4 *MYTHS* about Newborn Blood Pressure!! And why they're WRONG!!
Summary
TLDRDr. Tala, a neonatologist with 16 years of experience, discusses neonatal hypotension in a series of videos. She addresses common myths around blood pressure management in NICUs, focusing on the distinctions between vasopressors, inotropes, and chronotropic drugs. Dr. Tala emphasizes the importance of selecting the correct medication based on the underlying cause of low blood pressure, rather than using terms interchangeably. She also debunks the idea that blood pressure alone is a reliable indicator of neonatal oxygenation, advocating for a more comprehensive approach to evaluating and treating neonatal hypotension.
Takeaways
- 📉 Low blood pressure in neonates is not universally treated the same way across cases, and treatment should depend on the specific cause.
- 💊 Vasopressors and inotropes are different: vasopressors increase diastolic pressure by squeezing blood vessels, while inotropes enhance the heart's contractility, increasing systolic pressure.
- ⏱ Chronotropic drugs, such as epinephrine and dobutamine, increase the heart rate (chronotropy), while some drugs can have multiple effects depending on dosage.
- 👶 Neonatal blood pressure is a poor indicator of blood flow, especially within the first 24 hours of life; other markers like urine output, capillary refill, and lactic acid levels offer more insights.
- 🫀 Blood pressure is only a surrogate marker for blood flow and oxygenation. Even if blood pressure seems normal, there may still be insufficient blood flow to the body's tissues.
- 🧪 When assessing low blood flow, check for signs such as pale skin, delayed capillary refill, decreased urine output, and elevated lactic acid.
- 📏 The mean blood pressure, while commonly used, may not fully indicate adequate perfusion; assessing systolic and diastolic values can provide more clarity, especially in cases like PDA (Patent Ductus Arteriosus).
- 📊 Studies show only a weak correlation between low blood pressure treatment and improved neonatal outcomes, and not all cases of hypotension require intervention.
- 🧠 Treating low blood pressure alone doesn’t necessarily improve outcomes; it’s more effective to intervene when there are signs of inadequate oxygenation, such as high lactic acid levels.
- 📚 It’s critical to match the right medication to the cause of the hypotension—whether vasopressors or inotropes—rather than assuming a one-size-fits-all approach.
Q & A
What is considered a low blood pressure in neonates, and when should it be treated?
-A low blood pressure in neonates varies depending on gestational age, clinical condition, and other factors. It is not defined by a single number but rather by a combination of clinical signs and measurements. Treatment should be considered if there are signs of poor perfusion, such as pallor, delayed capillary refill, low urine output, or increased lactate levels, rather than just based on blood pressure alone.
What is the difference between inotropes and vasopressors?
-Inotropes are medications that increase the contractility of the heart, making it squeeze harder (e.g., epinephrine, dobutamine, milrinone). They generally increase systolic blood pressure. Vasopressors, on the other hand, work by constricting peripheral blood vessels, increasing diastolic blood pressure (e.g., norepinephrine, vasopressin, dopamine at higher doses). The two should not be used interchangeably as they have different effects.
Why is it important to choose the right medication for hypotension in neonates?
-Choosing the right medication is crucial because different types of hypotension may require different treatments. For example, a baby with septic shock and dilated blood vessels may benefit more from a vasopressor to increase diastolic blood pressure, while a baby with poor heart contractility would need an inotrope to improve systolic blood pressure. Using the wrong medication could exacerbate the condition.
Why might mean blood pressure not be the best indicator of a neonate's overall status?
-Mean blood pressure is just an average of systolic and diastolic pressures and does not give a complete picture of the baby’s perfusion status. A normal mean blood pressure can mask issues like a low systolic pressure, indicating poor cardiac output, or a low diastolic pressure, indicating peripheral vasodilation. It’s essential to consider systolic and diastolic pressures separately, along with other clinical signs.
