Early blood pressure, antihypotensive therapy and outcomes at 18-22months' corrected age in extremely preterm infants

Objective To investigate the relationships between early blood pressure (BP) changes, receipt of antihypotensive therapy and 18-22months' corrected age (CA) outcomes for extremely preterm infants. Design Prospective observational study of infants 23(0/7)-26(6/7)weeks' gestational age (GA). Hourly BP values and antihypotensive therapy exposure in the first 24h were recorded. Four groups were defined: infants who did or did not receive antihypotensive therapy in whom BP did or did not rise at the expected rate (defined as an increase in the mean arterial BP of 5mmHg/day). Random-intercept logistic modelling controlling for centre clustering, GA and illness severity was used to investigate the relationship between BP, antihypotensive therapies and infant outcomes. Setting Sixteen academic centres of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Main outcome measures Death or neurodevelopmental impairment/developmental delay (NIDD) at 18-22months' CA. Results Of 367 infants, 203 (55%) received an antihypotensive therapy, 272 (74%) survived to discharge and 331 (90%) had a known outcome at 18-22months' CA. With logistic regression, there was an increased risk of death/NIDD with antihypotensive therapy versus no treatment (OR 1.836, 95% CI 1.092 to 3.086), but not NIDD alone (OR 1.53, 95% CI 0.708 to 3.307). Conclusions Independent of early BP changes, antihypotensive therapy exposure was associated with an increased risk of death/NIDD at 18-22months' CA when controlling for risk factors known to affect survival and neurodevelopment. Clinical trial registration number clinicaltrials.gov #NCT00874393.