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Early postnatal hypotension is not associated with indicators of white matter damage or cerebral palsy in extremely low gestational age newborns

Journal of Perinatology volume 31, pages 524–534 (2011)Cite this article

Subjects

Abstract

Objective:

To evaluate, in extremely low gestational age newborns (ELGANs), relationships between indicators of early postnatal hypotension and cranial ultrasound indicators of cerebral white matter damage imaged in the nursery and cerebral palsy diagnoses at 24 months follow-up.

Study Design:

The 1041 infants in this prospective study were born at <28 weeks gestation, were assessed for three indicators of hypotension in the first 24 postnatal hours, had at least one set of protocol cranial ultrasound scans and were evaluated with a structured neurological exam at 24 months corrected age. Indicators of hypotension included: (1) lowest mean arterial pressure (MAP) in the lowest quartile for gestational age; (2) treatment with a vasopressor; and (3) blood pressure lability, defined as the upper quartile of the difference between each infant's lowest and highest MAP. Outcomes included indicators of cerebral white matter damage, that is, moderate/severe ventriculomegaly or an echolucent lesion on cranial ultrasound and cerebral palsy diagnoses at 24 months gestation. Logistic regression was used to evaluate relationships among hypotension indicators and outcomes, adjusting for potential confounders.

Result:

Twenty-one percent of surviving infants had a lowest blood pressure in the lowest quartile for gestational age, 24% were treated with vasopressors and 24% had labile blood pressure. Among infants with these hypotension indicators, 10% percent developed ventriculomegaly and 7% developed an echolucent lesion. At 24 months follow-up, 6% had developed quadriparesis, 4% diparesis and 2% hemiparesis. After adjusting for confounders, we found no association between indicators of hypotension, and indicators of cerebral white matter damage or a cerebral palsy diagnosis.

Conclusion:

The absence of an association between indicators of hypotension and cerebral white matter damage and or cerebral palsy suggests that early hypotension may not be important in the pathogenesis of brain injury in ELGANs.

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Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Betty H Cameron Women's and Children's Hospital, New Hanover Regional Medical Center, Wilmington, NC, USA

    J W Logan

  2. Wake Forest University School of Medicine, Winston-Salem, NC, USA

    T M O'Shea

  3. Harvard School of Public Health, Boston, MA, USA

    E N Allred

  4. Harvard Medical School, Boston, MA, USA

    E N Allred & A Leviton

  5. Children's Hospital Boston, Boston, MA, USA

    E N Allred & A Leviton

  6. The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M M Laughon & C L Bose

  7. Floating Hospital, Tufts Medical Center, Boston, MA, USA

    O Dammann

  8. Southern Illinois University School of Medicine, Springfield, IL, USA

    D G Batton

  9. Boston University School of Medicine, Boston, MA, USA

    K C Kuban

  10. Michigan State University, East Lansing, MI, USA

    N Paneth

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Correspondence to J W Logan.

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Competing interests

This study was supported by a cooperative agreement with the National Institute of Neurological Disorders and Stroke (5U01NS040069-05) and a program project grant from the National Institute of Child Health and Human Development (5P30HD18655). There are no conflict of interest, and no relationships that would in any way influence or bias this study.

Appendix

Appendix

Participating institutions (site principal investigators, sonologists and neuro-developmental examiners).

Baystate Medical Center, Springfield, MA, USA (Bhavesh Shah, Frederick Hampf, Herbert Gilmore, Susan McQuiston).

Beth Israel Deaconess Medical Center, Boston, MA, USA (Camilia R Martin, Jane Share).

Brigham & Women's Hospital, Boston, MA, USA (Linda J Van Marter, Sara Durfee).

Children's Hospital Boston, Boston, MA, USA (Alan Leviton, Kristen Ecklund, Samantha Butler, Haim Bassan, Adré Duplessis, Cecil Hahn, Omar Khwaha, AK Morgan, Janet S Soul).

DeVos Children's Hospital, Grand Rapids, MI, USA (Mariel Portenga, Bradford W Betz, Steven L Bezinque, Joseph Junewick, Wendy Burdo-Hartman, Lynn Fagerman, Kim Lohr, Steve Pastynrnak, Dinah Sutton).

Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA (Cynthia Cole/John Fiascone, Roy McCauley, Paige T Church, Cecelia Keller, Karen Miller).

Massachusetts General Hospital, Boston, MA, USA (Robert Insoft, Kalpathy Krishnamoorthy).

Michigan State Univeristy, East Lansing, MI, USA (Nigel Paneth).

North Carolina Children's Hospital, Chapel Hill, NC, USA (Carl Bose, Lynn A Fordham, Lisa Bostic, Janice Wereszczak, Diane Marshall, Kristi Milowic, Carol Hubbard).

Sparrow Hospital, Lansing, MI, USA (Padmani Karna, Ellen Cavenagh, Victoria J Caine, Padmani Karna, Nicholas Olomu, Joan Price).

University of Chicago Hospital, Chicago, IL, USA (Michael D Schreiber, Kate Feinstein, Leslie Caldarelli, Sunila E O’Conno, Michael Msall, Susan Plesha-Troyke).

University Health Systems of Eastern Carolina, Greenville, NC, USA (Stephen Engelke, Ira Adler, Sharon Buckwald, Rebecca Helms, Kathyrn Kerkering, Scott S MacGilvray, Peter Resnik).

U Mass Memorial Health Center, Worcester, MA, USA (Francis Bednarek, Jacqueline Wellman, Robin Adair, Richard Bream, Alice Miller, Albert Scheiner, Christy Stine).

Wake Forest University Baptist Medical Center and Forsyth Medical Center, Winston-Salem, NC, USA (T Michael O’Shea, Barbara Specter, Deborah Allred, Don Goldstein, Gail Hounshell, Robert Dillard, Cherrie Heller, Debbie Hiatt, Lisa Washburn).

William Beaumont Hospital, Royal Oak, MI, USA (Daniel Batton, Chung-ho Chang, Karen Brooklier, Melisa Oca).

Yale University School of Medicine, New Haven, CT, USA (Richard Ehrenkranz, Cindy Miller, Nancy Close, Elaine Romano, Joanne Williams).

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Logan, J., O'Shea, T., Allred, E. et al. Early postnatal hypotension is not associated with indicators of white matter damage or cerebral palsy in extremely low gestational age newborns. J Perinatol 31, 524–534 (2011). https://doi.org/10.1038/jp.2010.201

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