A survey on management practices of hypotension in preterm neonates: an Indian perspective
BackgroundHypotension is a common entity in the neonatal intensive care unit (NICU) and is reported in 24%–50% of preterm infants with birth weight less than 1,500 g. Rapid diagnosis and aggressive management is crucial to reduce its detrimental effects on end-organs especially the brain. Physicians...
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Frontiers Media S.A.
2024-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2024.1411719/full |
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| author | Rupam Das Rema Nagpal Sujata Deshpande Gunjana Kumar Anita Singh Aditya Kallimath Pradeep Suryawanshi |
| author_facet | Rupam Das Rema Nagpal Sujata Deshpande Gunjana Kumar Anita Singh Aditya Kallimath Pradeep Suryawanshi |
| author_sort | Rupam Das |
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| description | BackgroundHypotension is a common entity in the neonatal intensive care unit (NICU) and is reported in 24%–50% of preterm infants with birth weight less than 1,500 g. Rapid diagnosis and aggressive management is crucial to reduce its detrimental effects on end-organs especially the brain. Physicians often rely on blood pressure alone as a reliable indicator of tissue perfusion, but variations exist in the definition of this crucial parameter. There are also practice variations in the use of diagnostic tools and management modalities among physicians.MethodologyA physician-based cross-sectional survey of management practices of hypotension in preterm neonates in Indian NICUs was conducted using an online survey tool. The questionnaire addressed diagnostic criteria used, utility of echocardiography for the assessment of hypotension, and management strategies used, such as volume expansion, inotropes and steroids.ResultsThree hundred and twenty physicians, working predominantly in Level III NICUs, responded to the survey. The practice of delayed cord clamping was followed in the units of 78% respondents. Only 44% respondents had an institutional written protocol for the management of hypotension. The criteria for the diagnosis of hypotension varied, with 52% using mean blood pressure (BP) less than gestational age as the criteria. Capillary refill time, blood pressure and heart rate were the most common clinical criteria used. 85% respondents used echocardiography in the NICU, but only 73% utilised it for assessment of a hypotensive neonate. Physicians preferred a ‘volume-inotrope-echo-steroid’ strategy, with 85% respondents using volume expansion. Dopamine was the preferred first line inotrope, followed by norepinephrine and low-dose epinephrine.ConclusionThis survey reflects significant variations in practice amongst neonatal physicians in India. Bedside targeted echocardiography needs to be better utilised as a vital tool to determine the pathophysiology of disease and hemodynamic monitoring in the management of hypotension in neonates. While further research is needed on outcome-oriented objectives, awareness and dissemination of already existing guidelines would be useful to standardize clinical practice. |
| format | Article |
| id | doaj-art-92aba08515284e4fb2f788efbdaaab57 |
| institution | OA Journals |
| issn | 2296-2360 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-92aba08515284e4fb2f788efbdaaab572025-08-20T01:50:45ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-10-011210.3389/fped.2024.14117191411719A survey on management practices of hypotension in preterm neonates: an Indian perspectiveRupam Das0Rema Nagpal1Sujata Deshpande2Gunjana Kumar3Anita Singh4Aditya Kallimath5Pradeep Suryawanshi6Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, IndiaDepartment of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, IndiaDepartment of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, IndiaDepartment of Neonatology, National Institute of Medical Sciences and Research, Jaipur, IndiaSanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaDepartment of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, IndiaDepartment of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, IndiaBackgroundHypotension is a common entity in the neonatal intensive care unit (NICU) and is reported in 24%–50% of preterm infants with birth weight less than 1,500 g. Rapid diagnosis and aggressive management is crucial to reduce its detrimental effects on end-organs especially the brain. Physicians often rely on blood pressure alone as a reliable indicator of tissue perfusion, but variations exist in the definition of this crucial parameter. There are also practice variations in the use of diagnostic tools and management modalities among physicians.MethodologyA physician-based cross-sectional survey of management practices of hypotension in preterm neonates in Indian NICUs was conducted using an online survey tool. The questionnaire addressed diagnostic criteria used, utility of echocardiography for the assessment of hypotension, and management strategies used, such as volume expansion, inotropes and steroids.ResultsThree hundred and twenty physicians, working predominantly in Level III NICUs, responded to the survey. The practice of delayed cord clamping was followed in the units of 78% respondents. Only 44% respondents had an institutional written protocol for the management of hypotension. The criteria for the diagnosis of hypotension varied, with 52% using mean blood pressure (BP) less than gestational age as the criteria. Capillary refill time, blood pressure and heart rate were the most common clinical criteria used. 85% respondents used echocardiography in the NICU, but only 73% utilised it for assessment of a hypotensive neonate. Physicians preferred a ‘volume-inotrope-echo-steroid’ strategy, with 85% respondents using volume expansion. Dopamine was the preferred first line inotrope, followed by norepinephrine and low-dose epinephrine.ConclusionThis survey reflects significant variations in practice amongst neonatal physicians in India. Bedside targeted echocardiography needs to be better utilised as a vital tool to determine the pathophysiology of disease and hemodynamic monitoring in the management of hypotension in neonates. While further research is needed on outcome-oriented objectives, awareness and dissemination of already existing guidelines would be useful to standardize clinical practice.https://www.frontiersin.org/articles/10.3389/fped.2024.1411719/fullhypotensionsurveypractice variationsIndian NICUspreterm |
| spellingShingle | Rupam Das Rema Nagpal Sujata Deshpande Gunjana Kumar Anita Singh Aditya Kallimath Pradeep Suryawanshi A survey on management practices of hypotension in preterm neonates: an Indian perspective Frontiers in Pediatrics hypotension survey practice variations Indian NICUs preterm |
| title | A survey on management practices of hypotension in preterm neonates: an Indian perspective |
| title_full | A survey on management practices of hypotension in preterm neonates: an Indian perspective |
| title_fullStr | A survey on management practices of hypotension in preterm neonates: an Indian perspective |
| title_full_unstemmed | A survey on management practices of hypotension in preterm neonates: an Indian perspective |
| title_short | A survey on management practices of hypotension in preterm neonates: an Indian perspective |
| title_sort | survey on management practices of hypotension in preterm neonates an indian perspective |
| topic | hypotension survey practice variations Indian NICUs preterm |
| url | https://www.frontiersin.org/articles/10.3389/fped.2024.1411719/full |
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