Students Research in Progress
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: Preterm infants are at increased risk for hypertension and complications due to incomplete organogenesis.
1 The lack of guidelines for treating hypertension in this population leads clinicians to rely on experience to make treatment decisions. However, little is known about these treatment decisions.
Research Question or Hypothesis: Our study aimed to describe the dosing trajectories of antihypertensive agents in preterm infants.
Study Design: Retrospective cross-sectional study of preterm infants (gestational age < 37 weeks) treated inpatient at the University of Alabama at Birmingham Medical Center with an antihypertensive medication and who were infants at discharge (postnatal age < 1 year).
Methods: The three most common antihypertensive agents were identified. Dosing trajectories in mg/kg for each agent were plotted over time in hours.
Results: The study included 123 patients and 137 patient visits. The most common agents were propranolol (58%), captopril (12%), and esmolol (8.8%). Captopril was administered for an average of 319 hours, propranolol for 275 hours, and esmolol for 55 hours before discontinuation. The average time to dose increase was 10 hours for esmolol, 60 hours for captopril, and 118 hours for propranolol. Esmolol was initiated in patients with an average postnatal age of 3 days compared to 18 and 87 days for propranolol and captopril respectively.
Conclusion: Captopril was started low and increased slowly, likely due to safety concerns. Propranolol was initiated at the target dose and was the most prevalent agent, potentially due to its favorable safety/efficacy profile. Esmolol was used acutely with the most variable dosing trajectories because of its ability to be easily titrated as an infusion. Esmolol was also used in the youngest patients likely because they were unable to tolerate oral medications. This study will contribute to the development of prospective comparative effectiveness studies or randomized controlled trials of antihypertensive dosing strategies in preterm infants.
Presenting Author
Mary-Carty Pittman PharmD CandidateUniversity of North Carolina Eshelman School of Pharmacy
Authors
Matthew Laughon MD
Department of Pediatrics, School of Medicine, University of North Carolina
Matthew Loop PhD
Auburn University Harrison College of Pharmacy
Jieun Park PhD
Auburn University Harrison College of Pharmacy
Alejandro Perez PharmD Candidate
University of North Carolina Eshelman School of Pharmacy
Daniel Feig MD, PhD, MS
University of Alabama at Birmingham Heersink School of Medicine
Keia Sanderson MD, MSCr
University of North Carolina School of Medicine