Students Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Severe hypertension in preterm infants can result in life-threatening outcomes. Evidence regarding pharmacologic management of hypertension in preterm infants is limited. Consequently, clinicians rely on their expertise when making treatment decisions, which may be problematic because the expected benefits/harms of available treatment options are unknown.
Research Question or Hypothesis: What is the most commonly used antihypertensive medication for preterm infants with hypertension for first-line, second-line, and adjunctive therapy?
Study Design: Retrospective, cross-sectional, single-site, observational study.
Methods: The study sample included patients with a postnatal age < 1 year and gestational age at birth < 37 weeks who were admitted to the University of Alabama at Birmingham (UAB) and treated with an antihypertensive medication. Data was collected using electronic medical record data provided by UAB. The prevalence of each antihypertensive as first-line, second-line, and adjunctive therapy was determined and compared using prevalence ratios. Multinomial regression using Bayesian modeling was used to estimate prevalence ratios and 95% credible intervals (CIs). The statistical software used was “R” (brms package).
Results: There were 137 hospital encounters across 123 patients. Among these patients, 64% were male and 56% were white. The median age at discharge was 42 days and median birthweight was 1.6 kg. The median systolic blood pressure 24 hours before administration of the first antihypertensive medication was 77 mmHg. Second-line and adjunctive therapy were used in 6 and 11 hospital encounters, respectively. The prevalence of propranolol was 63% for first-line, (95% CI: 54-71%), 40% for second-line (95% CI: 14-70%), and 47% for adjunctive therapy (95% CI: 24-72%). For first-line therapy, propranolol was 5.9 times as prevalent as the second most prevalent agent.
Conclusion: In a large academic hospital, propranolol was the most commonly used agent for first-line antihypertensive therapy among preterm infants. There was not a discernable difference between the prevalence of antihypertensives used for second-line/adjunctive therapy.
Presenting Author
Alejandro Perez 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
Mary-Carty Pittman 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