Table 1.
Characteristics of studies which included preterm neonates with permissive hypotension.
| Study Year Design |
GA/ BW |
PNA | n | Method | Definition | Outcome | Mortality | IVH/PVL | NEC | ROP | ND |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Batton [31] 2012 RCT | 23–27 wks | <24 h | 10 T: 4 P: 6 |
IABP | 1–6 h—24 mm Hg 7–12 h—25 mm Hg 13–18 h—26 mm Hg 19–24 h—27 mm Hg |
Feasibility study, study was not feasible |
No differences T: 0/4 (0%) P: 2/6 (33%) |
No differences T: 0/4 (0%) P: 2/6 (33%) |
No differences T: 0/4 (0%) P: 0/6 (0%) |
NS | NS |
| Pereira [32] 2017 RCT |
<29 wks | <72 h | 60 T: 39 P: 21 |
Both | T: <30 mm Hg, <GA P: signs of poor perfusion or <19 mm Hg |
No differences in mortality or MBI |
No differences T: 7/39 (18%) P: 2/21 (9.5%) |
No differences IVH T: 6/39 (15.3%) P: 1/21 (4.7%) cPVL T: 0/39 (0%) P: 0/21 (0%) |
No differences T: 9/39 (23%) P: 6/21 (28%) |
No differences T: 3/39 (7.6%) P: 2/21 (9.5%) |
NS |
| Dempsey [30] 2021 RCT | <28 wks | <72 h | 58 T: 29 P: 29 |
IABP | <GA for 15 min | No differences in mortality or MBI |
No differences T: 6/29 (21%) P: 7/29 (24%) |
No differences IVH: T: 5/29 (17%) P: 2/29 (7%) PVL T: 2/29 (7%) P: 2/29 (7%) |
No differences T: 1/29 (3%) P: 4/29 (14%) |
NS | NS |
| Aladangady [76] 2023 Retrospective |
23–29 wks | <72 h | 671 T: 263 P: 408 |
Both | <30 mm Hg | Death and IVH was similar; P: NEC was higher |
No differences T: 56/263 (21.3%) P: 104/408 (25.5%) |
No differences T: 21/263 (8%) P: 51/408 (12.5%) |
P: Increased T: 37/263 (14.1%) P: 85/408 (20.8%) |
NS | NS |
| Batton [77] 2013 Prospective |
23–27 wks | <24 h | 367 T: 203 P: 164 |
Both | 15 definitions of low BP based on GA, <5th percentile and <25 mm Hg |
T: Increased mortality, increased IVH grade 3/4 or any IVH, increased ROP |
T: Increase T: 66/203 (33%) P: 36/164 (22%) |
T: IVH increased T: 44/203 (22%) P: 18/164 (11%) cPVL: no differences T: 11/203 (5%) P: 7/164 (4%) |
No differences T: 16/203 (8%) P: 11/164 (7%) |
T: Increase T: 31/203 (15%) P: 13/164 (8%) |
NS |
| Batton [78] 2015 Prospective |
23–27 wks | <24 h | 356 T: 198 P: 158 |
Both | Need for treatment, BP < GA | T: Increased Death or any NDI at 18–22 months |
T: Increased T: 57/198 (28%) P: 27/158 (17%) |
T: Increase IVH/PVL T: 49/198 (25%) P: 19/158 (12%) |
No differences T: 8/198 (4%) P: 6/158 (3.7%) |
NS | No differences T: 30/198 (15.1%) P:15/158 (9.4%) |
| Batton [29] 2009 Retrospective |
23–25 wks | <72 h | 101 T: 70 P: 31 |
Both | ≥3 MAP ≤25 mm Hg | neonates with low BP (± treatment) had worse ND | No difference T: 45/70 (64%) P: 23/31 (74%) |
No difference T: 16/70 (23%) P: 9/31 (29%) |
No difference T: 3/70 (4%) P: 4/31 (13%) |
No difference T: 28/70 (40%) P: 13/31 (43%) |
No difference T: 48/70 (68%) P: 19/31 (61%) |
| Durrmeyer [75] 2017 Prospective |
<29 wks | <72 h | 238 T: 119 P: 119 |
Both | <GA in weeks | T: Increased survival without severe morbidity T: Low MBI |
T decrease T: 20/119 (16.8%) P: 27/119 (22.6%) |
T decrease T: 12/119 (10.1%) P: 31/117 (26.5%) |
No differences T: 4/119 (3.4%) P: 6/118 (5.1%) |
No differences T: 1/99 (1%) P: 2/92 (2.2%) |
NS |
| Dempsey [79] 2009 Retrospective |
<1000 gm | <72 h | 104 T: 18 P: 34 N: 52 |
Both | P: BP < GA with good perfusion T: BP < GA but poor perfusion |
T: increased [OR 9.7, 95% CI: 2.6–36] T: Increase mortality or MBI, surgical NEC, or GI perforation |
T increase T: 13/18 (72%) P: 4/34 (12.5%) N: 10/52 (19%) |
T increase IVH T: 5/18 (27.7%) P: 4/34 (12%) N: 2/52 (3.8%) |
No differences T: 2/18 (11%) P: 3/34 (9%) N: 4/52 (8%) |
No differences | No differences |
| Faust [80] 2015 Retrospective |
<32 wks | <24 h | 4907 | Both | <median as per GA | Lowest MAP associate with mortality 67/1064 (6.3%), IVH 255/1064 (24%) and BPD 227/1064 (21.3%) |
T: No differences [OR 1.48, 95% CI 0.92, 2.38] |
T: Increase [OR 1.86, 95% CI: 1.43, 2.42] |
NS | No differences | NS |
| Gogcu [81] 2020 Case-control study |
<1000 gm | <24 h | 100 T: 34 P: 66 |
Both | <GA in weeks | Hypotension requiring treatment associated with increased SNHL risk |
NS | T: 9/34 (27%) P: 9/66 (14%) |
NS | NS | 15/25 (60%) Hearing impairment required treatment; 19/75 (25%) no hearing impairment group required treatment |
| Ahn [82] 2012 Retrospective |
<1000 gm | <72 h | 261 T: 47 P: 104 N: 110 |
Both | <GA in weeks | T: Increase in mortality, IVH, BPD |
T increase T: 24/47 (51%), P: 17/104 (16%) N: 13/110 (12%) |
T increase IVH >3 T: 18/40 (45%) P: 18/104 (17%) N: 9/110 (8%) |
T increase T: 6/34 (18%) P: 10/99 (10%) N: 7/109 (6%) |
T increase T: 13/33 (39%) P: 26/97 (27%) N: 23/104 (22%) |
MDI < 75 P: 3/36 (8%) N: 3/30 (10%) CPP: 15/83 (18%) N: 14/89 (16%) |
Abbreviations: GA: gestation age, BW: birth weight, PNA: postnatal age, h: hours, min: minutes, IVH: intraventricular hemorrhage, PVL: periventricular leukomalacia, cPVL: cystic periventricular leukomalacia, NEC: necrotizing enterocolitis, MBI: major brain injury, ROP: retinopathy of Prematurity, BPD: bronchopulmonary dysplasia, ND: neurodevelopment, RCT randomized controlled trial, wks: weeks, IABP: intraarterial blood pressure, T: treatment group, P: permissive group, N: normal group, GA: gestational age, NDI: neurodevelopmental impairment, GI: gastrointestinal, OR: Odds ratio, CI: confidence interval outcome, MAP: mean airway pressure, SNHL: sensorineural hearing loss.