Mean arterial pressures during the first 24 hours of life in ≤600-gram birth weight infants

被引：25

作者：

Cordero L. ^{[1
]}

Timan C.J. ^{[1
]}

Waters H.H. ^{[1
]}

Sachs L.A. ^{[1
]}

机构：

[1] Pediatrics Department, Ohio State University Medical Center, Columbus, OH

来源：

Journal of Perinatology | 2002年 / 22卷 / 5期

关键词：

D O I：

10.1038/sj.jp.7210736

中图分类号：

学科分类号：

摘要：

Objective: To determine mean arterial pressure values during the first 24 hours for "stable" and "unstable" extremely low birth weight (ELBW) infants and to ascertain its association with perinatal factors. Background: In ELBW infants, hypotension is diagnosed by nonspecific clinical signs together with reference arterial pressure values extrapolated from regression models or from scarce actual observations. Design: Retrospective cohort study. Methods: 101 ELBW (≤600 g) infants born in our medical center (1989-2000). Considered stable were 36 infants with umbilical cord hemoglobin ≥14 g/dl who, although mechanically ventilated, had normal acid-base balance, no patent ductus arteriosus, had not received indomethacin, steroids, muscle relaxants, narcotics, were never treated for hypotension and survived at least 7 days. The remaining 65 infants constituted the unstable group. Arterial pressures were determined by oscillometry (OBP) and direct transducer readings through an umbilical line (MAP). All admission and 10% of the readings were by OBP; the remaining 1877 measurements were by MAP. Results: Stable and unstable infants were similar in birth weight, demographics, history of chorioamnionitis, antepartum steroids, low Apgar scores, administration of epinephrine during resuscitation, and sepsis. Stable infants were different from unstable in gestational age (27 ± 2 vs 25 ± 2 weeks' gestational age [w GA]), history of preterm labor, preeclampsia, and neonatal mortality (22 vs 68%). Admission OBP (30 ± 7 vs 29 ± 10 Torr) were similar and 1-hour MAP were different (30 ± 6 vs 27 ± 7 Torr) between both groups. MAP for stable infants was higher throughout the 24 hours. Greater differences were noted between 3 and 6 hours when 34 of 65 unstable infants were treated for hypotension. Mean MAP and 10 percentile values for stable infants at 1, 3, 6, 12, and 24 hours were 30 (22), 31 (24), 32 (25), 34 (24), and 35 (28) Torr, respectively. MAPs did not correlate with birth weight, but they were lower among 19 stable infants ≤26 w GA than among 17 stable infants ≥27 w GA. History of preeclampsia, antenatal steroids, intratracheal epinephrine and cord hemoglobin did not influence MAP. Low 1-minute Apgar score and intracranial hemorrhage were associated with low MAP during the first day. Conclusion: There is a wide variation of GA among ELBW infants. MAPs increase with GA and with postnatal age. Shortly after birth, arterial pressures are similar for stable and unstable infants. Failure to increase MAP between 3 and 6 hours of life should create concern. MAP ≤28 Torr at 3 hours of life is a reasonable, but not absolute, predictor of the need for hypotension treatment.

引用

页码：348 / 353

页数：5

共 24 条

[1]

Tyson J.E., Younes J., Verter J., Wright L.L., Viability, morbidity, and resource use among newborns of 501-800-g birth weight, JAMA, 276, pp. 1645-1651, (1996)

[2]

Lorenz J.M., Survival of the extremely preterm infant in North American in the 1990s, Clin. Perinatol, 27, pp. 255-262, (2000)

[3]

Miall-Allen V.M., De Vries L.S., Dubowitz L.M.S., Whitelaw A.G.L., Blood pressure fluctuation and intraventricular hemorrhage in the preterm infant of less than 31 weeks' gestation, Pediatrics, 83, pp. 657-661, (1989)

[4]

Watkins A.M.C., West C.R., Cooke R.W.I., Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants, Early Hum. Dev, 19, pp. 103-110, (1989)

[5]

Bada H.S., Korones S.B., Perry E.H., Et al., Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage, J. Pediatr, 117, pp. 607-614, (1990)

[6]

Cunningham S., Symon A.G., Elton R.A., Zhu C., McIntosh N., Intra-arterial blood pressure reference ranges, death and morbidity in very low birthweight infants during the first seven days of life, Early Hum. Dev, 56, pp. 151-165, (1999)

[7]

Seri I., Evans J., Controversies in the diagnosis and management of hypotension in the newborn infant, Curr. Opin. Pediatr, 13, pp. 116-123, (2001)

[8]

Al-Aweel I., Pursley D.M., Rubin L.P., Shah B., Weisberger S., Richardson D.K., Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs, J. Perinatol, 21, pp. 272-278, (2001)

[9]

Kitterman J.A., Phibbs R.H., Tooley W.H., Aortic blood pressure in normal newborn infants during the first 12 hours of life, Pediatrics, 44, pp. 959-968, (1969)

[10]

Versmold H.T., Kitterman J.A., Phibbs R.H., Gregory G.A., Tooley W.H., Aortic blood pressure during the first 12 hours of life in infants with birth weight 610 to 4, 220 grams, Pediatrics, 67, pp. 607-613, (1981)

← 1 2 3 →