What are some clinical signs that indicate poor perfusion in a neonate?
-Signs of poor perfusion include pallor, delayed capillary refill (longer than 3-4 seconds), decreased urine output (less than 1 ml/kg/hr or a significant drop from the baseline), and increased lactate levels indicating anaerobic metabolism. These signs suggest that the blood is not reaching all the cells adequately.
What does a widened pulse pressure in a neonate indicate?
-A widened pulse pressure, where the difference between systolic and diastolic pressures is large, could indicate conditions such as a patent ductus arteriosus (PDA). In this situation, there may be adequate left ventricular function, but significant blood shunting during diastole, leading to decreased blood flow to the rest of the body despite a seemingly normal mean blood pressure.
How should we interpret a narrow pulse pressure in a neonate?
-A narrow pulse pressure, where systolic and diastolic pressures are close together, suggests that the heart is struggling to pump effectively against a higher afterload. This may indicate conditions like cardiac dysfunction or increased systemic vascular resistance, where the heart cannot generate sufficient cardiac output.
Does treating low blood pressure in neonates improve outcomes?
-Treating low blood pressure based solely on the number may not necessarily improve outcomes. Studies have shown that there is a weak correlation between blood pressure and actual perfusion, especially in the first 24 hours. Treatment should be targeted based on signs of poor perfusion and oxygen delivery to tissues, such as high lactate levels, rather than just blood pressure alone.
What was the primary outcome of the HIP trial on treating low blood pressure in preterm infants?
-The HIP trial found that infants treated with dopamine had slightly higher blood pressures, but there was no significant difference in the primary outcome of survival without severe brain injury compared to those who received a placebo. This suggests that treating low blood pressure with dopamine alone may not necessarily improve outcomes and highlights the need for individualized treatment approaches.
What are other indicators besides blood pressure that clinicians should consider when assessing neonatal perfusion and oxygenation status?
-Clinicians should consider signs such as pallor, delayed capillary refill, decreased urine output, and increased lactate levels. These indicate poor perfusion and inadequate oxygen delivery to tissues. Additionally, monitoring for metabolic acidosis can provide clues about the baby’s oxygenation and perfusion status beyond just blood pressure readings.
Outlines
🩺 Understanding Neonatal Hypotension: A New Approach
This paragraph introduces the main topic: hypotension in neonates. Dr. Tala, a neonatologist with 16 years of experience, shares insights on how to define low blood pressure in newborns and discusses the approach to treatment. She highlights that neonatal blood pressure management has evolved, with the realization that different babies may require different treatments depending on their condition. She emphasizes that blood pressure medications like vasopressors and inotropes are not interchangeable and should be used based on the baby's specific needs. The paragraph sets the stage for a discussion of neonatal hypotension myths and best practices.
💉 Myth 1: Vasopressors and Inotropes Are Not the Same
In this section, Dr. Tala debunks the myth that vasopressors and inotropes can be used interchangeably. She explains that while inotropes increase the heart's contractility, vasopressors work by constricting blood vessels to raise blood pressure. The key distinction is that inotropes like epinephrine and dobutamine target systolic pressure, while vasopressors such as norepinephrine and vasopressin influence diastolic pressure. She also introduces chronotropic drugs that affect heart rate. The paragraph stresses the importance of choosing the right medication based on the baby's condition and not treating all low blood pressures the same way.
📊 Myth 2: Blood Pressure Is Not Always a Good Indicator of Oxygenation
Dr. Tala addresses the misconception that blood pressure alone can reliably indicate a baby's oxygenation status. She explains that adequate oxygen delivery to the cells depends not only on blood pressure but also on factors like cardiac output and oxygen content in the blood. In some cases, a baby might have normal blood pressure but still suffer from poor oxygenation due to issues like anemia or respiratory distress. She highlights that a comprehensive assessment should include other markers of blood flow, such as skin perfusion, urine output, and lactic acid levels, to get a more accurate picture of the baby's oxygenation.
