Treatment for hypotension in the first 24 postnatal hours and the risk of hearing loss among extremely low birth weight infants

[Risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants]

OBJECTIVES

To investigate the risk factors and prognosis of hypotension within 72 hours after birth in extremely preterm infants.

METHODS

A retrospective analysis was conducted on clinical data of extremely preterm infants admitted to the Children's Hospital of Zhejiang University School of Medicine from January 2019 to April 2022. Based on the presence of hypotension within 72 hours after birth, the eligible infants were divided into a hypotension group (41 cases) and a normotension group (82 cases). The clinical characteristics, echocardiographic parameters within 72 hours after birth, and early complications were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors for hypotension within 72 hours after birth, and receiver operating characteristic curve analysis was performed to evaluate the predictive value of relevant indicators for the occurrence of hypotension within 72 hours after birth in the preterm infants.

RESULTS

The proportion of infants who required medication or surgical closure of patent ductus arteriosus (PDA), the proportions of infants with intraventricular hemorrhage ≥ grade III and severe pulmonary hemorrhage, and the mortality rate within 7 days in the hypotension group were significantly higher than those in the normotension group (P<0.05). Multivariate logistic regression analysis showed that lower birth weight, larger PDA diameter, and hemodynamically significant PDA were risk factors for the occurrence of hypotension within 72 hours after birth in extremely preterm infants (P<0.05). The receiver operating characteristic curve analysis showed that the combination of birth weight, PDA diameter, and hemodynamically significant PDA had an area under the curve of 0.873 (95%CI: 0.802-0.944, P<0.05) for predicting hypotension within 72 hours after birth, with a sensitivity of 73.2% and specificity of 91.5%.

CONCLUSIONS

Hypotension within 72 hours after birth is closely related to birth weight and PDA, and increases the risk of early severe complications and mortality in extremely preterm infants.

Hemodynamic Quality Improvement Bundle to Reduce the Use of Inotropes in Extreme Preterm Neonates

BACKGROUND

We evaluated the effect of the quality improvement (QI) bundle on the rate of inotrope use and associated morbidities.

METHODS

We included inborn preterm neonates born at < 29 weeks admitted to level III NICU. We implemented a QI bundle focusing on the first 72 h from birth which included delayed cord clamping, avoidance of routine echocardiography, the addition of clinical criteria to the definition of hypotension, factoring iatrogenic causes of hypotension, and standardization of respiratory management. The rate of inotropes use was compared before and after implementing the care bundle. Incidence of cystic periventricular leukomalacia (cPVL) was used as a balancing measure.

RESULTS

QI bundle implementation was associated with significant reduction in overall use of inotropes (24 vs 7%, p < 0.001), dopamine (18 vs 5%, p < 0.001), and dobutamine (17 vs 4%, p < 0.001). Rate of acute brain injury decreased significantly: acute brain injury of any grade (34 vs 20%, p < 0.001) and severe brain injury (15 vs 6%, p < 0.001). There was no difference in the incidence of cPVL (0.8 vs 1.4%, p = 0.66). Associations remained significant after adjusting for confounding factors.

CONCLUSIONS

A quality improvement bundled approach resulted in a reduction in inotropes use and associated brain morbidities in premature babies.

Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants

OBJECTIVE

To determine the relationship between maximum vasoactive-inotropic (VIS^max) and mortality in extremely premature (<29 weeks completed gestation), extremely low birth weight (ELBW, <1000 g) infants.

STUDY DESIGN

Single center, retrospective, and observational cohort study.

RESULTS

We identified 436 ELBW, <29 week, inborn infants cared for during the study period. Compared to infants with VIS^max of 0, the frequency of mortality based on VIS^max ranged from 3.3-fold to 46.1-fold. VIS^max > 30 was associated with universal mortality. Multivariable modeling that included gestational age, birth weight, and VIS^max revealed significant utility to predict mortality with negative predictive value of 87.0% and positive predictive value of 84.8% [adjusted AUROC: 0.90, (0.86-0.94)] among patients that received vasoactive-inotropic treatment.

CONCLUSION

VIS^max is an objective measure of hemodynamic/cardiovascular support that was directly associated with mortality in extremely premature ELBW infants. The VIS^max represents an important step towards neonatal precision medicine and risk stratification of extremely premature ELBW infants.