Early inotropes use is associated with higher risk of death and/or severe brain injury in extremely premature infants

Aziz, Ahmad; Thomas, Sumesh; Murthy, Prashanth; Rabi, Yacov; Soraisham, Amuchou; Stritzke, Amélie; Kamaluddeen, Majeeda; Al-Awad, Essa; Mohammad, Khorshid

doi:10.1080/14767058.2018.1560408

Cited by 30 publications

(18 citation statements)

References 51 publications

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“…We have found that the need of inotropic support within 72 h of birth increased the risk of any and severe IVH in infants born between 24 and 27 weeks' gestation. This is similar to what recently described by Abdulaziz et al [17]. In their study, they found an independent association between the early use of inotropes and death and/or severe brain injury in preterm infants born at < 29 weeks' gestation.…”

Section: Discussionsupporting

confidence: 92%

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Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy

et al. 2020

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Objectives To determine the incidence, trends, maternal and neonatal risk factors of severe intraventricular hemorrhage (IVH) among infants born 24-32 weeks and/or < 1500 g, and to evaluate the impact of changing of hospital policies and unit clinical practice on the IVH incidence. Study design Retrospective chart review of preterm infants with a gestational age (GA) of 24-32 6 weeks and/or weight of < 1500 g born at King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia, from 2016 to 2018. Multivariate logistic regression model was constructed to determine the probability of developing severe IVH and identify associations with maternal and neonatal risk factors. Results Among 640 infants, the overall incidence of severe IVH was 6.4% (41 infants), and its rate decreased significantly, from 9.4% in 2016 to 4.5% and 5% in 2017 and 2018 (p = 0.044). Multivariate analysis revealed that caesarian section delivery decreased the risk of severe IVH in GA group 24-27 weeks (p = 0.045). Furthermore use of inotropes (p = 0.0004) and surfactant (p = 0.0003) increased the risk of severe IVH. Despite increasing use of inotropes (p = 0.024), surfactant therapy (p = 0.034), and need for delivery room intubation (p = 0.015), there was a significant reduction in the incidence of severe IVH following the change in unit clinical practice and hospital policy (p = 0.007). Conclusion Cesarean section was associated with decreased all grades of IVH and severe IVH, while use of inotropes was associated with increased severe IVH. The changes in hospital and unit policy were correlated with decreased IVH during the study period.

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Section: Discussionsupporting

confidence: 92%

“…Different modalities have been used to decrease the rate of severe IVH, such as use of prophylactic indomethacin [13,14], limiting the attempts of intubation for extremely preterm infants [15,16] and minimizing the use of inotropes [17].…”

Section: Introductionmentioning

confidence: 99%

Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy

et al. 2020

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“…There were no statistically significant differences in other factors that have been implicated in the occurrence of IVH, including ventilatory management, abnormal pCO 2 (<35 mm•Hg and/or >55 mm•Hg) [36,37] early use of volume expanders and inotropes, [38] and occurrence of hypothermia [39]. Elevated pCO 2 levels > 60 mm Hg are associated with impaired cerebral auto-regulation and vasodilatation which increases exponentially with increasing pCO 2 levels [37].…”

Section: Discussionmentioning

confidence: 91%

Impact of a “Brain Protection Bundle” in Reducing Severe Intraventricular Hemorrhage in Preterm Infants <30 Weeks GA: A Retrospective Single Centre Study

et al. 2021

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Background: despite advances in perinatal care, periventricular/intraventricular hemorrhage (IVH) continues to remain high in neonatal intensive care units (NICUs) worldwide. Studies have demonstrated the benefits of implementing interventions during the antenatal period, stabilization after birth (golden hour management) and postnatally in the first 72 h to reduce the incidence of IVH. Objective: to compare the incidence of severe intraventricular hemorrhage (IVH ≥ Grade III) before and after implementation of a “brain protection bundle” in preterm infants <30 weeks GA. Study design: a pre- and post-implementation retrospective cohort study to compare the incidence of severe IVH following execution of a “brain protection bundle for the first 72 h from 2015 to 2018. Demographics, management practices at birth and in the NICU, cranial ultrasound results and short-term morbidities were compared. Results: a total of 189 and 215 infants were included in the pre- and post-implementation phase, respectively. No difference in the incidence of severe IVH (6.9% vs. 9.8%, p = 0.37) was observed on the first cranial scan performed after 72 h of age. Conclusion: the implementation of a “brain protection bundle” was not effective in reducing the incidence of severe IVH within the first 72 h of life in our centre.

