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


Journal Article

OBJECTIVE: 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. STUDY DESIGN: 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. RESULTS: 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). CONCLUSION: 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.

Full Text

Duke Authors

Cited Authors

  • Fernandez, E; Watterberg, KL; Faix, RG; Yoder, BA; Walsh, MC; Lacy, CB; Osborne, KA; Das, A; Kendrick, DE; Stoll, BJ; Poindexter, BB; Laptook, AR; Kennedy, KA; Schibler, K; Bell, EF; Van Meurs, KP; Frantz, ID; Goldberg, RN; Shankaran, S; Carlo, WA; Ehrenkranz, RA; Sanchez, PJ; Higgins, RD

Published Date

  • November 2014

Published In

Volume / Issue

  • 31 / 11

Start / End Page

  • 947 - 956

PubMed ID

  • 24515617

Pubmed Central ID

  • 24515617

Electronic International Standard Serial Number (EISSN)

  • 1098-8785

Digital Object Identifier (DOI)

  • 10.1055/s-0034-1368089


  • eng

Conference Location

  • United States