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Journal of Perinatology (2007) 27, 469478 r 2007 Nature Publishing Group All rights reserved. 0743-8346/07 $30 www.nature.com/jp
STATE-OF-THE-ART
Treating hypotension in the preterm infant: when and with what: a critical and systematic review
EM Dempsey1,2 and KJ Barrington1,2
1Departments of Pediatrics and OB/GYN, McGill University, Montreal, QC, Canada and 2NICU, Royal Victoria Hospital, Montreal, QC, Canada
A very large proportion of extremely preterm infants receive treatments for hypotension. There are, however, marked variations in indications for treatment, and in the interventions used, between neonatal intensive care units and between neonatologists.
Methods: We performed systematic reviews of the literature in order to determine which preterm infants may benet from treatment with interventions to elevate blood pressure (BP), and which interventions improve clinically important outcomes.
Results: Our review was not able to dene a threshold BP that was signicantly predictive of a poor outcome, nor whether any interventions for hypotensive infants improved outcomes, nor which interventions were more likely to be benecial.
Conclusions: There is a distinct lack of prospective research of this issue, which prevents good clinical care. It is possible that a simple BP threshold that indicates the need for therapy does not exist, and other factors, such as the clinical status or systemic blood ow measurements, may be much more informative. Such a paradigm shift will also require careful prospective study.
Journal of Perinatology (2007) 27, 469478; doi:10.1038/sj.jp.7211774
Keywords: hypotension; preterm infant; systematic review; inotropes; uid boluses
Introduction The diagnosis of hypotension and its subsequent management are controversial areas in the care of the very low birth weight (VLBW, <1500 g) newborn infant.1 The frequency of hypotension varies between neonatal intensive care units (NICUs) even when the same diagnostic criteria are applied.2 The frequency of intervention also varies dramatically,3,4 from 29 to 98% among infants less than 28 weeks gestation.5
Several studies have attempted to determine normal ranges of blood pressure (BP) in the newborn infant.613 However, the ranges presented vary considerably for a number of reasons including: retrospective data collection, small numbers of patients included, combined invasive and noninvasive measurements, inclusion of small for dates and appropriate for gestational age infants, collection of only a few data points and averaging data points over wide time ranges. In some instances, a single absolute mean...