🩸 Myth 3: Mean Blood Pressure Isn’t the Full Picture
Here, Dr. Tala challenges the common practice of relying heavily on mean blood pressure as a measure of neonatal health. While mean blood pressure can provide useful information, it doesn’t tell the whole story. She explains that in neonates, systolic and diastolic blood pressure also provide important clues about heart function and blood flow. For instance, a widened pulse pressure can indicate conditions like patent ductus arteriosus (PDA), where blood might not be reaching the body despite an acceptable mean pressure. She stresses the importance of considering all components of blood pressure rather than just focusing on the mean.
🔍 Myth 4: Treating Low Blood Pressure Always Improves Outcomes
Dr. Tala tackles the belief that treating low blood pressure in neonates will automatically lead to better outcomes. She discusses research, particularly the HIP trial, which tested the effect of treating low blood pressure with dopamine in premature babies. The study showed that while dopamine raised blood pressure, it didn’t necessarily lead to better outcomes in terms of survival without brain injury. However, the study was underpowered, meaning more research is needed. The key takeaway is that treatment should focus on improving blood flow and oxygen delivery, not just raising blood pressure.
Mindmap
Keywords
💡Hypotension
💡Inotropes
💡Vasopressors
💡Chronotropes
💡Cardiac Output
💡Mean Blood Pressure
💡Pulse Pressure
💡Lactic Acidosis
💡Perfusion
💡Vasoactive Agents
Highlights
Introduction by Dr. Tala, a neonatologist with 16 years of experience, discussing hypotension in neonates and blood pressure management in NICU.
Dr. Tala points out the misconception that vasopressors and inotropes are interchangeable and emphasizes that they work differently.
Inotropes increase heart contractility, while vasopressors constrict peripheral blood vessels, impacting diastolic blood pressure.
Epinephrine serves as both a chronotrope, increasing heart rate, and an inotrope, improving heart contraction.
Dopamine affects different receptors based on dosage, illustrating how medication effects vary with dose adjustments.
The importance of identifying the cause of hypotension to choose the right treatment: for sepsis, vasopressors are needed; for heart issues, inotropes are more appropriate.
Myth 1 debunked: Vasoactive agents affect neonatal blood pressure but come from different drug classes, including inotropes, vasopressors, and chronotropes.
Myth 2 debunked: Blood pressure alone is not a reliable indicator of neonatal oxygenation status; other factors like skin pallor, capillary refill, and lactic acidosis should be considered.
Myth 3 debunked: The mean blood pressure is not the most critical indicator of a baby's condition; both systolic and diastolic pressures provide additional insights.
The 'rule of thumb' for mean blood pressure is that it should be around the baby's gestational age, but this doesn't always reflect adequate blood flow.
Examples showing how narrow or wide pulse pressures can indicate underlying issues like PDA, even when the mean blood pressure appears normal.
Myth 4 debunked: Routinely treating low blood pressures in neonates doesn’t always improve outcomes; addressing the root cause is more crucial.
Study discussed: The HIP trial showed that dopamine raised blood pressure but did not significantly improve survival rates or brain injury outcomes.
Difficulties in determining the true effectiveness of blood pressure treatments due to study limitations and crossover between treatment groups.
Conclusion of the video: Treating blood pressure alone isn't enough to improve neonatal outcomes; clinicians should focus on whether the baby is receiving adequate oxygen at the cellular level.
