Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 966-977 (doi:10.1542/peds.2007-0075)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Limperopoulos, C. Articles by du Plessis, A. J. Search for Related Content PubMed PubMed Citation Articles by Limperopoulos, C. Articles by du Plessis, A. J. Related Collections Premature & Newborn Social Bookmarking                         What's this?

ARTICLE

Current Definitions of Hypotension Do Not Predict Abnormal Cranial Ultrasound Findings in Preterm Infants

Catherine Limperopoulos, PhD^a,b, Haim Bassan, MD^a, Leslie A. Kalish, ScD^c, Steven A. Ringer, MD^d, Eric C. Eichenwald, MD^d, Gene Walter, REEGT^a, Marianne Moore, BA, RN^a, Matthew Vanasse, RRT^a, Donald N. DiSalvo, MD^e, Janet S. Soul, MD, CM^a, Joseph J. Volpe, MD^a, Adré J. du Plessis, MBChB, MPH^a

^a Fetal-Neonatal Neurology Research Group, Department of Neurology
^c Clinical Research Program and Department of Pediatrics, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
^b Department of Neurology and Neurosurgery and School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Departments of
^d Newborn Medicine
^e Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

OBJECTIVE. Hypotension is a commonly treated complication of prematurity, although definitions and management guidelines vary widely. Our goal was to examine the relationship between current definitions of hypotension and early abnormal cranial ultrasound findings.

METHODS. We prospectively measured mean arterial pressure in 84 infants who were 30 weeks’ gestational age and had umbilical arterial catheters in the first 3 days of life. Sequential 5-minute epochs of continuous mean arterial pressure recordings were assigned a mean value and a coefficient of variation. We applied to our data 3 definitions of hypotension in current clinical use and derived a hypotensive index for each definition. We examined the association between these definitions of hypotension and abnormal cranial ultrasound findings between days 5 and 10. In addition, we evaluated the effect of illness severity (Score for Neonatal Acute Physiology II) on cranial ultrasound findings.

RESULTS. Acquired lesions as shown on cranial ultrasound, present in 34 (40%) infants, were not predicted by any of the standard definitions of hypotension or by mean arterial pressure variability. With hypotension defined as mean arterial pressure < 10th percentile (<33 mmHg) for our overall cohort, mean value for mean arterial pressure and hypotensive index predicted abnormal ultrasound findings but only in infants who were 27 weeks’ gestational age and those with lower illness severity scores.

CONCLUSIONS. Hypotension as diagnosed by currently applied thresholds for preterm infants is not associated with brain injury on early cranial ultrasounds. Blood pressure management directed at these population-based thresholds alone may not prevent brain injury in this vulnerable population.

---

Key Words: blood pressure • hypotension • cranial ultrasound • prematurity • GM-IVH

Abbreviations: BP—blood pressure • GA—gestational age • GM-IVH—germinal matrix–intraventricular hemorrhage • MAP—mean arterial blood pressure • CV—coefficient of variation • HOI—hypotensive index • CVI—coefficient of variation index • AUROC—area under the receiver operating characteristic curve • SNAP-II—Score for Neonatal Acute Physiology II

---

Accepted May 7, 2007.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. J. du Plessis The Role of Systemic Hemodynamic Disturbances in Prematurity-Related Brain Injury J Child Neurol, September 1, 2009; 24(9): 1127 - 1140. [Abstract] [PDF]

				S. Malaeb and O. Dammann Fetal Inflammatory Response and Brain Injury in the Preterm Newborn J Child Neurol, September 1, 2009; 24(9): 1119 - 1126. [Abstract] [PDF]

				H. O'Leary, M. C. Gregas, C. Limperopoulos, I. Zaretskaya, H. Bassan, J. S. Soul, D. N. Di Salvo, and A. J. du Plessis Elevated Cerebral Pressure Passivity Is Associated With Prematurity-Related Intracranial Hemorrhage Pediatrics, July 1, 2009; 124(1): 302 - 309. [Abstract] [Full Text] [PDF]

				A. Pellicer, M. del Carmen Bravo, R. Madero, S. Salas, J. Quero, and F. Cabanas Early Systemic Hypotension and Vasopressor Support in Low Birth Weight Infants: Impact on Neurodevelopment Pediatrics, May 1, 2009; 123(5): 1369 - 1376. [Abstract] [Full Text] [PDF]

				E. C. Eichenwald and A. R. Stark Management and Outcomes of Very Low Birth Weight N. Engl. J. Med., April 17, 2008; 358(16): 1700 - 1711. [Full Text] [PDF]

				C. Limperopoulos, H. Bassan, N. R. Sullivan, J. S. Soul, R. L. Robertson Jr, M. Moore, S. A. Ringer, J. J. Volpe, and A. J. du Plessis Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk Factors Pediatrics, April 1, 2008; 121(4): 758 - 765. [Abstract] [Full Text] [PDF]

				R. W. Hall and J. R. Kaiser Hypotension and Brain Injury in Premature Infants Pediatrics, March 1, 2008; 121(3): 654 - 654. [Full Text] [PDF]

				A. J. du Plessis Hypotension and Brain Injury in Premature Infants: In Reply Pediatrics, March 1, 2008; 121(3): 654 - 655. [Full Text] [PDF]