Early mean systemic blood pressure as a risk factor in neurodevelopmental outcome of ELBW preterm infants

Abstract

Background: ELBW preterm infants are at extremely high risk for adverse neurodevelopmental (ND) outcome. Systemic hypotension is an important peri-natal risk factor in neurodevelopmental outcome. Numerous other risk factors exist for adverse neurodevelopmental outcome. Aim: To assess whether early mean systemic blood pressure and other risk factors contribute to poor ND outcome in ELBW preterm infants managed at Panorama Medi-Clinic. Methods: A retrospective, analytical study using data obtained from 2003 to 2008. Data from the Vermont Oxford Network database of which Panorama Medi-Clinic is a member was used to select a cohort of inborn, surviving infants weighing ≤ 1000g or ≤ 30 weeks gestational age. Early mean systemic BP records were obtained from nursing records. ND data was obtained from the neurodevelopmental clinic or routine follow up clinics notes. Infants with major defects at birth were excluded. The cohort was classified according to their general developmental quotient and whether or not they had signs of cerebral palsy into a normal or abnormal neurodevelopmental group. All patients remained completely anonymous and ethical clearance was obtained from the ethics committee at Panorama Medi- Clinic. P a g e | VII Results: 82 infants were eligible. 78 were entered the study. 4 were lost to follow up. Average birth weight was 782.1g ± 148.23. Average gestational age was 27.06w ± 1.32. Normal neurodevelopmental outcome was found in 64(82%). An abnormal neurodevelopmental outcome was found in 14(18%). No statistically significant difference was found by logistical regression when mean systemic blood was compared between normal and abnormal neurodevelopmental groups. If a cut off BP of <30 mm Hg, or inotropic agents were administered, no statistical difference was found between the normal and abnormal groups. Severe grades of IVH, ROP, post-natal steroids, and chronic lung disease, and gastro-intestinal perforation, were identified as risk factor of adverse outcome