Antenatal Glucocorticoids Reduce the Incidence of Refractory Hypotension in Low Birthweight Infants during the Early Neonatal Period, but Do Not Affect It beyond This Time

Tomotaki, Seiichi; Iwanaga, Kougoro; Hanaoka, Shintaro; Tomotaki, Hiroko; Matsukura, Tadashi; Niwa, Fusako; Kawai, Masahiko

doi:10.1055/s-0040-1701608

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…Previous studies have shown that use of antenatal steroids is associated with higher systemic blood pressure and decreased vasopressor use in preterm infants. [18][19][20][21][22] However, we did not notice a significant relationship between lack of antenatal steroids use and likelihood of receiving vasopressors. This may be because the overall use of antenatal steroids was very high at baseline in our study population.…”

Section: Discussioncontrasting

confidence: 65%

Use of Vasopressors in Extremely Preterm Infants in First Week of Life

et al. 2021

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Objective A significant variability exists for diagnosis and treatment of hypotension in extremely preterm infants. Benefits of the use of vasopressors remain unclear. We wanted to identify the risk factors associated with use of vasopressors in the first week of life and their impact on outcomes of extremely preterm infants. Study Design Retrospective review of all newborns ≤28 weeks of gestational age (GA) admitted in neonatal intensive care unit from October 1, 2012 to October 31, 2015 done. Data regarding antenatal and neonatal characteristics and outcomes were recorded. Study infants were divided into two cohorts and compared based on vasopressor use. Chi-square, t-test, and multiple logistic regression were performed as appropriate and significance set at p <0.05. Results Of 213 extremely preterm infants, 90 (42.3%) received vasopressors in first week of life. The mean arterial pressure (MAP) at admission in these infants was significantly lower than that of infants who did not require vasopressors (27 ± 8 vs. 30 ± 6 mmHg, p < 0.05). Vasopressors were initiated within 24 hours in 91% of babies. After controlling for other variables, use of vasopressors was significantly higher in infants with lower birthweight (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6–8.3), 5-minute Apgar's score ≤5 (OR: 1.8, 95% CI: 1.2–3.12), and admission hypothermia (OR: 2.7, 95% CI: 1.3–4.9). The use of vasopressors was significantly associated with severe intraventricular hemorrhage (IVH), even after controlling for other significant variables (OR: 5.9, 95% CI: 1.6–9.3). Conclusion Lower birthweight, low 5-minute Apgar's score, and admission hypothermia are characteristics associated with early use of vasopressors in extremely preterm infants. Infants treated with vasopressors are at a higher risk of developing severe IVH. Key Points

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Section: Discussioncontrasting

confidence: 65%

Use of Vasopressors in Extremely Preterm Infants in First Week of Life

et al. 2021

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“…Such a definition would prevent the overuse of inotropic drugs and unintentional aggregation of the severity of IVH [ 22 , 114 ]. Several studies indicate that hydrocortisone therapy is increasingly being used for refractory hypotensive preterm infants because such infants are proposed to have an inadequate hypothalamic-pituitary-adrenal axis response to stress during the first week of life [ 99 , 110 ].…”

Section: Postnatal Strategymentioning

confidence: 99%

Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants

Tsao¹

2023

J Korean Neurosurg Soc

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Intraventricular haemorrhage (IVH) is a serious concern for preterm infants and can predispose such infants to brain injury and poor neurodevelopmental outcomes. IVH is particularly common in preterm infants. Although advances in obstetric management and neonatal care have led to a lower mortality rate for preterm infants with IVH, the IVH-related morbidity rate in this population remains high. Therefore, the present review investigated the pathophysiology of IVH and the evidence related to interventions for prevention. The analysis of the pathophysiology of IVH was conducted with a focus on the factors associated with cerebral hemodynamics, vulnerabilities in the structure of cerebral vessels, and host or genetic predisposing factors. The findings presented in the literature indicate that fluctuations in cerebral blood flow, the presence of hemodynamic significant patent ductus arteriosus, arterial carbon dioxide tension, and impaired cerebral venous drainage; a vulnerable or fragile capillary network; and a genetic variant associated with a mechanism underlying IVH development may lead to preterm infants developing IVH. Therefore, strategies focused on antenatal management, such as routine corticosteroid administration and magnesium sulfate use; perinatal management, such as maternal transfer to a specialized center; and postnatal management, including pharmacological agent administration and circulatory management involving prevention of extreme blood pressure, hemodynamic significant patent ductus arteriosus management, and optimization of cardiac function, can lower the likelihood of IVH development in preterm 4 infants. Incorporating neuroprotective care bundles into routine care for such infants may also reduce the likelihood of IVH development. The findings regarding the pathogenesis of IVH further indicate that cerebrovascular status and systemic hemodynamic changes must be analyzed and monitored in preterm infants and that individualized management strategies must be developed with consideration of the risk factors for and physiological status of each preterm infant.

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