Blood pressure intervention levels in preterm infants: pilot randomised trial

被引:14
作者
Pereira, Sujith Stanley [1 ,2 ]
Sinha, Ajay Kumar [1 ,2 ]
Morris, Joan Katherine [3 ]
Wertheim, David F. [4 ]
Shah, Divyen K. [1 ,2 ]
Kempley, Stephen Terence [1 ,2 ]
机构
[1] Neonatal Unit, Royal London Hosp, Barts Hlth NHS Trust, London, England
[2] Barts & London Queen Marys Sch Med & Dent, Blizard Inst, Ctr Genom & Child Hlth, London E1 2AT, England
[3] Queen Mary Univ London, Wolfson Inst Prevent Med, London, England
[4] Kingston Univ, Fac Sci Engn & Comp, Kingston, England
来源
ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION | 2019年 / 104卷 / 03期
关键词
BIRTH-WEIGHT INFANTS; CARDIAC-OUTPUT; 1ST DAY; HYPOTENSION; MANAGEMENT; DIAGNOSIS;
D O I
10.1136/archdischild-2017-314159
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective To examine the feasibility of a trial allocating different blood pressure (BP) intervention levels for treatment in extremely preterm infants. Design Three-arm open randomised controlled trial performed between February 2013 and April 2015. Setting Single tertiary level neonatal intensive care unit. Patients Infants born < 29 weeks' gestation were eligible to participate, if parents consented and they did not have a major congenital malformation. Interventions Infants were randomised to different levels of mean arterial BP at which they received cardiovascular support: active (< 30 mm Hg), moderate (< gestational age mm Hg) or permissive (signs of poor perfusion or < 19 mm Hg). Once this threshold was breached, all were managed using the same treatment guideline. BP profiles were downloaded continuously; cardiac output and carotid blood flow were measured at 1 day and 3 days, and amplitude integrated EEG was recorded during the first week. Cranial ultrasound scans were reviewed blind to study allocation. Main outcome measure Inotrope usage and achieved BP. Results Of 134 cases screened, 60 were enrolled, with mean gestation 25.8 weeks (SD 1.5) and birth weight 817 g (SD 190). Invasively measured BP on the first day and inotrope usage were highest in the active and lowest in the permissive arms. There were no differences in haemodynamic or EEG variables or in clinical complications. Predefined cranial ultrasound findings did not differ significantly; no infants in the active arm had parenchymal brain lesions. Conclusion The BP threshold used to trigger treatment affects the achieved BP and inotrope usage, and it was possible to explore these effects using this study design.
引用
收藏
页码:F298 / F305
页数:8
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