Etiology, clinical manifestations, evaluation, and management of low blood pressure in extremely preterm infants
- Beau Batton, MD
Beau Batton, MD
- Associate Professor of Pediatrics and Chief of Neonatology
- Southern Illinois School of Medicine
Blood pressure (BP) management in the extremely preterm (EPT) infant (gestational age [GA] <28 weeks) is challenging due to the presence of multiple disease processes, unpredictable adaptation to extrauterine life, and difficulty assessing organ perfusion. Although there are data that suggest EPT infants with low BP (eg, perceived hypotension) are at an increased risk for adverse outcomes, low BP in EPT infants with adequate perfusion may not be an independent risk factor for poor outcome. Because data are insufficient regarding the efficacy and safety for antihypotensive therapy in adequately perfused EPT infants, it remains unclear how best to manage low BP in this group of patients. In contrast, the small minority (approximately 10 to 15 percent) of patients with both low BP and poor perfusion are in shock and require immediate attention to restore adequate perfusion (see "Etiology, clinical manifestations, evaluation, and management of neonatal shock", section on 'Initial stabilization').
The challenges of BP management of EPT infants with good perfusion will be discussed here. The etiology, clinical manifestations, evaluation, and management of neonatal shock are discussed separately. (See "Etiology, clinical manifestations, evaluation, and management of neonatal shock".)
●Extremely preterm (EPT) infant – Infants born <28 weeks gestational age (GA)
●Extremely low birth weight (ELBW) infant – Infants born with BW <1000 g
●Cardiac output (CO) is the volume of blood ejected by the heart each minute. It is the product of heart rate (HR) and stroke volume (SV):
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- Physiological changes in BP
- BP measurement reliability
- Defining hypotension
- Assessing the impact of anti-hypotensive therapies
- Untreated low BP and outcomes
- Risk for developing shock with low BP and good perfusion
- BP alone not a sufficient measure of perfusion
- ETIOLOGIES OF LOW BLOOD PRESSURE
- MANAGEMENT APPROACH
- Poor perfusion
- Adequate perfusion
- SUMMARY AND RECOMMENDATIONS