10.1016/s1541-9800(11)70534-8

Vollständiger Abstract

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<h4>Objective</h4>To evaluate the physiological response following vasopressin initiation and identify factors associated with mortality in extremely preterm infants with refractory cardiopulmonary instability.<h4>Study design</h4>Retrospective cohort study of infants born at less than 29 weeks' gestation who received vasopressin. Physiological responses and mortality were evaluated using multivariate logistic regression and receiver operating characteristic analyses.<h4>Results</h4>The cohort included 87 infants, of whom 60 (69.0%) died before discharge. Prior to vasopressin initiation, non-survivors had lower pH (7.20 [7.07-7.26] vs. 7.25 [7.21-7.30]; p = 0.009), higher lactate concentrations (5.6 vs. 1.1 mmol/L; p = 0.001), and higher oxygen saturation index (14.7 vs. 12.0; p = 0.022). Following vasopressin initiation, mean blood pressure increased from 29.0 to 39.0 mmHg at 24 h (p < 0.001), while FiO 2 requirements, oxygenation indices, and lactate concentrations decreased. Lower pre-treatment pH (adjusted OR 0.53, 95% CI 0.33-0.87; p = 0.012), higher oxygen saturation index (adjusted OR 1.10, 95% CI 1.02-1.19; p = 0.017), and higher lactate concentration (adjusted OR 1.62, 95% CI 1.04-2.54; p = 0.035) were independently associated with mortality. Lactate showed the strongest discrimination for mortality (AUC 0.85, 95% CI 0.69-0.97).<h4>Conclusion</h4>Vasopressin initiation was associated with improved physiological markers. Mortality was associated more strongly with impaired perfusion and oxygenation severity than with blood pressure alone.

Abstract: PubMed · Datensatz