Transcripts
what is considered a low blood pressure
in a neonate when should we be treating
those low blood pressures and how should
we be treating those low blood pressures
which medications should we be choosing
hi I'm Dr tala and I've been a
neonatologist for about 16 years now I'm
also post call today so bear with me a
little bit but for the next three videos
we're going to be discussing blood
pressures or more specifically
hypotension in the neck Cube there are
so many questions about Neon
hypertension and in the next couple of
videos we're going to go over the myths
that we all kind of perpetrate in the
niku in part three of this series we're
going to be discussing different
clinical approaches to different types
of hypertension if you will before I go
on I just want to say I used so many
resources for these videos but I kept
coming back to these two papers by Dr
Ginger and Dr malali I've put the
references below they are excellent
review articles on neonatal hypertension
let's get started with myth number one
so the first myth is that we can use the
terms vasopress and inotropes
interchangeably because they basically
mean the same thing okay I'm starting
here because it really sums up how we've
been treating blood pressure management
up until recently that a low blood
pressure in one baby is the same thing
as a low blood pressure on another baby
and we should give them the same
medication and so we might as well call
all the medications the same thing and
we'll talk about this a lot more in the
coming two videos but we're realizing
that really none of that is true and all
these different blood pressure
medications if you will work in a
slightly different way so ideally we
need to pick exactly the right
medication for a specific scenario so a
lot of the time when we're using the
terms vasopress and inotropes
interchangeably then we're just flat out
wrong they don't work the same way and
it also kind of glosses over that we
don't really understand what's going on
with the baby if we're using these terms
in the same way so let's go over these
definitions an inotrope is a medication
that causes the heart to squeeze harder
or it increases the contractility of the
heart remember this by thinking
inotropes make the heart go in and out
in and out inotrope in and out help me
anyway these are medications like
epinephrine dobutamine and meanone and
they will all generally cause an
increase in systolic blood pressure
vasopressors on the other hand are
medications that will squeeze the
peripheral blood vessels so literally
Vaso vessel presser squeeze and these
are medications like norepinephrine
vasopressin and dopamine generally these
medication because they're squeezing the
arterials and the blood vessels in the
periphery are causing an increase in
diastolic blood pressure another
definition that we use is chronotropic
drugs so chronotropic Chrono think like
a watch makes the heart rate go faster
so think what medication are we for
example using in the delivery room in a
code to try to make the heart rate go
faster yep epinephrine so epinephrine is
also Al a chronotropic drug as is for
example dobutamine it will make the
heart beat faster two important things
here that I'm sure you figured out
already and that is that each individual
drug may have more than one effect for
example epinephrine is both a
chronotrope so makes the heartbeat
faster and an inotrope so makes the
heart squeeze harder as well and it's
also possible that depending on the dose
of the drug being given then we're more
likely to see one effect over the other
so for example with dopamine which
everybody's used we use it at different
Doses and like you all know at different
doses we expect it to be hitting more of
one type of receptor so we kind of
expect it to be having slightly
different effects depending on the
dosage and we'll be talking about that a
lot more and the second thing is and
this is like really the Crux of these
whole videos is that we should be really
figuring out why the baby has a low
blood pressure and then treating with
the right medication for example if a
baby is septic and all the peripheral
vessels are all dilated and the
diastolic blood pressure is low then we
want to give a vasopressor to squeeze
those vessels and increase the diastolic
blood pressure or for example the baby
had hiie and the Heart took a hit as
well and is not squeezing well then in
this scenario what do we want we
definitely don't want a vasopressor that
will make the heart having to work even
harder against the increased pressures
in this scenario we would want an
inotrope so that it will squeeze the
heart better so to rewrite myth number
one vasoactive agents are medications
that affect a baby's blood pressure and
they include different classes of drugs
including inotropes vasopressins
chronotropes myth number two a blood
pressure is a good indicator of the
baby's oxy ation status we can really
get to the heart of this why do we care
