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Am J Perinatol 2024; 41(04): 498-504
DOI: 10.1055/a-1704-1851
Original Article

Blood Pressure Goals: Is Cerebral Saturation the New Mean Arterial Pressure?

Kevin J. McKim
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California
,
Stephen Lucafo
2   Milipore Sigma, Burlington, Massachusetts
,
Shazia Bhombal
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California
,
Lisa Bain
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California
,
Valerie Y. Chock 
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California
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Abstract

Objective The objective of this article was to correlate hypotension and cerebral saturation from near-infrared spectroscopy (cNIRS) in neonates on dopamine.

Study Design Retrospective review of neonates receiving dopamine between August 2018 and 2019 was performed. Hypotension thresholds included mean arterial pressure (MAP) of postmenstrual age (PMA) ± 5 and 30 mm Hg and gestational age (GA) ± 5 mm Hg. Time below threshold MAP was compared with time with cerebral hypoxia (cNIRS <55%).

Results Hypotension occurred 6 to 33% of the time on dopamine in 59 cases. Hypotension did not correlate with abnormal cNIRS overall, within PMA subgroups or by outcomes. Hypotensive periods with MAP < GA had fewer corresponding percent time with abnormal cNIRS events (3.7 ± 1.3%) compared with MAP < PMA (11.9 ± 4.9%, p < 0.003) or 30 mm Hg thresholds (12.2 ± 4.7%, p < 0.0001). In most premature infants, mean cNIRS values during hypotension were still within normal range (57 ± 6%).

Conclusion cNIRS may be a more clinically relevant measure than MAP for the assessment of neonatal hypotension.

Key Points

  • Hypotension occurred 6 to 33% of the time on dopamine in 59 cases.

  • Hypotension did not correlate with abnormal cNIRS overall, within PMA subgroups or by outcomes.

  • MAP

  • We found no cNIRS difference between IVH grades, mortality, average Hct, lactates, or urine output.

  • cNIRS may be a more clinically relevant measure than MAP for the assessment of neonatal hypotension.

Keywords

Blood pressure - Neonates - Hypotension - NIRS

Supplementary Material



Publication History

Received: 30 June 2021

Accepted: 17 November 2021

Accepted Manuscript online:
23 November 2021

Article published online:
18 January 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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