OBJECTIVE. The goals were to identify the blood pressures of extremely low gestational age newborns that prompt intervention, to identify other infant characteristics associated with receipt of therapies intended to increase blood pressure, and to assess the interinstitutional variability in the use of these therapies.METHODS. The cohort included 1507 extremely low gestational age newborns born at 23 weeks to 27 weeks of gestation, at 14 institutions, between March 2002 and August 2004; 1387 survived the first postnatal week. Blood pressures were measured as clinically indicated. Interventions were grouped as any treatment (ie, vasopressor and/or fluid boluses of 10 mL/kg) and vasopressor treatment, and logistic regression analyses were performed.RESULTS. At each gestational age, the lowest mean arterial pressures in treated and untreated infants tended to increase with advancing postnatal age. Infants who received any therapy tended to have lower mean arterial pressures than infants who did not, but uniform thresholds for treatment were not apparent. The proportion of infants receiving any treatment decreased with increasing gestational age from 93% at 23 weeks to 73% at 27 weeks. Treatment nearly always began during the first 24 hours of life. Lower gestational age, lower birth weight, male gender, and higher Score for Neonatal Acute Physiology–II values were associated with any treatment and vasopressor treatment. Institutions varied greatly in their tendency to offer any treatment and vasopressor treatment. Neither the lowest mean arterial pressure on the day of treatment nor other characteristics of the infants accounted for center differences in treatment.CONCLUSIONS. Blood pressure in extremely premature infants not treated for hypotension increased directly with both increasing gestational age and postnatal age. The decision to provide treatment was associated more strongly with the center where care was provided than with infant attributes.
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机译：目的。目标是确定提示干预的极低胎龄新生儿的血压，确定与旨在增加血压的疗法相关的其他婴儿特征以及评估使用这些疗法的机构间差异。该队列包括2002年3月至2004年8月间在14个机构中妊娠23周至27周出生的1507例极低的胎龄新生儿。 1387在产后的第一周幸存下来。根据临床指标测量血压。干预措施分为任何治疗（即升压药和/或体液大于10 mL / kg）和升压药治疗，并进行逻辑回归分析。在每个胎龄，经治疗和未经治疗的婴儿的最低平均动脉压往往随着出生后年龄的增加而增加。与未接受治疗的婴儿相比，接受任何治疗的婴儿的平均动脉压往往较低，但尚无统一的治疗阈值。随着胎龄的增加，接受任何治疗的婴儿比例从23周的93％下降到27周的73％。治疗几乎总是在生命的头24小时开始。较低的胎龄，较低的出生体重，男性和较高的新生儿急性生理学-II值均与任何治疗和升压药物治疗相关。机构在提供任何治疗和升压药物治疗方面的趋势差异很大。治疗当天的最低平均动脉压和婴儿的其他特征均不能解释治疗的中心差异。未接受低血压治疗的早产儿的血压随胎龄和出生后年龄的增加而直接升高。提供治疗的决定与提供护理的中心比与婴儿属性的联系更紧密。
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