Prognóstico clínico de recém-nascidos pré-termo com hipotensão: estudo retrospetivo

Abstract

Background: Preterm infants are at higher risk of maladapting to the extrauterine environment. Blood pressure measurements are widely used to assess this transition process; however, the definition of hypotension in this population is controversial. Thus, there is no mean arterial blood pressure (MABP) threshold established that warrants treatment intervention. We aimed to assess the incidence of hypotension in preterm infants, according to 3 different definitions of hypotension, and to evaluate its clinical impact when it occurs within the first 72 hours of life. Methods: This retrospective observational study reviewed clinical data regarding preterm infants born at less than 30 weeks of gestational age (GA) between January 1, 2012, and December 31, 2023, admitted to the level III Neonatal Intensive Care Unit of Unidade Local de Saúde São João. We analyzed 3 definitions of hypotension and compared their clinical outcomes to the corresponding group who did not meet the hypotension criteria. Results: A total of 145 preterm infants were included. Of these, 23.4% had hypotension based on the criteria of MABP below their GA, 44.1% had hypotension according to the definition MABP below 30 mmHg, and 21.4% had hypotension since their MABP fell below P2.3. MABP<GA had a higher incidence of necrotizing enterocolitis (NEC) ≥ grade 2, intraventricular hemorrhage (IVH) ≥ grade 3, periventricular hemorrhagic infarction (PVHI), and mortality. MABP<30 mmHg had a higher incidence of hemodynamically significant patent ductus arteriosus, NEC ≥ grade 2, IVH ≥ grade 3, PVHI, and mortality. MABP<P2.3 found a higher incidence of pneumothorax, IVH ≥ grade 3, PVHI, and mortality. Moderate agreement was found between the definitions MABP <GA and MABP <P2.3. ROC curves showed a strong predictive value when MABP<30 mmHg. Conclusion: All 3 definitions of hypotension studied revealed a morbidity impact and a higher incidence of mortality.