Definitions of Cardiovascular Insufficiency and Relation to Outcomes in Critically III Newborn Infants

• Type of Material: Article
• Authors: Erika Fernandez, University of New Mexico; Kristi L. Watterberg, University of New Mexico; Roger G. Faix, University of Utah; Bradley A. Yoder, Case Western Reserve University; Michele C. Walsh, Case Western Reserve University; Conra Backstrom Lacy, University of New Mexico; Karen A. Osborne, Case Western Reserve University; Abhik Das, RTI International; Douglas E. Kendrick, RTI International; Barbara Stoll, Emory University; Brenda B. Poindexter, Indiana University; Abbot R. Laptook, Brown University; Kathleen A. Kennedy, University of Texas; Kurt Schibler, University of Cincinnati; Edward F. Bell, University of Iowa; Krisa P. Van Meurs, Stanford University; Ivan D. Frantz, III, Tufts Medical Center; Ronald N. Goldberg, Duke University; Seetha Shankaran, Wayne State University; Waldemar A. Carlo, University of Alabama at Birmingham; Richard A. Ehrenkranz, Yale University; Pablo J. Sanchez, University of Texas Southwestern Medical Center; Rosemary D. Higgins, Eunice Kennedy Shriver National Institute of Child Health and Human Development
• Language: English
• Date: 2015-09-01
• Publisher: Thieme Publishing
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 by Thieme Medical Publishers, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1055/s-0035-1547321
• Title of Journal or Parent Work: American Journal of Perinatology
• ISSN: 0735-1631
• Volume: 32
• Issue: 11
• Start Page: 1024
• End Page: 1030
• Grant/Funding Information: The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support for the Neonatal Research Network's Term Hypotension Study.
• Keywords: blood pressure; NEURODEVELOPMENT; cardiovascular insufficiency; Life Sciences & Biomedicine; VENA-CAVA FLOW; ARTERIAL BLOOD-PRESSURE; Pediatrics; newborn; BIRTH-WEIGHT INFANTS; Science & Technology; INTRAVENTRICULAR HEMORRHAGE; infant; INTENSIVE-CARE; EXTREMELY PRETERM INFANTS; outcomes; HYPOTENSION; PREMATURE-INFANTS; MORBIDITY; Obstetrics & Gynecology
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Epidemiology; Health Sciences, General

Abstract

Background: We previously reported on the overall incidence, management, and outcomes in infants with cardiovascular insufficiency (CVI). However, there are limited data on the relationship of the specific different definitions of CVI to short-term outcomes in term and late preterm newborn infants. Objective: This study aims to evaluate how four definitions of CVI relate to short-term outcomes and death. Study Design: The previously reported study was a multicenter, prospective cohort study of 647 infants ≥ 34 weeks gestation admitted to a Neonatal Research Network (NRN) newborn intensive care unit (NICU) and mechanically ventilated (MV) during their first 72 hours. The relationship of five short-term outcomes at discharge and four different definitions of CVI were further analyzed. Results: All the four definitions were associated with greater number of days on MV and days on O<inf>2</inf>. The definition using a threshold blood pressure (BP) measurement alone was not associated with days of full feeding, days in the NICU or death. The definition based on the treatment of CVI was associated with all the outcomes including death. Conclusions: The definition using a threshold BP alone was not consistently associated with adverse short-term outcomes. Using only a threshold BP to determine therapy may not improve outcomes.