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Towards logical treatment of hypotension
Abstracts
214
3. Klarr, J.M., Faix, R.G., Pry, C.J. and Bhatt-Mehta, 177-122. Towards
logical treatment
“South Cleveland Tyne, UK.
Hospital,
of hypotension. Middlesbrough,
V. (1994): J. Pediatr., 125,
J.P. Wyllie”,
UK, ‘Freenuzn
AS. Hunter’, Hospital,
E. Heyh,
Newcastle-upon-
Blood pressureis a result of cardiac output and systemic resistance.The former can be assessedusing ultrasound and the effect of treatments for hypotension assessed. Hypotensive infants with systolic or mean blood pressurebelow the 10th centile receiving either colloid or inotrope as a first intervention, were assessedusing echo-Doppler. No acidotic (pH < 7.25) patients were included and all but three were premature. Left ventricular output (LVO), fractional shortening (FS), left ventricular end diastolic diameter (LVEDD) and aortic diameter (Ao) were measuredjust before, 1 and 2 h after treatment. Blood pressure, heart rate and blood gaseswere also recorded. An increase in LVO of less than 10% was ignored as this is within the variation of the technique. Results: Twenty-six babiesreceived colloid (10 ml/kg) with an increasein LVO of > 10% in 17, which was sustainedto 2 h in only three infants. LVO was increasedin 14 of 16 infants with LVEDD:Ao < 2-O but in only three of 10 infants with LVEDD. Ao > 2 (P < 0.005) All infants with a sustainedeffect had LVEDD:Ao < 2-O. Twenty-four infants received dobutamine (5 pg/kg/min) and 15 had increased LVO at 1 h which was sustainedin 12 at 2 h. Of 15 with increasedLVO, 11 had FS < 30% and four > 30% (P < 0.05). Conclusion: To increase LVO, inotropes should logically be considered if FS < 30% and colloid only if LVEDD:Ao is < 2.0. The colloid effect is likely to be transient.
Measurement properties of CRIB (clinical risk index for babies) - validity beyond the first 12 h of life, reliability and responsiveness. P.W. Fowlie, C.R. Gould, W.O. Tamow-Mordi, D. Strang, Department of Child Health, Ninewells Hospital
and Medical
School,
University
of Dundee,
Dundee,
UK.
Objective: To assess(1) the validity of CRIB (clinical risk index for babies) as a measureof risk and illness severity beyond the first 12 h of life, (2) the reliability of CRIB, and (3) the ability of CRIB to measurechange in risk and illness severity over time in individual infants (responsiveness). Methods: Retrospective study in a cohort of 398 infants born weighing I 1500 g or born at < 31 weeks’ gestation in six Scottish neonatal units, three tertiary and three non-tertiary. Models were fitted to the data using regressiontechniques and ROC curves created to assessvalidity and responsiveness.Reliability was assessed using correlation coefficients. Results: CRIB score throughout the first week of life was significantly associated with the risk of death, P < 0.05: CRIB 12 h, area under ROC curve (AZ) = 0.86;
214
3. Klarr, J.M., Faix, R.G., Pry, C.J. and Bhatt-Mehta, 177-122. Towards
logical treatment
“South Cleveland Tyne, UK.
Hospital,
of hypotension. Middlesbrough,
V. (1994): J. Pediatr., 125,
J.P. Wyllie”,
UK, ‘Freenuzn
AS. Hunter’, Hospital,
E. Heyh,
Newcastle-upon-
Blood pressureis a result of cardiac output and systemic resistance.The former can be assessedusing ultrasound and the effect of treatments for hypotension assessed. Hypotensive infants with systolic or mean blood pressurebelow the 10th centile receiving either colloid or inotrope as a first intervention, were assessedusing echo-Doppler. No acidotic (pH < 7.25) patients were included and all but three were premature. Left ventricular output (LVO), fractional shortening (FS), left ventricular end diastolic diameter (LVEDD) and aortic diameter (Ao) were measuredjust before, 1 and 2 h after treatment. Blood pressure, heart rate and blood gaseswere also recorded. An increase in LVO of less than 10% was ignored as this is within the variation of the technique. Results: Twenty-six babiesreceived colloid (10 ml/kg) with an increasein LVO of > 10% in 17, which was sustainedto 2 h in only three infants. LVO was increasedin 14 of 16 infants with LVEDD:Ao < 2-O but in only three of 10 infants with LVEDD. Ao > 2 (P < 0.005) All infants with a sustainedeffect had LVEDD:Ao < 2-O. Twenty-four infants received dobutamine (5 pg/kg/min) and 15 had increased LVO at 1 h which was sustainedin 12 at 2 h. Of 15 with increasedLVO, 11 had FS < 30% and four > 30% (P < 0.05). Conclusion: To increase LVO, inotropes should logically be considered if FS < 30% and colloid only if LVEDD:Ao is < 2.0. The colloid effect is likely to be transient.
Measurement properties of CRIB (clinical risk index for babies) - validity beyond the first 12 h of life, reliability and responsiveness. P.W. Fowlie, C.R. Gould, W.O. Tamow-Mordi, D. Strang, Department of Child Health, Ninewells Hospital
and Medical
School,
University
of Dundee,
Dundee,
UK.
Objective: To assess(1) the validity of CRIB (clinical risk index for babies) as a measureof risk and illness severity beyond the first 12 h of life, (2) the reliability of CRIB, and (3) the ability of CRIB to measurechange in risk and illness severity over time in individual infants (responsiveness). Methods: Retrospective study in a cohort of 398 infants born weighing I 1500 g or born at < 31 weeks’ gestation in six Scottish neonatal units, three tertiary and three non-tertiary. Models were fitted to the data using regressiontechniques and ROC curves created to assessvalidity and responsiveness.Reliability was assessed using correlation coefficients. Results: CRIB score throughout the first week of life was significantly associated with the risk of death, P < 0.05: CRIB 12 h, area under ROC curve (AZ) = 0.86;