且与这些新生儿发生（严重）脑损伤的风险增加相关。