about a good blood pressure at all well
this is a question that we can answer we
care about a blood pressure because
we're hoping that it will indicate
adequate blood flu to make sure that all
the cells in the body are getting the
oxygen that they need or another more
scientific way of saying it we need
adequate blood flow to make sure that we
are getting end organ profusion and
maintaining cellular metabolism so if
the heart isn't pumping hard enough or
there's another reason why the blood
isn't reaching all the cells in the body
then we're going to have a problem the
babies also don't get the oxygen they
need if there literally isn't enough
oxygen in the blood so even if the heart
is pumping really well and the blood
pressure is fine but for example the
baby is really anemic and isn't carrying
enough oxygen or for example the baby
has horrible pulmonary hyp potential or
respiratory distress and the baby's sats
are in the 50s and the blood just isn't
carrying any Oxygen then again those
cells aren't going to get the oxygen
that they need so basically to make sure
that the cells all the cells in the body
are receiving the oxygen they need for
their cellular metabolism we need two
important things we need sufficient
cardiac output which means that the
heart is working well enough to
distribute the blood to all the cells in
the body and we need sufficient oxygen
within the blood as well we'll be
talking more about those terms cardiac
output and stuff a little bit later but
for now what I want you to understand is
that what we do is we use blood pressure
as a sorate marker for how good the
blood flow is to all the cells in the
body so what we're saying is if there is
a good blood pressure then we can assume
that there is good profusion of all the
cells in the body body again we're using
the blood pressure as a surrogate for
blood flow which brings us back to our
myth and as Studies have shown there is
only a weak correlation between a baby's
blood pressure and blood flow in the
body this is especially true in the
first 24 hours of life or immediately
after delivery and for anybody that's
interested this study was done by
measuring the blood flow in the superior
venne Carver or kind of measuring the
amount of blood flow that is coming back
to the heart and then correlating that
with the blood pressure so what this
means is we could have a normal blood
pressure but in reality there's a really
low blood flow or we could have a low
blood pressure but really we have enough
blood flow to all the cells in the body
little caveat here obviously if a baby's
blood pressure is super low like it's in
the teens and like a 35 weer then at
that point the chances of having
adequate blood flow is basically zero so
if it's really really low then yes we're
not going to have good blood flow which
again brings us back to our myth so just
because there is a low blood pressure it
doesn't mean we have a low blood flow so
what we need to do is look for other
markers of low blood flow in addition to
the blood pressure so what are the
markers well let's start with if the
baby is pale and has poor perfusion so
think about it if the baby doesn't have
enough blood going to all the cells in
the body it's definitely going to try to
shunt that blood towards essential
organs so towards the heart and the
Brain the skin isn't really an essential
organ so less blood will be going to the
skin and so the baby will appear pale
and there'll be decreased perfusion so
you'll have a delayed capillary refill
so like a 3 to 4 second cap refill time
also the kidneys aren't essential for
second to Second survival so again the
blood would also be diverted away from
the kidneys and how would you know that
this is happening because there would be
decreased urine output objectively
decreased urine output would be
considered less than 1 ml per kilo per
hour but really what's more important is
how much the baby is urinating now
compared to how much it was urinating
previously so if the baby was peeing
like 4 MLS per kilo per hour and is now
peeing 1.1 then that's a huge drop off
in urine output then ultimately if the
cells in the different organs aren't
receiving the oxygen they need then how
are those cells going to metabolize yep
Anor robic and what do the cells produce
when they metabolize anerobic
lactic acid so seeing an increase in
lactic acid is also further proof that
all the cells in the body aren't getting
the oxygen they receive so for example
if you measure the lactic acid and it's
above two or above between 2 to four
milles per liter then this is a sign of
the cells receiving inadequate oxygen if
you're not measuring the lactic acid
then this could also be shown by an
increase in metabolic acidosis on the
gases I know you know that I'm just
saying it let's reward that myth blood
pressure may be one indicator of the
baby's oxygenation status other
indicators would be whether the baby is
pale does the baby have delayed
profusion so a delayed cap refill has
