New Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
University of Eastern Finland, School of Medicine, Kuopio, Finland.
PLoS One. 2021 Nov 30;16(11):e0260377. doi: 10.1371/journal.pone.0260377. eCollection 2021.
Very low birthweight (VLBW) infants are at risk of intraventricular haemorrhage (IVH) and delayed closure of ductus arteriosus. We investigated mean arterially recorded blood pressure (MAP) changes during the first day of life in VLBW infants as potential risk factors for a patent ductus arteriosus (PDA) and IVH. This retrospective cohort study exploring MAP changes during adaption and risk factors for a PDA and IVH comprised 844 VLBW infants admitted to the Helsinki University Children's Hospital during 2005-2013. For each infant, we investigated 600 time-points of MAP recorded 4-24 hours after birth. Based on blood pressure patterns revealed by a data-driven method, we divided the infants into two groups. Group 1 (n = 327, mean birthweight = 1019 g, mean gestational age = 28 + 1/7 weeks) consisted of infants whose mean MAP was lower at 18-24 hours than at 4-10 hours after birth. Group 2 (n = 517, mean birthweight = 1070 g, mean gestational age = 28 + 5/7 weeks) included infants with a higher mean MAP at 18-24 hours than at 4-10 hours after birth. We used the group assignments, MAP, gestational age at birth, relative size for gestational age, surfactant administration, inotrope usage, invasive ventilation, presence of respiratory distress syndrome or sepsis, fluid intake, and administration of antenatal steroids to predict the occurrence of IVH and use of pharmacological or surgical therapy for a PDA before 42 weeks of gestational age. Infants whose mean MAP is lower at 18-24 hours than at 4-10 hours after birth are more likely to undergo surgical ligation of a PDA (odds ratio = 2.1; CI 1.14-3.89; p = 0.018) and to suffer from IVH (odds ratio = 1.83; CI 1.23-2.72; p = 0.003).
极低出生体重儿（VLBW）有发生脑室出血（IVH）和动脉导管未闭（PDA）延迟关闭的风险。我们研究了 VLBW 婴儿生命最初一天的平均动脉压（MAP）变化，以探索其作为 PDA 和 IVH 潜在风险因素的可能性。本研究回顾性地纳入了 2005 年至 2013 年期间入住赫尔辛基大学儿童医院的 844 例 VLBW 婴儿，探索 MAP 变化与 PDA 和 IVH 风险因素之间的关系。我们为每个婴儿研究了出生后 4-24 小时记录的 600 个 MAP 时间点。基于数据驱动方法揭示的血压模式，我们将婴儿分为两组。第 1 组（n = 327，平均出生体重为 1019 g，平均胎龄为 28+1/7 周）由出生后 18-24 小时 MAP 低于出生后 4-10 小时的婴儿组成。第 2 组（n = 517，平均出生体重为 1070 g，平均胎龄为 28+5/7 周）包括出生后 18-24 小时 MAP 高于出生后 4-10 小时的婴儿。我们使用分组、MAP、出生时胎龄、相对胎龄大小、表面活性剂使用、儿茶酚胺使用、有创通气、呼吸窘迫综合征或败血症的存在、液体摄入以及产前类固醇使用情况，来预测 42 周前 IVH 和使用药物或手术治疗 PDA 的发生。与出生后 4-10 小时相比，出生后 18-24 小时 MAP 较低的婴儿更有可能接受 PDA 手术结扎（比值比=2.1；95%置信区间 1.14-3.89；p=0.018），并且更易发生 IVH（比值比=1.83；95%置信区间 1.23-2.72；p=0.003）。