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“…Vasopressors may induce rapid cerebral hemodynamic changes, thereby impacting the germinal matrix, which may lead to IVH (33,34). Other studies have proposed that vasopressors may affect the selfregulation of cerebral vessels, leading to cerebral ischemia and reperfusion injury prior to IVH occurrence (8,35). Besides, nonjudicious use of cardiovascular pharmacological support may also paradoxically augment the magnitude of left-right shunt of PDA by increasing systemic vascular resistance (36).…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus, however, on the definition of an acceptable blood pressure; therefore, wide variations in intervention thresholds, medication selection, duration, and dosage of cardiovascular pharmacological support exist (4,5). In addition, it is unclear whether cardiovascular pharmacological support during the early stage of life could improve the outcomes of preterm infants (6)(7)(8)(9). Data on cardiovascular pharmacological support in Chinese NICUs and outcomes among infants who received drugs have not been reported.…”

Section: Clinical Trial Registrationmentioning

confidence: 99%

Cardiovascular Pharmacological Support Among Preterm Infants in Chinese Referral Center Neonatal Intensive Care Units

Luo

Jiang

et al. 2021

Front. Pediatr.

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Objective: To describe cardiovascular pharmacological support in infants born at <34 weeks' gestation within the first postnatal week in Chinese neonatal intensive care units (NICUs).Design: A secondary analysis of data from a multicenter randomized controlled study (REIN-EPIQ). A questionnaire regarding cardiovascular support practices was also completed by all participating NICUs.Setting: Twenty-five tertiary hospitals from 19 provinces in China.Patients: All infants born at <34 weeks' gestation and admitted to participating NICUs within the first postnatal week from May 2015 to April 2018 were included. Infants who were discharged against medical advice were excluded.Measures and Main Results: Among the 26,212 preterm infants <34 weeks, 16.1% received cardiovascular pharmacological support. The use rates increased with decreasing gestational age and birth weight, with 32.5% among infants <28 weeks and 35.9% among infants <1,000 g. Cardiovascular pharmacological support was independently associated with higher risks of death (aOR 2.8; 95% CI 2.4–3.3), severe intraventricular hemorrhage (IVH) (aOR 2.1; 95% CI 1.8–2.5) and bronchopulmonary dysplasia (BPD) (aOR 2.2; 95% CI 2.0–2.5). Overall 63.1% courses of cardiovascular pharmacological support were >3 days. Prolonged cardiovascular pharmacological support (>3 days) was independently associated with lower rates of survival without morbidity in very-low-birth-weight infants, compared with infants with shorter durations. Dopamine was the most commonly used cardiovascular agent. The cardiovascular pharmacological support rates varied from 1.9 to 65.8% among the participating NICUs.Conclusions: The rate of cardiovascular pharmacological support within the first postnatal week was high with prolonged durations in Chinese NICUs. Marked variation in cardiovascular support existed among participating NICUs. Cardiovascular pharmacological support during the early postnatal period, especially prolonged, may be associated with adverse neonatal outcomes.Clinical Trial Registration: The original trial was registered as “Reduction of Infection in Neonatal Intensive Care Units using the Evidence-based Practice for Improving Quality” (ID: NCT02600195) on clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT02600195?term=NCT02600195&draw=2&rank=1.

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Early inotropes use is associated with higher risk of death and/or severe brain injury in extremely premature infants

Cited by 30 publications

References 51 publications

Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy

Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy

Impact of a “Brain Protection Bundle” in Reducing Severe Intraventricular Hemorrhage in Preterm Infants <30 Weeks GA: A Retrospective Single Centre Study

Cardiovascular Pharmacological Support Among Preterm Infants in Chinese Referral Center Neonatal Intensive Care Units

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