the baby's urine out put dropped off and
do we have increased lactic acidosis or
an increasing metabolic acidosis myth
number three the mean blood pressure is
the most important indicator of overall
status now I know that you know that
this isn't true because otherwise why
would we be even measuring or kind of
figuring out the systolic and the
diastolic blood pressures and then
documenting them remember the mean blood
pressure is exactly what it sounds like
it's the average blood pressure that the
baby EXP experiencing so basically it's
the average between the systolic and the
diastolic blood pressures in adults
because our heart beats slower we spend
a lot longer in diast than syy so the
average blood pressure in adults is
closer to the diastolic blood pressure
in babies whose heart rates beat a lot
faster their mean blood pressure is
relatively closer to their systolic
blood pressure the reason why we talk
about mean blood pressure so much and I
think there are probably two reasons
here the first is is that when we are
doing non-invasive blood pressure
monitoring the mean blood pressure is
what's actually really being measured
and then the other systolic and
diastolic are kind of being figured out
so if anything the mean blood pressure
is probably a slightly more accurate
reading and the other big reason is that
we all often use the mean blood pressure
as kind of an acceptable blood pressure
for premature infants so I learned this
and I actually teach it to people as a
pretty good starting point if you're
really concerned about the blood
pressure and that is that the mean blood
pressure should be about the gestational
age of the baby so for example if the
baby is born at 30 weeks and we have a
mean blood pressure of 31 then hopefully
that's okay by the way this number came
from the German neonatal Network where
they looked at about 5,000 babies who
were less than 32 weeks and they found
that if they teased out the number was
that if in the first 24 hours of Life
the mean blood pressure of the baby was
less than the baby's gestational age in
weeks then that baby had an increased
risk for ivh BPD and death and so mean
blood pressure became kind of like a
catchy thing to remember in the unit oh
it has to be the gestational age not
only that but we kind of extrapolated it
so we have a 4 we old X32 weer okay the
mean blood pressure should be 36 but as
you would or suspect the mean blood
pressure doesn't tell the full story
about whether the baby is getting
adequate blood flow it might be a good
starting point but it doesn't tell the
full story and I can give you all an
example that you've all seen so many
times so let's assume that you have a
2-e old x25 we infant with a mean blood
pressure of 28 but when you look at the
systolic and the diastolic the systolic
is 40 and the diastolic is 17 the mean
is okay but what do you think about the
actual systolic and the diastolic or the
pulse pressure that diastolic definitely
sounds low but let's figure out the
pulse pressure and how do we figure out
whether it's wide or not so what we do
is we double the diastolic so 17 * 2 is
34 if the double the diastolic is still
less than the systolic then we consider
this a widened pulse pressure so in this
situation 34 is obviously less than 40
we do have a widened pulse pressure and
it looks very much like we have a very
low diastolic blood pressure in this
baby you may listen to the heart and
hear a really loud murmur so this would
all go with a PDA now with a PDA or a
symptomatic PDA you might have adequate
pumping from the left ventricle but a
lot of that blood may get shunted off
during diast so even though the mean
blood pressure is adequate there might
not be enough blood actually getting to
the body so you might see decreas in
urine output or increasing acidosis
because of a PDA and we've all had these
scenarios before in the niku let's cover
another example and this is directly
from Dr el kash's paper so let's say
that you have a 30-week baby with a mean
blood pressure of 30 again maybe that
appears acceptable but then let's assume
that the systolic blood pressure is 32
and the diastolic blood pressure is 25
if if anything this pulse pressure is
narrow the diastolic blood pressure is
pretty high and the systolic blood
pressure is pretty low what does this
mean this suggests that the heart is
trying to squeeze against higher
pressures and most likely with that low
systolic the heart isn't able to create
the cardiac output that it needs to so
if the heart isn't get getting enough
cardiac output then the cells in the
body are probably not getting the oxygen
that they need so even though the mean
blood pressure appears adequate here it
looks like the heart isn't being able to
pump adequately so let's reward that
myth the mean blood pressure may be one
indicator of adequate blood flow going
to the baby's body but the systolic and
the diastolic blood pressure Also may
give you clues about why that baby is
