Incidence, management, and outcomes of cardiovascular insufficiency in critically ill term and late preterm newborn infants

Erika Fernandez; Kristi L Watterberg; Roger G Faix; Bradley A Yoder; Michele C Walsh; Conra Backstrom Lacy; Karen A Osborne; Abhik Das; Douglas E Kendrick; Barbara J Stoll; Brenda B Poindexter; Abbot R Laptook; Kathleen A Kennedy; Kurt Schibler; Edward F Bell; Krisa P Van Meurs; Ivan D Frantz III; Ronald N Goldberg; Seetha Shankaran; Waldemar A Carlo; Richard A Ehrenkranz; Pablo J Sanchez; Rosemary D Higgins

doi:10.1055/s-0034-1368089

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Incidence, management, and outcomes of cardiovascular insufficiency in critically ill term and late preterm newborn infants

Journal article

Peer reviewed

Incidence, management, and outcomes of cardiovascular insufficiency in critically ill term and late preterm newborn infants

Erika Fernandez, Kristi L Watterberg, Roger G Faix, Bradley A Yoder, Michele C Walsh, Conra Backstrom Lacy, Karen A Osborne, Abhik Das, Douglas E Kendrick, Barbara J Stoll, …

American journal of perinatology, Vol.31(11), pp.947-956

11/2014

DOI: 10.1055/s-0034-1368089

PMCID: PMC4127379

PMID: 24515617

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Abstract

The objective of this study was to characterize the incidence, management, and short-term outcomes of cardiovascular insufficiency (CVI) in mechanically ventilated newborns, evaluating four separate prespecified definitions. Multicenter, prospective cohort study of infants ≥34 weeks gestational age (GA) and on mechanical ventilation during the first 72 hours. CVI was prospectively defined as either (1) mean arterial pressure (MAP) < GA; (2) MAP < GA + signs of inadequate perfusion; (3) any therapy for CVI; or (4) inotropic therapy. Short-term outcomes included death, days on ventilation, oxygen, and to full feedings and discharge. Of 647 who met inclusion criteria, 419 (65%) met ≥1 definition of CVI. Of these, 98% received fluid boluses, 36% inotropes, and 17% corticosteroids. Of treated infants, 46% did not have CVI as defined by a MAP < GA ± signs of inadequate perfusion. Inotropic therapy was associated with increased mortality (11.1 vs. 1.3%; p < 0.05). More than half of the infants met at least one definition of CVI. However, almost half of the treated infants met none of the definitions. Inotropic therapy was associated with increased mortality. These findings can help guide the design of future studies of CVI in newborns.

Pregnancy

Prospective Studies

Humans

Cardiovascular Diseases - therapy

Critical Illness

Male

Gestational Age

Respiration, Artificial

Incidence

Infant, Premature

Cardiovascular Diseases - epidemiology

Female

Term Birth

Details

Title: Subtitle: Incidence, management, and outcomes of cardiovascular insufficiency in critically ill term and late preterm newborn infants
Creators: Erika Fernandez - Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
Kristi L Watterberg - Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
Roger G Faix - Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
Bradley A Yoder - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
Michele C Walsh - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
Conra Backstrom Lacy - Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
Karen A Osborne - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
Abhik Das - Statistics and Epidemiology Unit, RTI International, Rockville, Maryland
Douglas E Kendrick - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
Barbara J Stoll - Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
Brenda B Poindexter - Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
Abbot R Laptook - Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
Kathleen A Kennedy - Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas
Kurt Schibler - Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
Edward F Bell - Department of Pediatrics, University of Iowa, Iowa City, Iowa
Krisa P Van Meurs - Division of Neonatal and Developmental Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
Ivan D Frantz III - Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
Ronald N Goldberg - Department of Pediatrics, Duke University, Durham, North Carolina
Seetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, Michigan
Waldemar A Carlo - Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama
Richard A Ehrenkranz - Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
Pablo J Sanchez - Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
Rosemary D Higgins
Resource Type: Journal article
Publication Details: American journal of perinatology, Vol.31(11), pp.947-956
DOI: 10.1055/s-0034-1368089
PMID: 24515617
PMCID: PMC4127379
NLM abbreviation: Am J Perinatol
ISSN: 0735-1631
eISSN: 1098-8785
Grant note: UL1 TR000142 / NCATS NIH HHS UG1 HD040492 / NICHD NIH HHS UG1 HD053089 / NICHD NIH HHS U10 HD27856 / NICHD NIH HHS U10 HD53089 / NICHD NIH HHS U10 HD027871 / NICHD NIH HHS U10 HD27880 / NICHD NIH HHS UL1 RR24979 / NCRR NIH HHS UL1 RR25744 / NCRR NIH HHS U10 HD27904 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS U10 HD27853 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD36790 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS UL1 TR000371 / NCATS NIH HHS UL1 TR001449 / NCATS NIH HHS UL1 TR000454 / NCATS NIH HHS UL1 RR24139 / NCRR NIH HHS UL1 RR25008 / NCRR NIH HHS U10 HD40492 / NICHD NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS UL1 RR024979 / NCRR NIH HHS UL1 TR001067 / NCATS NIH HHS U10 HD53119 / NICHD NIH HHS UG1 HD068278 / NICHD NIH HHS U10 HD053124 / NICHD NIH HHS U10 HD34216 / NICHD NIH HHS U10 HD27851 / NICHD NIH HHS U10 HD053119 / NICHD NIH HHS U10 HD53109 / NICHD NIH HHS UL1 RR025764 / NCRR NIH HHS UG1 HD053109 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS UL1 RR025008 / NCRR NIH HHS UL1 RR024139 / NCRR NIH HHS UL1 TR001108 / NCATS NIH HHS UL1 RR031977 / NCRR NIH HHS U10 HD21364 / NICHD NIH HHS UL1 RR25761 / NCRR NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS U10 HD27871 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS UL1 TR001085 / NCATS NIH HHS U10 HD40689 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD068278 / NICHD NIH HHS UL1 RR31977 / NCRR NIH HHS U10 HD027851 / NICHD NIH HHS U10 HD21385 / NICHD NIH HHS UL1 RR025761 / NCRR NIH HHS UG1 HD087229 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS UL1 RR025744 / NCRR NIH HHS UL1 RR25764 / NCRR NIH HHS U10 HD53124 / NICHD NIH HHS
Language: English
Date published: 11/2014
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093487102771

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