Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study
Abstract
:1. Introduction
2. Patients and Methods
Statistical Analysis
3. Results
3.1. Maternal, Prenatal, and Neonatal Characteristics of the Treated and Control Groups
3.2. Demographic, Prenatal, and Neonatal Data in the Early Treatment and Late-Treated Subgroups
3.3. Multiple Regression Analyses
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Inotrope | Number (%) of Treated Neonates |
---|---|
Dopamine | 73 (88) |
Dobutamine | 37 (44.6) |
Epinephrine | 13 (15.7) |
Norepinephrine | 11 (13.3) |
Milrinone | 5 (6.0) |
Characteristics | Groups of Neonates | p-Value | |
---|---|---|---|
Control | Treated | ||
N | 139 | 83 | |
Maternal data | |||
Hypertension $ | 25 (18.0) | 12 (14.5) | 0.751 £ |
Chorioamnionitis $ | 17 (12.2) | 17 (20.5) | 0.123 £ |
Prenatal steroids $ | 123 (88.5) | 74 (89.2) | 1.0 £ |
Mg administration $ | 60 (46.5) | 40 (51.9) | 0.541 £ |
Anesthesia for labor/CS $ | 117 (84.2) | 60 (72.3) | 0.176 £ |
Caesarean section $ | 122 (87.8) | 65 (78.3) | 0.093 £ |
Inborn $ | 133 (95.7) | 77 (92.8) | 0.534 £ |
Delayed cord clamping $ | 70 (50.4) | 30 (36.7) | 0.055 £ |
PPROM $ | 36 (25.9) | 26 (31.3) | 0.473 £ |
Neonatal data | |||
Gestational age (wks) * | 30 (28; 31) | 26 (24; 29) | <0.001 # |
Birth weight (g) * | 1270 (1110; 1540) | 810 (632; 1085) | <0.001 # |
1 min Apgar score * | 7 (6; 8) | 5 (4; 7) | <0.001 # |
5 min Apgar score * | 9 (8; 9) | 8 (7; 8) | <0.001 # |
Base deficit on NICU admission * | −5.4 (−7.3; −3.6) | −7 (−9.6; −4.8) | <0.001 # |
pH on admission * | 7.32 (7.27; 7.38) | 7.30 (7.24; 7.37) | 0.101 # |
Male sex $ | 55 (39.6) | 43 (51.8) | 0.102 £ |
SGA $ | 10 (7.2) | 10 (12.0) | 0.327 £ |
IUGR $ | 23 (16.5) | 17 (20.5) | 0.557 £ |
Intubation at birth $ | 26 (18.7) | 52 (62.7) | <0.001 £ |
Surfactant at birth $ | 14 (10.1) | 27 (32.5) | <0.001 £ |
Symptomatic PDA $ | 13 (9.4) | 35 (42.2) | <0.001 £ |
Severe IVH $ | 3 (2.2) | 33 (39.8) | <0.001 £ |
Pulmonary hemorrhage $ | 8 (5.8) | 21 (25.3) | <0.001 £ |
Air-leak syndromes $ | 5 (3.6) | 9 (10.8) | 0.044 £ |
Sepsis (confirmed early or late) $ | 50 (36) | 49 (59) | 0.001 £ |
Septic shock $ | 6 (4.3) | 28 (33.7) | <0.001 £ |
Fentanyl monotherapy $ | 11 (7.9) | 21 (25.3) | 0.002 £ |
Sedative monotherapy $ | 0 (0) | 10 (12) | <0.001 £ |
Fentanyl and sedatives $ | 2 (1.4) | 22 (26.5) | <0.001 £ |
NEC stage II, III $ | 8 (5.8) | 10 (12.0) | 0.159 £ |
Surgical NEC $ | 2 (1.4) | 6 (7.2) | 0.055 £ |
BPD any grade $ | 52 (37.4) | 27 (32.5) | 0.555 £ |
RDS $ | 73 (52.5) | 62 (74.7) | 0.001 £ |
Overall mechanical ventilation $ | 125 (89.9) | 82 (98.8) | 0.011 £ |
Invasive ventilation $ | 46 (33.1) | 80 (96.4) | <0.001 £ |
Non-invasive ventilation $ | 116 (83.5) | 42 (50.6) | <0.001 £ |
Survival $ | 130 (96.3) | 34 (42.0) | <0.001 £ |
Days in NICU for all population * | 50 (41; 69.7) | 17 (6.3; 80.5) | <0.001 # |
Days in NICU for survivors * | 52 (42; 70) | 95 (63; 134) | <0.001 # |
Days in NICU for non-survivors * | 5.0 (1.5; 12.5) | 7.5 (2.5; 15) | 0.432 # |
Characteristics | Subgroups of Treated Neonates | p | |
---|---|---|---|
Early-Treated | Late -Treated | ||
N | 56 | 27 | |
Maternal data | |||
Hypertension $ | 5 (10) | 7 (28) | 0.091 £ |
Chorioamnionitis $ | 14 (26.9) | 3 (11.1) | 0.150 £ |
Prenatal steroids $ | 49 (87.5) | 25 (92.6) | 0.711 £ |
Mg $ | 25 (48.1) | 15 (60.0) | 0.461 £ |
Anesthesia for labor/CS $ | 37 (66.2) | 23 (85.2) | 0.140 £ |
Caesarean section $ | 43 (76.8) | 22 (81.5) | 0.779 £ |
Inborn $ | 53 (94.6) | 24 (88.9) | 0.385 £ |
Delayed cord clamping $ | 16 (28.6) | 14 (51.9) | 0.068 £ |
PPROM $ | 20 (35.7) | 6 (22.2) | 0.323 £ |
Neonatal data | |||
