Early postnatal hypotension and developmental delay at 24 months of age among extremely low gestational age newborns
J Wells Logan, T Michael O'Shea, Elizabeth N Allred, Matthew M Laughon, Carl L Bose, Olaf Dammann, Daniel G Batton, Stephen C Engelke, Alan Leviton, ELGAN Study Investigators, Bhavesh Shah, Solveg Pflueger, Herbert Gilmore, Susan McQuiston, R Martin, Linda J Van Marter, Alan Leviton, Samantha Butler, Haim Bassan, Adré Duplessis, Cecil Hahn, Omar Khwaha, A K Morgan, Janet S Soul, Mariel Portenga, Barbara Doss, Wendy Burdo-Hartman, Lynn Fagerman, Kim Lohr, Steve Pastynrnak, Dinah Sutton, Cynthia Cole, John Fiascone, Ina Bhan, Paige T Church, Cecelia Keller, Karen Miller, Robert Insoft, Drucilla Roberts, Kalpathy Krishnamoorthy, Nigel Paneth, Carl Bose, Chad Livasy, Lisa Bostic, Janice Wereszczak, Diane Marshall, Kristi Milowic, Carol Hubbard, Padmani Karna, Gabriel Chamyan, Victoria J Caine, Padmani Karna, Nicholas Olomu, Joan Price, Michael D Schreiber, Aliya Husain, Leslie Caldarelli, Sunila E O'Conno, Michael Msall, Susan Plesha-Troyke, Stephen Engelke, Sharon Buckwald, Rebecca Helms, Kathyrn Kerkering, Scott S MacGilvray, Peter Resnik, Francis Bednarek, Karen Strehloh, Robin Adair, Richard Bream, Alice Miller, Albert Scheiner, Christy Stine, T Michael O'Shea, Deborah Allred, Don Goldstein, Gail Hounshell, Robert Dillard, Cherrie Heller, Debbie Hiatt, Lisa Washburn, Royal Oak, Daniel Batton, Chung-ho Chang, Karen Brooklier, Melisa Oca, Richard Ehrenkranz, Vinita Parkas, Nancy Close, Elaine Romano, Joanne Williams, J Wells Logan, T Michael O'Shea, Elizabeth N Allred, Matthew M Laughon, Carl L Bose, Olaf Dammann, Daniel G Batton, Stephen C Engelke, Alan Leviton, ELGAN Study Investigators, Bhavesh Shah, Solveg Pflueger, Herbert Gilmore, Susan McQuiston, R Martin, Linda J Van Marter, Alan Leviton, Samantha Butler, Haim Bassan, Adré Duplessis, Cecil Hahn, Omar Khwaha, A K Morgan, Janet S Soul, Mariel Portenga, Barbara Doss, Wendy Burdo-Hartman, Lynn Fagerman, Kim Lohr, Steve Pastynrnak, Dinah Sutton, Cynthia Cole, John Fiascone, Ina Bhan, Paige T Church, Cecelia Keller, Karen Miller, Robert Insoft, Drucilla Roberts, Kalpathy Krishnamoorthy, Nigel Paneth, Carl Bose, Chad Livasy, Lisa Bostic, Janice Wereszczak, Diane Marshall, Kristi Milowic, Carol Hubbard, Padmani Karna, Gabriel Chamyan, Victoria J Caine, Padmani Karna, Nicholas Olomu, Joan Price, Michael D Schreiber, Aliya Husain, Leslie Caldarelli, Sunila E O'Conno, Michael Msall, Susan Plesha-Troyke, Stephen Engelke, Sharon Buckwald, Rebecca Helms, Kathyrn Kerkering, Scott S MacGilvray, Peter Resnik, Francis Bednarek, Karen Strehloh, Robin Adair, Richard Bream, Alice Miller, Albert Scheiner, Christy Stine, T Michael O'Shea, Deborah Allred, Don Goldstein, Gail Hounshell, Robert Dillard, Cherrie Heller, Debbie Hiatt, Lisa Washburn, Royal Oak, Daniel Batton, Chung-ho Chang, Karen Brooklier, Melisa Oca, Richard Ehrenkranz, Vinita Parkas, Nancy Close, Elaine Romano, Joanne Williams
Abstract
Objectives: To evaluate in extremely low gestational age newborns, relationships between indicators of hypotension during the first 24 postnatal hours and developmental delay at 24 months of age.
Methods: The 945 infants in this prospective study were born at <28 weeks, were assessed for three indicators of hypotension in the first 24 postnatal hours, and were evaluated with the Bayley Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 24 months corrected age. Indicators of hypotension included: (1) mean arterial pressure in the lowest quartile for gestational age; (2) treatment with a vasopressor; and (3) blood pressure lability, defined as the upper quartile for the difference between the lowest and highest mean arterial pressure. Logistic regression was used to evaluate relationships between hypotension and developmental outcomes, adjusting for potential confounders.
Results: 78% of infants in this cohort received volume expansion or vasopressor; all who received a vasopressor were treated with volume expansion. 26% had an MDI <70 and 32% had a PDI <70. Low MDI and PDI were associated with low gestational age, which in turn, was associated with receipt of vasopressor treatment. Blood pressure in the lowest quartile for gestational age was associated with vasopressor treatment and labile blood pressure. After adjusting for potential confounders, none of the indicators of hypotension were associated with MDI <70 or PDI <70.
Conclusions: In this large cohort of extremely low gestational age newborns, we found little evidence that early postnatal hypotension indicators are associated with developmental delay at 24 months corrected gestational age.
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Source: PubMed