{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T23:26:04Z","timestamp":1776209164296,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      To evaluate the efficacy, safety and long\u2010term effects of pharmacological options for hypotension in very preterm newborns through a meta\u2010analysis of available randomized controlled trials (\n                      <jats:styled-content style=\"fixed-case\">RCTs<\/jats:styled-content>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>RCTs published up to March 2025 involving newborns born at \u2264\u200930\u2009weeks of gestational age or \u2264\u20091500\u2009g at birth, treated with any pharmacological intervention for hypotension were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We analysed 12 RCTs (enrolling 539 newborns). None of the drugs analysed improve survival or clinical outcome. Dopamine (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0008,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200928%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.24, OR 4.53 95% CI 1.87\u201311.00) and hydrocortisone (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008, OR 9.31 95% CI 1.78\u201348.72, heterogeneity not applicable) appeared effective in resolving hypotension in very preterm newborns, compared to placebo. However, dopamine increased the risk of intraventricular haemorrhage by 3.47 times (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.75, 95% CI 1.10\u201310.93) compared with placebo. Epinephrine (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010, OR 0.16 95% CI 0.04\u20130.64, heterogeneity not applicable) and hydrocortisone (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03, OR 4.23 95% CI 1.11\u201316.17, heterogeneity not applicable) were associated with a higher risk of hyperglycemia when compared to dobutamine and placebo, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pharmacological treatment of neonatal hypotension may improve blood pressure without positive effects on mortality and neurodevelopment in very preterm newborns. However, associated adverse effects such as intraventricular haemorrhage and hyperglycemia appear relevant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO Registration number: CRD42024619749<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apa.70411","type":"journal-article","created":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T04:29:50Z","timestamp":1765081790000},"page":"536-553","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pharmacological Hypotensive Treatment in Very Preterm Newborns: Systematic Review and Meta\u2010Analysis of Randomised Controlled Trials"],"prefix":"10.1111","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-0692","authenticated-orcid":false,"given":"Giovanni","family":"Boscarino","sequence":"first","affiliation":[{"name":"Pediatric Clinic, University Hospital, Department of Medicine and Surgery University of Parma  Parma Italy"},{"name":"Department of Maternal and Child Health, Policlinico Umberto I Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Giulia","family":"Conti","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Policlinico Umberto I Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanna","family":"Esposito","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, University Hospital, Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Terrin","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Policlinico Umberto I Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2015.12.005"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211464"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1891\/0730-0832.34.1.31"},{"key":"e_1_2_12_5_1","article-title":"An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication","volume":"11","author":"Agakidou E.","year":"2024","journal-title":"Children (Basel)"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1542\/neo.8-1-e32"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2005.03.009"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(18)30030-7"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2005.03.006"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.5152\/TurkArchPediatr.2022.21361"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2011.12.010"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000240552"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(95)70445-0"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(18)30692-4"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1542\/neo.5-1-e22"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1891\/0730-0832.34.1.46"},{"key":"e_1_2_12_17_1","article-title":"Dopamine Versus Dobutamine for Hypotensive Preterm Infants","volume":"3","author":"Subhedar N. 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