Cerebral oxygen saturation and autoregulation during hypotension in extremely preterm infants
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, multicentrická studie, randomizované kontrolované studie, práce podpořená grantem
PubMed
33879849
DOI
10.1038/s41390-021-01483-w
PII: 10.1038/s41390-021-01483-w
Knihovny.cz E-zdroje
- MeSH
- arteriální tlak * účinky léků MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- dopamin terapeutické užití MeSH
- gestační stáří MeSH
- homeostáza MeSH
- hypotenze krev farmakoterapie mortalita patofyziologie MeSH
- intraventrikulární krvácení do mozku mortalita patofyziologie MeSH
- kojenec MeSH
- kojenecká mortalita MeSH
- kyslík krev MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- mozková hypoxie krev mortalita patofyziologie MeSH
- mozkový krevní oběh * MeSH
- novorozenci extrémně nezralí * MeSH
- prospektivní studie MeSH
- saturace kyslíkem * MeSH
- sympatomimetika terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Evropa MeSH
- Názvy látek
- biologické markery MeSH
- dopamin MeSH
- kyslík MeSH
- sympatomimetika MeSH
BACKGROUND: The impact of the permissive hypotension approach in clinically well infants on regional cerebral oxygen saturation (rScO2) and autoregulatory capacity (CAR) remains unknown. METHODS: Prospective cohort study of blinded rScO2 measurements within a randomized controlled trial of management of hypotension (HIP trial) in extremely preterm infants. rScO2, mean arterial blood pressure, duration of cerebral hypoxia, and transfer function (TF) gain inversely proportional to CAR, were compared between hypotensive infants randomized to receive dopamine or placebo and between hypotensive and non-hypotensive infants, and related to early intraventricular hemorrhage or death. RESULTS: In 89 potentially eligible HIP trial patients with rScO2 measurements, the duration of cerebral hypoxia was significantly higher in 36 hypotensive compared to 53 non-hypotensive infants. In 29/36 hypotensive infants (mean GA 25 weeks, 69% males) receiving the study drug, no significant difference in rScO2 was observed after dopamine (n = 13) compared to placebo (n = 16). Duration of cerebral hypoxia was associated with early intraventricular hemorrhage or death. Calculated TF gain (n = 49/89) was significantly higher reflecting decreased CAR in 16 hypotensive compared to 33 non-hypotensive infants. CONCLUSIONS: Dopamine had no effect on rScO2 compared to placebo in hypotensive infants. Hypotension and cerebral hypoxia are associated with early intraventricular hemorrhage or death. IMPACT: Treatment of hypotension with dopamine in extremely preterm infants increases mean arterial blood pressure, but does not improve cerebral oxygenation. Hypotensive extremely preterm infants have increased duration of cerebral hypoxia and reduced cerebral autoregulatory capacity compared to non-hypotensive infants. Duration of cerebral hypoxia and hypotension are associated with early intraventricular hemorrhage or death in extremely preterm infants. Since systematic treatment of hypotension may not be associated with better outcomes, the diagnosis of cerebral hypoxia in hypotensive extremely preterm infants might guide treatment.
Coombe Woman and Infants University Hospital Dublin Ireland
Department of Electrical Engineering ESAT Stadius KU Leuven Leuven Belgium
Department of Neonatal Intensive Care University Hospital Antwerp Edegem Belgium
Department of Neonatology Tomas Bata University Zlín Czech Republic
Department of Neonatology University Hospital of Ostrava Ostrava Czech Republic
Department of Neonatology University Hospitals Leuven Leuven Belgium
Departments of Pediatrics Pharmacology and Surgery University of Alberta Edmonton AB Canada
INFANT Research Centre University College Cork Cork Ireland
National Maternity Hospital Dublin Ireland
UCL Institute for Women's Health University College London London UK
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