Gestational age (wks) * | 26 (24; 29) | 27 (24; 27) | 0.018 # |
Birth weight (g) * | 725 (602; 1220) | 865 (746; 1220) | 0.194 # |
1 min Apgar score * | 5 (3; 7) | 7 (4; 7) | 0.092 # |
5 min Apgar score * | 8 (7; 8) | 8 (8; 9) | 0.001 # |
Base deficit on NICU admission * | −7.9 (−12.6; −6.0) | −5 (−6.6; −3.2) | <0.001 # |
pH on admission * | 7.29 (7.23; 7.35) | 7.33 (7.30; 7.41) | 0.008 # |
Male sex $ | 31 (55.4) | 12 (44.4) | 0.064 £ |
SGA $ | 4 (7.1) | 6 (22.2) | 0.071 £ |
IUGR $ | 7 (12.5) | 10 (37.0) | 0.021 £ |
Intubation at birth $ | 39 (69.6) | 13 (48.1) | 0.098 £ |
Surfactant at birth $ | 19 (33.9) | 8 (29.6) | 0.805 £ |
Symptomatic PDA $ | 23 (41.1) | 12/27 (44.4) | 0.957 £ |
Severe IVH $ | 28 (50.0) | 5 (18.5) | 0.008 £ |
Pulmonary hemorrhage $ | 16 (28.6) | 5 (18.5) | 0.423 £ |
Air-leak syndromes $ | 9 (16.1) | 0 (0) | 0.028 £ |
Sepsis (confirmed early or late) $ | 28 (50.0) | 21 (77.8) | 0.030 £ |
Septic shock $ | 13 (23.2) | 15 (55.6) | 0.008 £ |
Fentanyl monotherapy $ | 13 (23.2) | 7 (25.9) | 1.0 £ |
Sedative monotherapy $ | 6 (10.7) | 4 (15.4) | 0.718 £ |
Fentanyl and sedatives $ | 17 (30.4) | 5 (18.5) | 0.423 £ |
NEC stage II–III $ | 4 (7.2) | 6 (22.2) | 0.071 £ |
Surgical NEC $ | 3 (5.4) | 3 (11.1) | 0.385 £ |
BPD any stage $ | 13 (23.2) | 14 (51.9) | 0.018 £ |
RDS $ | 40 (71.4) | 22 (81.5) | 0.423 £ |
Overall mechanical ventilation $ | 55 (98.2) | 27 (100) | 0.999 £ |
Invasive ventilation $ | 54 (96.4) | 26 (96.3) | 0.999 £ |
Non-invasive ventilation $ | 21 (37.5) | 21 (13.3) | 0.001 £ |
Survival $ | 17 (30.9) | 17 (65.4) | 0.004 £ |
Days in NICU for all population * | 11 (4; 50) | 63 (23.5; 98.5) | <0.001 # |
Days in NICU for survivors * | 88 (62; 133) | 65 (63; 138) | 0.823 # |
Days in NICU for non-survivors * | 7 (1.7; 12.5) | 16.5 (6.75; 28.5) | 0.014 # |
Significant Independent Factors | Odds Ratio | Confidence Intervals | p-Value | |
---|---|---|---|---|
Lower | Upper | |||
GA | 0.74 | 0.63 | 0.86 | <0.001 |
Fentanyl | 4.66 | 2.05 | 10.88 | <0.001 |
SIVH | 6.67 | 1.94 | 31.19 | 0.01 |
Septic shock | 4.95 | 1.76 | 15.45 | <0.001 |
Discriminating ability | ||||
AUC | 0.88 | 0.84 | 0.93 | |
Threshold | 0.34 | |||
Specificity | 0.86 | |||
Sensitivity | 0.82 |
Significant Independent Factors | Odds Ratio | Confidence Intervals | p-Value | |
---|---|---|---|---|
Lower | Upper | |||
GA | 0.769 | 0.648 | 0.908 | 0.002 |
Base deficit | 0.900 | 0.806 | 0.989 | 0.042 |
Fentanyl ± sedatives | 4.089 | 1.809 | 9.329 | 0.001 |
SIVH | 5.544 | 2.032 | 16.157 | 0.001 |
Discriminating ability | ||||
AUC | 0.877 | 0.824 | 0.932 | |
Threshold | 0.272 | |||
Specificity | 0.861 | |||
Sensitivity | 0.804 |
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Stathopoulou, T.; Agakidou, E.; Paschaloudis, C.; Kontou, A.; Chatzioannidis, I.; Sarafidis, K. Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study. Children 2023, 10, 1667. https://doi.org/10.3390/children10101667
Stathopoulou T, Agakidou E, Paschaloudis C, Kontou A, Chatzioannidis I, Sarafidis K. Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study. Children. 2023; 10(10):1667. https://doi.org/10.3390/children10101667
Chicago/Turabian StyleStathopoulou, Theodora, Eleni Agakidou, Christos Paschaloudis, Angeliki Kontou, Ilias Chatzioannidis, and Kosmas Sarafidis. 2023. "Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study" Children 10, no. 10: 1667. https://doi.org/10.3390/children10101667
APA StyleStathopoulou, T., Agakidou, E., Paschaloudis, C., Kontou, A., Chatzioannidis, I., & Sarafidis, K. (2023). Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study. Children, 10(10), 1667. https://doi.org/10.3390/children10101667