Blood Pressure Goals: Is Cerebral Saturation the New Mean Arterial Pressure

Objective The objective of this article was to correlate hypotension and cerebral saturation from near-infrared spectroscopy (cNIRS) in neonates on dopamine. Study Design Retrospective review of neonates receiving dopamine between August 2018 and 2019 was performed. Hypotension thresholds included mean arterial pressure (MAP) of postmenstrual age ( PMA) +/- 5 and 30mm Hg and gestational age ( GA) +/- 5mm Hg. Time below threshold MAP was compared with time with cerebral hypoxia (cNIRS <55%). Results Hypotension occurred 6 to 33% of the time on dopamine in 59 cases. Hypotension did not correlate with abnormal cNIRS overall, within PMA subgroups or by outcomes. Hypotensive periods with MAP< GA had fewer corresponding percent time with abnormal cNIRS events (3.7 +/- 1.3%) compared with MAP< PMA ( 11.9 +/- 4.9%, p< 0.003) or 30mm Hg thresholds (12.2 +/- 4.7%, p< 0.0001). In most premature infants, mean cNIRS values during hypotension were still within normal range (57 +/- 6%). Conclusion cNIRS may be a more clinically relevant measure than MAP for the assessment of neonatal hypotension.