TY - JOUR
T1 - Validity of biomarkers of early circulatory impairment to predict outcome: A retrospective analysis
AU - NeoCirculation Consortium (NEO-CIRC)
AU - Bravo, María Carmen
AU - López-Ortego, Paloma
AU - Sánchez, Laura
AU - Madero, Rosario
AU - Cabañas, Fernando
AU - Koch, Armin
AU - Rojas-Anaya, Héctor
AU - Rabe, Heike
AU - Pellicer, Adelina
AU - Amess, Philip
AU - Aiton, Neil
AU - Crook, David
AU - Fernandez-Alvarez, Ramon
AU - Mahoney, Liam
AU - Ramsay, Rebecca
AU - Kouman, Sonia Sobowiec
AU - Jullien, Vincent
AU - Le Saux, Thomas
AU - Pons, Gerard
AU - Zohar, Sarah
AU - Biertz, Frank
AU - Brinkhaus, Marjan
AU - Smith, Andrea
AU - Ziert, Yvonne
AU - Heredia, Jon Lopez
AU - Herrera, Maria Cruz Lopez
AU - Mielgo, Victoria
AU - Göpel, Wolfgang
AU - Härtel, Christoph
AU - Kotidis, Charalampos
AU - Turner, Mark
AU - Weindling, Michael
AU - Roll, Claudia
AU - Pavía, Marta
AU - Gleeson, Clare
AU - Bryson, Simon
AU - Matyas, Melinda
AU - Zaharie, Gabriela
AU - Bokodi, Géza
AU - Szabó, Miklós
AU - Ertl, Tibor
AU - Funke, Simone
AU - Ergenekon, Ebru
AU - Gücüyener, Kivilcim
AU - Soysal, Ebnem
AU - Dammann, Christiane
AU - Raju, Tonse N.K.
AU - Evans, Nicholas
AU - Läer, Stephanie
AU - Mader, Silke
N1 - Funding Information:
This study has been performed as part of the NEO-CIRCulation Project. The work was partially supported by NEO-CIRC FP7-HEALTH grant (agreement no: 282533).
Funding Information:
This study has been performed as part of the NEO-CIRCulation Project. The work was partially supported by NEO-CIRC FP7-HEALTH grant (agreement no: 282533). We thank the partners of the NEO-CIRC consortium for their ongoing scientific discussions of the topic (Chief Investigator: AP, Madrid, Spain. Principal Project Coordinator: HR, Brighton, UK. Local Investigators: Philip Amess, Neil Aiton, David Crook, Ramon Fernandez-Alvarez, Liam Mahoney, HR, Rebecca Ramsay, HR-A, Sonia Sobowiec Kouman, Brighton, UK; Vincent Jullien, Thomas Le Saux, Gerard Pons, Sarah Zohar, Paris, France; Frank Biertz, Marjan Brinkhaus, AK, Andrea Smith, Yvonne Ziert, Hannover, Germany; Jon Lopez Heredia, Maria Cruz Lopez Herrera, Victoria Mielgo, Bizkaia, Spain; Wolfgang Göpel, Christoph Härtel, Lübeck, Germany; Charalampos Kotidis, Mark Turner, Michael Weindling, Liverpool, UK; Claudia Roll, Datteln, Germany; Maria del Carmen Bravo, FC, PL-O, LS, Marta Pavía, AP, Madrid, Spain; Clare Gleeson, Simon Bryson, Manchester, UK; MelindaMatyas, Gabriela Zaharie, Cluj-Napoca, Romania; Géza Bokodi, Miklós Szabó, Budapest, Hungary; Tibor Ertl, Simone Funke, Pécs, Hungary; Ebru Ergenekon,
Publisher Copyright:
Copyright © 2019 Bravo, López-Ortego, Sánchez, Madero, Cabañas, Koch, Rojas-Anaya, Rabe and Pellicer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019
Y1 - 2019
N2 - 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 <51 ml/kg/min. Results: Ninety eight infants formed the study cohort. Thirty six received CVT (2-95 h). Logistic regression models adjusted for gestational age showed a positive association between CVT and the risk of death or moderate-severe abnormal cranial ultrasound at term equivalent [(OR 5.2, 95%CI: 1.8-15.1) p = 0.002]. MABP < GA-1 mmHg and lactate > 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.
AB - 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 <51 ml/kg/min. Results: Ninety eight infants formed the study cohort. Thirty six received CVT (2-95 h). Logistic regression models adjusted for gestational age showed a positive association between CVT and the risk of death or moderate-severe abnormal cranial ultrasound at term equivalent [(OR 5.2, 95%CI: 1.8-15.1) p = 0.002]. MABP < GA-1 mmHg and lactate > 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.
UR - http://www.scopus.com/inward/record.url?scp=85067437167&partnerID=8YFLogxK
U2 - 10.3389/fped.2019.00212
DO - 10.3389/fped.2019.00212
M3 - Journal articles
AN - SCOPUS:85067437167
VL - 7
JO - Frontiers in Pediatrics
JF - Frontiers in Pediatrics
IS - MAY
M1 - 212
ER -