Hypotension in Preterm Neonates: The Relationship Between Early Postnatal Inotropic Support and Morbidity and Mortality

Öz

Objective: Hemodynamic instability is frequently observed during the early postnatal period in very low birth weight preterm infants. In this study, we aimed to evaluate the association between the requirement for early postnatal inotropic therapy and mid-term morbidities and mortality. Methods: This retrospective cohort study included preterm neonates born at ≤32 weeks of gestation who were admitted to a level III neonatal intensive care unit between January 2020 and December 2023. Infants who died within the first 24 hours of life or had major congenital anomalies, genetic disorders, or perinatal asphyxia were excluded. Patients were classified according to the presence of hypotension and requirement for inotropic therapy within the first 72 hours of life. Hypotension was defined as a mean arterial pressure lower than the infant’s gestational age in weeks, confirmed by at least two consecutive measurements. Clinical and maternal demographic data, respiratory support characteristics, and neonatal morbidities were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of severe intraventricular hemorrhage. Results: A total of 207 preterm neonates born at ≤32 weeks of gestation were included in the analysis, and 65 (32.3%) received inotropic therapy during the first 72 hours of life. Infants who received inotropic therapy had significantly lower birth weight (952 ± 328 g vs. 1120 ± 281 g, p = 0.01) and gestational age (26 ± 1.7 weeks vs. 27.8 ± 1.8 weeks, p < 0.01) compared with those who did not receive inotropes. Severe intraventricular hemorrhage (IVH) occurred significantly more frequently in the inotrope-treated group (29.2%, p < 0.01), and mortality was markedly higher in this group (43% vs. 11.3%, p < 0.01). Median vasoactive inotropic score (VIS) values were significantly higher both in non-survivors compared with survivors (20 vs. 10, p = 0.037) and in infants who developed severe IVH compared with those who did not (20 vs. 10, p = 0.025). Logistic regression analysis demonstrated that increasing gestational age was an independent protective factor against severe IVH (OR: 0.632, 95% CI: 0.433–0.924, p = 0.018). Mortality was independently associated with the presence of severe IVH (OR: 3.931, 95% CI: 1.462–10.565, p = 0.007). Conclusion: Early postnatal hypotension and inotropic therapy requirement in preterm neonates were associated with increased rates of severe IVH and mortality, suggesting a poor prognosis in this population.

Anahtar Kelimeler

• Hypotension
• inotropes
• mortality
• prematurity

Prematüre Yenidoğanlarda Hipotansiyon: Postnatal Erken İnotrop Desteğinin Morbidite ve Mortalite ile İlişkisi

Öz

Giriş: Hemodinamik instabilite, çok düşük doğum ağırlıklı preterm bebeklerde erken postnatal dönemde sık olarak gözlenmektedir. Bu çalışmamızda, erken postnatal dönemde inotrop tedavisi gereksinimi ile orta dönem morbiditeler ve mortalite arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntemler: Bu retrospektif kohort çalışmaya, Ocak 2020 ile Aralık 2023 tarihleri arasında üçüncü basamak yenidoğan yoğun bakım ünitesine yatırılan ve gebelik yaşı ≤32 hafta olan prematüre yenidoğanlar dahil edildi. Yaşamın ilk 24 saati içinde kaybedilen, majör konjenital anomalisi, genetik hastalığı veya perinatal asfiksi öyküsü bulunan bebekler çalışma dışı bırakıldı. Hastalar, yaşamın ilk 72 saati içinde hipotansiyon varlığı ve inotrop tedavisi gereksinimine göre sınıflandırıldı. Hipotansiyon, en az iki ardışık ölçümde ortalama arter basıncının bebeğin gebelik haftasından düşük olması olarak tanımlandı. Klinik ve maternal demografik veriler, solunum desteği özellikleri ve neonatal morbiditeler kaydedildi. Şiddetli intraventriküler kanamanın bağımsız belirleyicilerini araştırmak amacıyla çok değişkenli lojistik regresyon analizi uygulandı. Bulgular: Analize gebelik yaşı ≤32 hafta olan toplam 207 prematüre yenidoğan dahil edildi ve bunların 65’ine (%32,3) yaşamın ilk 72 saatinde inotrop tedavisi uygulandı. İnotrop tedavisi alan bebeklerin doğum ağırlığı (952 ± 328 g’ye karşı 1120 ± 281 g, p = 0,01) ve gestasyon yaşı (26 ± 1,7 haftaya karşı 27,8 ± 1,8 hafta, p < 0,01), inotrop almayanlara göre anlamlı derecede daha düşüktü. Şiddetli intraventriküler kanama (İVK), inotrop tedavisi alan grupta anlamlı olarak daha sık görüldü (%29,2, p < 0,01) ve mortalite bu grupta belirgin şekilde daha yüksekti (%43’e karşı %11,3, p < 0,01). Medyan vazoaktif inotrop skor (VIS) değerleri hem kaybedilen hastalarda yaşayanlara göre (20’ye karşı 10, p = 0,037) hem de şiddetli IVK gelişen hastalarda gelişmeyenlere göre (20’ye karşı 10, p = 0,025) daha yüksekti. Lojistik regresyon analizinde artan gestasyon yaşının şiddetli IVK için bağımsız koruyucu bir faktör olduğu gösterildi (OR: 0,632, %95 GA: 0,433–0,924, p = 0,018). Sonuç: Prematüre bebeklerde erken postnatal dönemde gelişen hipotansiyon ve inotrop tedavisi gereksinimi, ciddi IVK ve yüksek mortalite ile ilişkili bulunmuş olup, bu durumun kötü prognozun bir göstergesi olabileceği düşünülmektedir.

Anahtar Kelimeler

• Hipotansiyon
• inotrop
• mortalite
• prematürite.

Kaynakça

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