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Validity of Biomarkers of Early Circulatory Impairment to Predict Outcome: A Retrospective Analysis

Authors :
María Carmen Bravo
Paloma López-Ortego
Laura Sánchez
Rosario Madero
Fernando Cabañas
Armin Koch
Héctor Rojas-Anaya
Heike Rabe
Adelina Pellicer
Source :
Frontiers in Pediatrics, Vol 7 (2019)
Publication Year :
2019
Publisher :
Frontiers Media S.A., 2019.

Abstract

Objectives: The definition of circulatory impairment in the premature infant is controversial. Current research suggests overdiagnosis and overtreatment. We aimed to analyse which biomarkers move clinicians to initiate cardiovascular treatment (CVT). The prognostic capacity for adverse outcome (death and/or moderate-severe brain damage by cranial ultrasound at term equivalent) of these biomarkers was evaluated.Study Design: Retrospective data analysis from preterm infants enrolled in a placebo-controlled trial on dobutamine for low superior vena cava (SVC) flow, who showed normal SVC flow within the first 24 h (not randomized). Five positive biomarkers were considered: MABP < gestational age (GA)-1 mmHg; MABP < GA-5 mmHg; lactate > 4 mmol/L; BE < −9 mmol/L; SVC flow 4 mmol/L were the most prevalent biomarkers at start of treatment. Low BE, high serum lactate and low SVC flow at first echocardiography showed a trend toward being associated with adverse outcome, although not statistically significant.Conclusions: Low blood pressure and high lactate are the most prevalent biomarkers used for CVT prescription. Lactic acidosis and low SVC flow early after birth showed a trend toward being associated with adverse outcome. These findings support using a combination of biomarkers for inclusion in a placebo-controlled trial on CVT during transitional circulation.

Details

Language :
English
ISSN :
22962360
Volume :
7
Database :
Directory of Open Access Journals
Journal :
Frontiers in Pediatrics
Publication Type :
Academic Journal
Accession number :
edsdoj.251d5e029aa44c5a7ee1f1d9daa1fd6
Document Type :
article
Full Text :
https://doi.org/10.3389/fped.2019.00212