Thewissen Liesbeth, Naulaers Gunnar, Hendrikx Dries, Caicedo Alexander, Barrington Keith, Boylan Geraldine, Cheung Po-Yin, Corcoran David, El-Khuffash Afif, Garvey Aisling, Macko Jozef, Marlow Neil, Miletin Jan, O'Donnell Colm P F, O'Toole John M, Straňák Zbyněk, Van Laere David, Wiedermannova Hana, Dempsey Eugene
Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.
Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium.
Pediatr Res. 2021 Aug;90(2):373-380. doi: 10.1038/s41390-021-01483-w. Epub 2021 Apr 20.
The impact of the permissive hypotension approach in clinically well infants on regional cerebral oxygen saturation (rScO) and autoregulatory capacity (CAR) remains unknown.
Prospective cohort study of blinded rScO measurements within a randomized controlled trial of management of hypotension (HIP trial) in extremely preterm infants. rScO, mean arterial blood pressure, duration of cerebral hypoxia, and transfer function (TF) gain inversely proportional to CAR, were compared between hypotensive infants randomized to receive dopamine or placebo and between hypotensive and non-hypotensive infants, and related to early intraventricular hemorrhage or death.
In 89 potentially eligible HIP trial patients with rScO measurements, the duration of cerebral hypoxia was significantly higher in 36 hypotensive compared to 53 non-hypotensive infants. In 29/36 hypotensive infants (mean GA 25 weeks, 69% males) receiving the study drug, no significant difference in rScO was observed after dopamine (n = 13) compared to placebo (n = 16). Duration of cerebral hypoxia was associated with early intraventricular hemorrhage or death. Calculated TF gain (n = 49/89) was significantly higher reflecting decreased CAR in 16 hypotensive compared to 33 non-hypotensive infants.
Dopamine had no effect on rScO compared to placebo in hypotensive infants. Hypotension and cerebral hypoxia are associated with early intraventricular hemorrhage or death.
Treatment of hypotension with dopamine in extremely preterm infants increases mean arterial blood pressure, but does not improve cerebral oxygenation. Hypotensive extremely preterm infants have increased duration of cerebral hypoxia and reduced cerebral autoregulatory capacity compared to non-hypotensive infants. Duration of cerebral hypoxia and hypotension are associated with early intraventricular hemorrhage or death in extremely preterm infants. Since systematic treatment of hypotension may not be associated with better outcomes, the diagnosis of cerebral hypoxia in hypotensive extremely preterm infants might guide treatment.
在临床状况良好的婴儿中，采用允许性低血压策略对局部脑氧饱和度（rScO）和自动调节能力（CAR）的影响尚不清楚。
在一项针对极早产儿低血压管理的随机对照试验（HIP试验）中，对盲法测量的rScO进行前瞻性队列研究。比较了随机接受多巴胺或安慰剂的低血压婴儿之间、低血压婴儿与非低血压婴儿之间的rScO、平均动脉血压、脑缺氧持续时间以及与CAR成反比的传递函数（TF）增益，并将其与早期脑室内出血或死亡相关联。
在89例有rScO测量值的潜在符合条件的HIP试验患者中，36例低血压婴儿的脑缺氧持续时间显著高于53例非低血压婴儿。在29/36例接受研究药物的低血压婴儿（平均胎龄25周，69%为男性）中，与安慰剂组（n = 16）相比，多巴胺组（n = 13）的rScO无显著差异。脑缺氧持续时间与早期脑室内出血或死亡相关。与33例非低血压婴儿相比，16例低血压婴儿计算出的TF增益（n = 49/89）显著更高，反映出CAR降低。
与安慰剂相比，多巴胺对低血压婴儿的rScO无影响。低血压和脑缺氧与早期脑室内出血或死亡相关。
在极早产儿中，用多巴胺治疗低血压可提高平均动脉血压，但不能改善脑氧合。与非低血压婴儿相比，低血压极早产儿的脑缺氧持续时间延长，脑自动调节能力降低。脑缺氧持续时间和低血压与极早产儿早期脑室内出血或死亡相关。由于系统性治疗低血压可能与更好的预后无关，低血压极早产儿脑缺氧的诊断可能会指导治疗。
