International survey on diagnosis and management of hypotension in extremely preterm babies
Open Access
- 4 January 2014
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Journal of Pediatrics
- Vol. 173 (6), 793-798
- https://doi.org/10.1007/s00431-013-2251-9
Abstract
Hypotension is a commonly diagnosed and treated complication of extremely low gestational age newborns (ELGAN), but enormous variation in diagnosis, management and clinical practice has been documented. We sought to evaluate practice regarding the management of hypotension in ELGANs and developed a web-based questionnaire addressing diagnosis, intervention thresholds and modes of treatment of hypotension in ELGANs. We received 216 completed questionnaires from respondents in 38 countries. Most responses (83 %) were from specialist units where, together, over 26,000 very low birth weight (VLBW) infants are cared for annually. The majority (73 %) defined hypotension as a mean blood pressure (BP) in mmHg less than the gestational age in weeks. Sixty percent assessed the circulation with additional methods; echocardiography was the most commonly used (74 %), with left ventricular output and fractional shortening the two most common measurements made. The majority (85 %) used volume administration as the initial intervention. Dopamine was the inotrope most commonly used initially (80 %). If the initial inotrope therapy failed, dobutamine was the most popular second-line treatment (28 %). Delayed cord clamping was used at 51 % of the centres. Conclusion: The definition of hypotension in ELGANs continues to follow traditional standards. Functional echocardiography is now used to assess the circulation at many centres. Volume expansion and dopamine remain the most frequently used therapies.Keywords
This publication has 17 references indexed in Scilit:
- Corticosteroids for treating hypotension in preterm infantsEmergencias, 2011
- Mortality after Fluid Bolus in African Children with Severe InfectionNew England Journal of Medicine, 2011
- Early postnatal hypotension and developmental delay at 24 months of age among extremely low gestational age newbornsArchives of Disease in Childhood: Fetal & Neonatal, 2010
- Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infantsArchives of Disease in Childhood: Fetal & Neonatal, 2010
- Clinical monitoring of systemic hemodynamics in critically ill newbornsEarly Human Development, 2010
- Permissive hypotension in the extremely low birthweight infant with signs of good perfusionArchives of Disease in Childhood: Fetal & Neonatal, 2009
- Bedside detection of low systemic flow in the very low birth weight infant on day 1 of lifeEuropean Journal of Pediatrics, 2008
- Diagnosis and treatment of preterm transitional circulatory compromiseEarly Human Development, 2005
- Superior vena cava flow in newborn infants: a novel marker of systemic blood flowArchives of Disease in Childhood: Fetal & Neonatal, 2000
- Development of audit measures and guidelines for good practice in the management of neonatal respiratory distress syndrome. Report of a Joint Working Group of the British Association of Perinatal Medicine and the Research Unit of the Royal College of Physicians.Archives of Disease in Childhood, 1992