Raschetti Roberto, Torchin Héloïse, Marchand-Martin Laetitia, Gascoin Géraldine, Cambonie Gilles, Brissaud Olivier, Rozé Jean-Christophe, Storme Laurent, Ancel Pierre-Yves, Mekontso-Dessap Armand, Durrmeyer Xavier
Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.
Université Paris Cité, CRESS, INSERM, INRA, Paris, France.
Front Cardiovasc Med. 2022 Jul 14;9:852666. doi: 10.3389/fcvm.2022.852666. eCollection 2022.
Hypotension is a common condition during the first postnatal days of very preterm infants and has been associated with an increased risk of adverse outcomes but its management remains controversial. There is a consensus to promote the use of neonatologist-performed echocardiography (NPE) in hypotensive very preterm infants, although no clinical trial ever assessed this practice.
We conducted a retrospective analysis of prospectively collected data from the French national EPIPAGE-2 cohort to evaluate the association of NPE with survival, severe morbidity, and therapeutic management in very preterm infants with early hypotension. Reasons for administering antihypotensive treatments were also analyzed. We included infants born before 30 weeks of gestation with hypotension within 72 h of birth. Infants managed with (NPE group) or without (no-NPE group) NPE use were compared after matching on gestational age and a propensity score, reflecting each patient's probability of having an NPE based on his/her baseline covariates. This matching procedure intended to control for the indication bias of NPE.
Among 966 eligible infants, 809 were included (NPE group, = 320; no-NPE group, = 489), and 229 from each group could be matched. The NPE group did not differ significantly from the no-NPE group for survival (OR 1.01, 95% CI 0.64 to 1.60; = 0.95) or survival without severe morbidity at discharge (OR 0.92, 95% CI 0.63 to 1.34; = 0.66), but received more antihypotensive treatments [144/229 (62.9%) vs. 99/229 (43.0%), < 0.001]. Isolated hypotension was the main reason for treatment in both groups. Among treated infants, volume expansion was administered at equal rates to the NPE and no-NPE groups [118/144 (82.1%) vs. 79/99 (80.1%), = 0.67], but the NPE group received inotropic drugs more often [77/144 (53.7%) vs. 37/99 (37.8%), = 0.023].
NPE use in hypotensive preterm infants was not associated with in-hospital outcomes and had little influence on the nature of and reasons for antihypotensive treatments. These results suggest the need to optimize NPE use.
低血压是极早产儿出生后最初几天的常见情况，与不良结局风险增加相关，但其管理仍存在争议。尽管尚无临床试验评估过这种做法，但对于在低血压的极早产儿中推广使用由新生儿科医生进行的超声心动图检查（NPE）已达成共识。
我们对法国全国性EPIPAGE-2队列前瞻性收集的数据进行了回顾性分析，以评估NPE与早期低血压的极早产儿的生存、严重疾病及治疗管理之间的关联。还分析了给予抗低血压治疗的原因。我们纳入了妊娠30周前出生且出生后72小时内出现低血压的婴儿。在根据胎龄和倾向评分进行匹配后，比较使用NPE（NPE组）和未使用NPE（非NPE组）的婴儿。倾向评分反映了每个患者基于其基线协变量接受NPE的概率。这种匹配程序旨在控制NPE的指征偏倚。
在966名符合条件的婴儿中，809名被纳入（NPE组，n = 320；非NPE组，n = 489），每组229名可进行匹配。NPE组与非NPE组在生存（比值比1.01，95%置信区间0.64至1.60；P = 0.95）或出院时无严重疾病的生存情况（比值比0.92，95%置信区间0.63至1.34；P = 0.66）方面无显著差异，但接受抗低血压治疗的更多[144/229（62.9%）对99/229（43.0%），P < 0.001]。单纯低血压是两组治疗的主要原因。在接受治疗的婴儿中，扩容在NPE组和非NPE组中的给药率相同[118/144（82.1%）对79/99（80.1%），P = 0.67]，但NPE组更常接受强心药物治疗[77/144（53.7%）对37/99（37.8%），P = 0.023]。
在低血压早产儿中使用NPE与住院结局无关，对抗低血压治疗的性质和原因影响不大。这些结果表明需要优化NPE的使用。
