Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
PLoS One. 2021 Oct 14;16(10):e0258328. doi: 10.1371/journal.pone.0258328. eCollection 2021.
Hypotension in the early stages of life appears in 20% of very low birth weight (VLBW) infants. The gestational age and birth weight are the risk factors highly related to the postnatal hypotension. Other risk factors slightly differ between different studies. So, we evaluated the risk factors and prognosis that are associated with infants treated with hypotension in the early stages of life, after excluding the influences of gestational age and small for gestational age (SGA). VLBW infants registered in the Korean Neonatal Network between 2013 and 2015 treated for hypotension within a week after their birth were selected as study subjects. The rest were used as a control group. Risk factors and the prevalence of severe complications, including mortality, were investigated and compared after matching for gestational age and SGA. The treatment rate for hypotension within the first postnatal week was inversely related to decreasing gestational ages and birth weights. In particular, 63.4% of preterm infants born at ≤ 24 weeks' gestation and 66.9% of those with a birth weight < 500 g were treated for hypotension within a week of birth. Regression analysis after matching showed that 1-minute Apgar score, neonatal cardiac massage or epinephrine administration, symptomatic patent ductus arteriosus, early onset sepsis, and chorioamnionitis were significantly associated with hypotension. In the hypotension group, mortality, grade 3 or higher intraventricular hemorrhage, periventricular leukomalacia, and moderate to severe bronchopulmonary dysplasia rates were significantly higher after the matching for gestational age and SGA. Hypotension during the first postnatal week is very closely related to the prematurity and the condition of the infant shortly after birth. Regular prenatal care including careful monitoring and appropriate neonatal resuscitation are very crucial to decrease the risk of hypotension in the early stages of life.
生命早期的低血压出现在 20%极低出生体重（VLBW）婴儿中。胎龄和出生体重是与出生后低血压高度相关的危险因素。其他危险因素在不同的研究中略有不同。因此，我们在排除胎龄和小于胎龄儿（SGA）的影响后，评估了与生命早期低血压治疗相关的危险因素和预后。选择在 2013 年至 2015 年间在韩国新生儿网络登记并在出生后一周内接受低血压治疗的 VLBW 婴儿作为研究对象。其余的被用作对照组。在匹配胎龄和 SGA 后，调查和比较了危险因素和严重并发症（包括死亡率）的发生率。出生后第一周低血压的治疗率与胎龄和出生体重的降低呈负相关。特别是，在胎龄≤24 周出生的早产儿中，63.4%和出生体重<500g 的早产儿中，66.9%在出生后一周内接受了低血压治疗。匹配后的回归分析显示，1 分钟 Apgar 评分、新生儿心脏按摩或肾上腺素给药、症状性动脉导管未闭、早发性败血症和绒毛膜羊膜炎与低血压显著相关。在低血压组中，在匹配胎龄和 SGA 后，死亡率、3 级或以上脑室内出血、脑室周围白质软化和中重度支气管肺发育不良的发生率显著升高。生命早期第一周的低血压与早产和婴儿出生后不久的状况密切相关。包括仔细监测和适当新生儿复苏在内的定期产前保健对降低生命早期低血压的风险非常重要。
