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    Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week

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    Authors
    Laughon, Matthew
    Bose, Carl
    Allred, Elizabeth N.
    O'Shea, T. Michael
    Van Marter, Linda J.
    Bednarek, Francis J.
    Leviton, Alan
    UMass Chan Affiliations
    Department of Pediatrics
    Document Type
    Journal Article
    Publication Date
    2007-02-01
    Keywords
    Blood Pressure Determination; Female; Gestational Age; Humans; Hypotension; Infant, Newborn; Infant, Premature, Diseases; Male
    Pediatrics
    
    Metadata
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    Link to Full Text
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803046/pdf/nihms156445.pdf
    Abstract
    OBJECTIVE: The goals were to identify the blood pressures of extremely low gestational age newborns that prompt intervention, to identify other infant characteristics associated with receipt of therapies intended to increase blood pressure, and to assess the interinstitutional variability in the use of these therapies. METHODS: The cohort included 1507 extremely low gestational age newborns born at 23 weeks to 27 weeks of gestation, at 14 institutions, between March 2002 and August 2004; 1387 survived the first postnatal week. Blood pressures were measured as clinically indicated. Interventions were grouped as any treatment (ie, vasopressor and/or fluid boluses of >10 mL/kg) and vasopressor treatment, and logistic regression analyses were performed. RESULTS: At each gestational age, the lowest mean arterial pressures in treated and untreated infants tended to increase with advancing postnatal age. Infants who received any therapy tended to have lower mean arterial pressures than infants who did not, but uniform thresholds for treatment were not apparent. The proportion of infants receiving any treatment decreased with increasing gestational age from 93% at 23 weeks to 73% at 27 weeks. Treatment nearly always began during the first 24 hours of life. Lower gestational age, lower birth weight, male gender, and higher Score for Neonatal Acute Physiology-II values were associated with any treatment and vasopressor treatment. Institutions varied greatly in their tendency to offer any treatment and vasopressor treatment. Neither the lowest mean arterial pressure on the day of treatment nor other characteristics of the infants accounted for center differences in treatment. CONCLUSIONS: Blood pressure in extremely premature infants not treated for hypotension increased directly with both increasing gestational age and postnatal age. The decision to provide treatment was associated more strongly with the center where care was provided than with infant attributes.
    Source
    Pediatrics. 2007 Feb;119(2):273-80. Link to article on publisher's site
    DOI
    10.1542/peds.2006-1138
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/43515
    PubMed ID
    17272616
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1542/peds.2006-1138
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