Hemodynamic Quality Improvement Bundle to Reduce the Use of Inotropes in Extreme Preterm Neonates

Venkata, Sujith Kumar Reddy Gurram; Srivastava, Ankur; Murthy, Prashanth; Scott, James N.; Zein, Hussein; Leijser, Lara M.; Ghosh, Anirban; Momin, Sarfaraz; Thomas, Sumesh; Mohammad, Khorshid

doi:10.1007/s40272-022-00502-5

Cited by 6 publications

(2 citation statements)

References 50 publications

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“…In this study, extremely preterm infants with isolated AH who did not receive any anti-hypotensive treatment were more likely to develop a brain injury compared to those who were treated for isolated hypotension [4]. On the other hand, treatment with inotropes has been identified as a significant risk factor independently associated with increased mortality and neurodevelopmental impairment [8,9]. This could justify the slight decrease in the use of inotropes observed overtime (from 2009-2013 to 2014-2015) [10].…”

Section: Introductionmentioning

confidence: 72%

Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study

Stathopoulou,

Agakidou,

Paschaloudis

et al. 2023

Children

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This was a single center, retrospective cohort study designed to evaluate the association between the administration of inotropes to hypotensive very low gestational age infants (VLGAI) and prenatal and neonatal risk factors. Inpatient medical records were reviewed to identify neonates treated with inotropes (treated group) and a control group for comparison. Two hundred and twenty two (222) VLGAI (less than 32 weeks’ gestation) were included in the final analysis and were stratified based on timing of treatment with 83 infants (37.4%) and 139 infants (62.6%) in the treated and control groups, respectively. A total of 56/83 (67%) received inotropes for arterial hypotension during the first 3 days (early treatment subgroup) and 27/83 (32.5%) after 3 days of life (late-treated subgroup). Fentanyl, severe intraventricular hemorrhage (IVH), and gestational age (GA) were the risk factors most significantly associated with the need for inotrope use both during the first 3 days of life and the whole NICU stay, before and after adjustment for confounders. In conclusion, fentanyl, severe IVH, and GA are the risk factors most strongly associated with the need for inotrope treatment in VLGAI. Measures to modify these risk factors may decrease the need for cardiovascular medications and improve outcomes.

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Section: Introductionmentioning

confidence: 72%

Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study

Stathopoulou,

Agakidou,

Paschaloudis

et al. 2023

Children

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“…Recent research ( 1 ) that aimed to reduce the use of inotropes resulted in a reduction of brain morbidities in premature babies; these findings add to serious efforts to clarify whether cerebral perfusion is improved or reduced with any inotrope use. Unfortunately, despite decades of use, we still have little evidence regarding the outcome of the various inotropes accepted for treating neonatal hypotension.…”

Section: Introductionmentioning

confidence: 98%

The role of human milk feeds on inotrope use in newborn infants with sepsis

Moliner

Verd

Leiva³

et al. 2023

Front. Pediatr.

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BackgroundRegarding neonatal hypotension, there is no certainty as to whether inotrope properties are beneficial or whether they may be harmful. However, given that the antioxidant content of human milk plays a compensatory role in neonatal sepsis and that human milk feeding has direct effects in modulating the cardiovascular function of sick neonates, this research hypothesized that human milk feeds might predict lower requirements of vasopressors in the management of neonatal septic shock.MethodBetween January 2002 and December 2017, all late preterm and full-term infants attending a neonatal intensive care unit, with clinical and laboratory findings of bacterial or viral sepsis, were identified in a retrospective study. During their first month of life, data on feeding type and early clinical characteristics were collected. A multivariable logistic regression model was constructed to determine the impact of human milk on the use of vasoactive drugs in septic newborns.Results322 newborn infants were eligible to participate in this analysis. Exclusively formula-fed infants were more likely to be delivered via C-section, to have a lower birth weight and a lower 1-minute Apgar score than their counterparts. Human milk-fed newborns had 77% (adjusted OR = 0.231; 95% CI: 0.07–0.75) lower odds of receiving vasopressors than exclusively formula-fed newborns.ConclusionWe report that any human milk feeding is associated with a decrease in the need for vasoactive medications in sepsis-affected newborns. This observation encourages us to undertake further research to determine whether human milk feeds mitigate the use of vasopressors in neonates with sepsis.

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Standardizing clinician training and patient care in the neonatal neurocritical care: A step-by-step guide

Mohammad

2024

Seminars in Perinatology

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Hemodynamic Quality Improvement Bundle to Reduce the Use of Inotropes in Extreme Preterm Neonates

Cited by 6 publications

References 50 publications

Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study

Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study

The role of human milk feeds on inotrope use in newborn infants with sepsis

Standardizing clinician training and patient care in the neonatal neurocritical care: A step-by-step guide

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