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Background <p>Preterm infants are at high risk of cardiovascular maladaptation after birth. Blood pressure is widely used to assess this transition, despite no established mean arterial blood pressure (MABP) treatment threshold. This study aimed to assess the incidence of hypotension in preterm infants according to three different definitions and to evaluate its association with clinical outcomes when it occurs within the first 72&#xa0;h of life.</p> Methods <p>This retrospective cohort study included inborn infants born at less than 30 weeks of gestational and admitted to a level III neonatal intensive care unit between January 1, 2012, and December 31, 2023. Three definitions of hypotension were analyzed, and outcomes were compared between infants who did and did not meet each definition.</p> Results <p>Of 145 preterm infants studied, 23.4% met the criteria for MABP &lt; GA, 44.1% met the criteria for MABP &lt; 30 mmHg, and 21.4% met the criteria for MABP &lt; P2.3. In the unadjusted analysis, MABP &lt; GA, MABP &lt; 30 mmHg, and MABP &lt; P2.3 were associated with several adverse outcomes. After adjustment for gestational age and birthweight, IVH ≥ grade 3 remained independently associated with MABP &lt; GA, no outcomes remained statistically significant in the MABP &lt; 30&#xa0;mm Hg group, and pneumothorax and PVHI remained significantly associated with MABP &lt; P2.3. Moderate agreement was found between MABP &lt; GA and MABP &lt; P2.3. ROC curve analysis showed the strongest predictive value for MABP &lt; 30 mmHg for IVH ≥ grade 3, PVHI, and mortality.</p> Conclusion <p>Hypotension in preterm infants is prognostically relevant, but its clinical significance depends on the definition used. MABP &lt; 30 mmHg showed the strongest predictive performance, while gestational age- and percentile-based thresholds identified distinct adverse outcome patterns.</p>

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Clinical Prognosis of Preterm Infants with Hypotension: A Retrospective Study

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Beatriz Pinto,
  • Filipa Flôr-de-Lima,
  • Cristina Ferreras,
  • Rita Moita,
  • Joana Nunes,
  • Gustavo Rocha,
  • Inês Azevedo,
  • Paulo Soares

摘要

Background

Preterm infants are at high risk of cardiovascular maladaptation after birth. Blood pressure is widely used to assess this transition, despite no established mean arterial blood pressure (MABP) treatment threshold. This study aimed to assess the incidence of hypotension in preterm infants according to three different definitions and to evaluate its association with clinical outcomes when it occurs within the first 72 h of life.

Methods

This retrospective cohort study included inborn infants born at less than 30 weeks of gestational and admitted to a level III neonatal intensive care unit between January 1, 2012, and December 31, 2023. Three definitions of hypotension were analyzed, and outcomes were compared between infants who did and did not meet each definition.

Results

Of 145 preterm infants studied, 23.4% met the criteria for MABP < GA, 44.1% met the criteria for MABP < 30 mmHg, and 21.4% met the criteria for MABP < P2.3. In the unadjusted analysis, MABP < GA, MABP < 30 mmHg, and MABP < P2.3 were associated with several adverse outcomes. After adjustment for gestational age and birthweight, IVH ≥ grade 3 remained independently associated with MABP < GA, no outcomes remained statistically significant in the MABP < 30 mm Hg group, and pneumothorax and PVHI remained significantly associated with MABP < P2.3. Moderate agreement was found between MABP < GA and MABP < P2.3. ROC curve analysis showed the strongest predictive value for MABP < 30 mmHg for IVH ≥ grade 3, PVHI, and mortality.

Conclusion

Hypotension in preterm infants is prognostically relevant, but its clinical significance depends on the definition used. MABP < 30 mmHg showed the strongest predictive performance, while gestational age- and percentile-based thresholds identified distinct adverse outcome patterns.