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

Yıl 2026, Cilt: 53 Sayı: 1, 117 - 127, 10.03.2026

Leyla Şero , Muhammet Asena , Nilufer Okur , Duygu Tunçel

https://doi.org/10.5798/dicletip.1906463

https://izlik.org/JA86FH85TS

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

Etik Beyan

The study protocol received approval from the Clinical Research Ethics Committee of the University of Health Sciences (approval date: 12 December 2024; approval number: 277). All procedures were performed in accordance with the ethical principles of the Declaration of Helsinki.

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

https://izlik.org/JA86FH85TS

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

• 1.Dempsey EM, Barrington KJ, Marlow N, et al.Hypotension in Preterm Infants (HIP) randomisedtrial. Arch Dis Child Fetal Neonatal Ed.2021;106(4):398-403. doi:10.1136/archdischild-2020-320241
• 2.Doucette SM, Kelly EN, Church PT, Lee S, Shah V.Canadian Neonatal Network (CNN) Investigatorsand CNFUN Investigators and Steering Committee.Association of inotrope use withneurodevelopmental outcomes in infants <29 weeksgestation: a retrospective cohort study. J MaternFetal Neonatal Med. 2022;35(25):6044-52.doi:10.1080/14767058.2021.1904872
• 3.Alderliesten T, Arasteh E, Van Alphen A, et al.Treatment of Hypotension of Prematurity: arandomised trial. Arch Dis Child Fetal Neonatal Ed.2025;111(1): F60-F66. Published 2025 Dec 15.doi:10.1136/archdischild-2024-328253
• 4.Hwang-Bo S, Seo YM, Oh MY, Im SA, Youn YA. Theprognosis of refractory hypotension and severeintraventricular hemorrhage in very low birthweight infants. Medicine (Baltimore). 2022 Jul29;101(30): e29598.doi:10.1097/MD.0000000000029598.
• 5.Abdul Aziz AN, Thomas S, Murthy P, et al. Earlyinotropes use is associated with higher risk of deathand/or severe brain injury in extremely prematureinfants. J Matern Fetal Neonatal Med.2020;33(16):2751-8.doi:10.1080/14767058.2018.1560408
• 6.Dilli D, Soylu H, Tekin N. Neonatal hemodynamicsand management of hypotension in newborns. TurkPediatri Ars. 2018;53(Suppl 1) :S65–75.
• 7.Nagy Z, Obeidat M, Máté V, et al. Occurrence andTime of Onset of Intraventricular Hemorrhage inPreterm Neonates: A Systematic Review and Meta-Analysis of Individual Patient Data. JAMA Pediatr.2025;179(2):145-54.doi:10.1001/jamapediatrics.2024.5998
• 8.Alotaibi WSM, Alsaif NS, Ahmed IA, et al.Reduction of severe intraventricular hemorrhage, atertiary single-center experience: incidence trends,associated risk factors, and hospital policy. Childs Nerv Syst. 2020;36(12):2971-9. doi:10.1007/s00381-020-04621-7
• 9.Beausoleil TP, Janaillac M, Barrington KJ, LapointeA, Dehaes M. Cerebral oxygen saturation andperipheral perfusion in the extremely prematureinfant with intraventricular and/or pulmonaryhaemorrhage early in life. Sci Rep. 2018;8(1):6511.Published 2018 Apr 25. doi:10.1038/s41598-018-24836-8
• 10.Piscopo BR, Malhotra A, Hunt RW et al. Theinterplay between birth weight and intraventricularhemorrhage in very preterm neonates-aretrospective cohort study. Am J Obstet GynecolMFM. 2025 Apr;7(4):101628. doi:10.1016/j.ajogmf.2025.101628. Epub 2025 Feb 4.PMID: 39914515.
• 11.Ergon EY, Özdemir SA, Çolak R, et al. PreventablePostnatal Risk Factors of Retinopathy ofPrematurity. Dicle Medical Journal.2024;51(3):433–41.
• 12.Bao L, Huang J. Risk factors for intraventricularhemorrhage in very low birth weight infants: asystematic review and meta-analysis. Frontiers inPediatrics. 2025;13, 1728632.
• 13.Ongun H, Ozyazıci Ozkan SE. Predictors ofIntraventicular Hemorhage in the NeonatalIntensive Care Unit. J Crit Intensive Care.2021;12(1):1-7. doi: 10.37678/dcybd.2021.2583
• 14.Couto C, Proença E. Management of low systemicblood flow in extremely preterm infants. Birth andGrowth Medical Journal. 2024; 33(1), 29-39. Doi:10.25753/BirthGrowthMJ.v33.i1.28239
• 15.Giesinger RE, Rios DR, Chatmethakul T, et al.Impact of Early Hemodynamic Screening onExtremely Preterm Outcomes in a High-Performance Center. Am J Respir Crit Care Med.2023;208(3):290-300. doi:10.1164/rccm.202212-2291OC
• 16.Marlow N, Barrington KJ, ODonnell CPF, et al.Outcomes of extremely preterm infants whoparticipated in a randomised trial of dopamine fortreatment of hypotension (the HIP trial) at 2 yearscorrected age. Arch Dis Child Fetal Neonatal Ed.2025;110(6):542-7. Published 2025 Oct 17.doi:10.1136/archdischild-2024-327894
• 17.Osborn DA, Paradisis M, Evans N. The effect ofinotropes on morbidity and mortality in preterminfants with low systemic or organ blood flow.Cochrane Database Syst Rev. 2007;(1):CD005090.
• 18.Kharrat A., Ripstein G., Baczynski M., et al.Validity of the vasoactive-inotropic score in pretermneonates receiving cardioactive therapies. Earlyhuman development. 2022; 173, 105657.
• 19.Özalkaya E, Arifoğlu İ, Yarış E, et al. A newmortality score in preterm infants: the vasoactiveinotropic score. BMC Pediatr. 2025;25(1):317.doi:10.1186/s12887-025-05638-0
• 20.Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity andmortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11(2):234-238. doi:10.1097/PCC.0b013e3181b806fc
• 21.Zaveri PG, Walker AM, Upadhyay K, Talati AJ. Useof Vasopressors in Extremely Preterm Infants inFirst Week of Life. Am J Perinatol. 2023;40(5):513-8.doi:10.1055/s-0041-1729558
• 22.Raschetti R, Torchin H, Marchand-Martin L, et al.In-hospital Outcomes and Early HemodynamicManagement According to Echocardiography Use inHypotensive Preterm Infants: A NationalPropensity-Matched Cohort Study. Front CardiovascMed.2022; 9:852666.doi:10.3389/fcvm.2022.852666