not getting enough blood flow myth
number four routinely treating low blood
pressures and neonates in improves
outcomes and this is the key part of
everything we do right like why even
measure something and treat it if it's
not going to make any difference in the
outcome so to take an example completely
out of context say we measure the
thyroid level in a baby and we find out
that it's low and so we give thyroid
medications if giving thyroid
medications doesn't really affect how
the baby does in the future we wouldn't
even bother giving thyroid medications
we wouldn't even bother testing the
thyroid because it doesn't make any
difference so this is how we should
think about all of medicine if we find
the low blood pressures and we do
something about it does it actually make
a difference we know from historical
studies that having a very low blood
pressure is not good for outcomes so it
increases the risk of ivh as well as bad
neurodevelopmental outcomes in the
future having very low blood pressures
and babies but the question Still
Remains if the babies do have low blood
pressure whatever we end up calling that
and we treat the low blood pressure do
those babies end up doing better well
you can imagine how hard this study is
to do if you're doing it retrospectively
so you're looking back at charts of
babies that were treated with blood
pressure medications then you would
assume that the babies that ended up
getting the blood pressure medications
versus those that didn't were kind of
sicker anyway so they were more
predisposed to have bad outcomes anyway
so that's very difficult to tease out
whether actually treating the low blood
pressures has helped or not and then
obviously doing that study prospectively
would be very difficult too so say you
had a huge group of premature babies and
then you randomize them to either
receive blood pressure medication for
low blood pressures or not to receive
medication you can imagine all the Hoops
that you'd have to jump through and also
that would be very difficult as the
clinician taking care of the baby when
we've so been trained that low blood
pressures is bad we'd like find it
really hard not to actually act on that
so A very difficult study to do well
amazingly a large group of researchers
as part of the hypertension in premature
infants or hip trial actually did manage
to start this study they enrolled
infants less than 28 weeks and they
defined a low blood pressure like we've
been talking about as a blood pressure
lower than the gestational age if the
babies did have low blood pressure then
they were randomized into two different
groups so in one group the babies were
given a fluid Bolis 10 m per kilo and
then started on dopamine and in the
other group they were given a fluid
bolus and then started on the placebo
which was
D5W and this was all blinded so the
providers didn't know if the babies were
getting dopamine or D5W this graph shows
the baby's blood pressures and you can
see that the babies that actually
received dopamine did have slightly
higher blood pressures which is nice at
least dopamine mean works I guess you
can say the primary outcome of the study
was survival without severe brain injury
on ultrasound and this was actually
slightly more common in the placebo
group so 69% versus in the dopamine
group 62% mortality was the same in the
two groups as was BPD neck and pvl so if
you just look at this data you might be
thinking well maybe we shouldn't really
be starting dopamine at all and these
babies with low blood pressures
unfortunately though this study was very
underpowered and they only ended up
recruiting about 8% of the babies that
they wanted to for lots and lots of
reasons but really because there aren't
that many pre-term babies and they
required that the preey babies all had
invasive blood pressure monitoring as
well so it was very difficult to recruit
babies also there were a lot of babies
that if they did end up showing signs of
decreased profusion so for example if
they had a lactate of more than four
then the clinicians could go ahead and
use other blood pressure medications to
try to improve those babies blood flow
so there was kind of a bit of crossover
between these two groups anyway because
a lot of the babies in the placebo group
did receive extra medications for their
blood pressures so let's reward that
myth treating a low blood pressure when
it's being shown that the cells have
inadequate oxygen for metabolism so for
example with High lactic acid or
whatever is more likely to affect
outcome than when we just treat the
blood pressure alone that was really
wordy right that brings us to the end of
our first four myths about blood
pressure if you have reached this far
then please like this video tell us
where you're watching from and also will
you tell us which vasoactive agents you
use in your niku I just want to say one
more time thank you so much for being
here
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