{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:31:46Z","timestamp":1790699506049,"version":"4.1.0"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec027\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Isolated hypotension (IH) without any clinical or biochemical features of poor perfusion is a common occurrence in very preterm infants (VPTI). There exists no recommendations guiding its management.The objective of this review was to compare the effect of active vs. restrictive approach to treat IH in VPTI.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec028\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>Medline, Embase and Web of Science were searched until 1<jats:sup>st<\/jats:sup> April 2024. RCTs and non-RCTs were included. Mortality, major brain injury (MBI) (intraventricular hemorrhage &gt;\u2009 grade 2 or cystic periventricular leukomalacia), mortality or neurodevelopmental impairment (NDI) at 18\u201324 months\u2019 corrected age were the critical outcomes evaluated.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec029\">\n<jats:title>Results<\/jats:title>\n<jats:p>44 studies were included: 9 were synthesized in a meta-analysis and 35 studies in the narrative review. Clinical benefit or harm could not be ruled out for the outcomes from the meta-analyses of RCTs. Meta-analysis of 3 non-RCTs suggested that active treatment of IH in VPTI of &lt;\u2009 24 hours of life possibly increased the odds of MBI (aOR: 95% CI 1.85 (1.45; 2.36), very low certainty). Meta-analysis of 2 non-RCTs that had included VPTI &lt;\u2009 72 hours indicated a possibly decreased risk of MBI (aOR: 95% CI 0.44 (0.24; 0.82), very low certainty) and NEC \u2265\u2009 stage 2 (aOR: 95% CI 0.61 (0.41; 0.92), very low certainty) with active treatment of IH. Active treatment of IH in the first 24 hours possibly increased the risk of mortality or long-term NDI (aOR: 95% CI 1.84 (1.10; 3.09), very low certainty) and the risk of hearing loss at 2 years (aOR: 95% CI 3.60 (1.30; 9.70), very low certainty). Clinical benefit or harm could not be ruled out for other outcomes. There was insufficient evidence with respect to preterm neonates of \u2265\u2009 32 weeks.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec030\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>IH may not be treated in VPTI in the first 24 hours. However, IH occurring between 24 hours - 72 hours of life may be treated. The evidence certainty was very low.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0309520","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T17:22:50Z","timestamp":1742318570000},"page":"e0309520","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Active versus restrictive approach to isolated hypotension in preterm neonates: A Systematic Review, Meta-analysis and GRADE based Clinical Practice Guideline"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7092-3597","authenticated-orcid":true,"given":"Viraraghavan Vadakkencherry","family":"Ramaswamy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunjana","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6718-5228","authenticated-orcid":true,"given":"Abdul Kareem","family":"Pullattayil S","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek S","family":"Aradhya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep","family":"Suryawanshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Sahni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supreet","family":"Khurana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1786-0002","authenticated-orcid":true,"given":"Kiran","family":"More","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the National Neonatal Forum, India, Clinical Practice Guidelines Group on Neonatal Shock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"issue":"4","key":"pone.0309520.ref001","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1136\/archdischild-2020-320241","article-title":"Hypotension in Preterm Infants (HIP) randomised trial","volume":"106","author":"EM Dempsey","year":"2021","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"3","key":"pone.0309520.ref002","doi-asserted-by":"crossref","first-page":"F298","DOI":"10.1136\/archdischild-2017-314159","article-title":"Blood pressure intervention levels in preterm infants: pilot randomised trial","volume":"104","author":"SS Pereira","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"6","key":"pone.0309520.ref003","doi-asserted-by":"crossref","first-page":"e1865-73","DOI":"10.1542\/peds.2012-2779","article-title":"Use of antihypotensive therapies in extremely preterm infants","volume":"131","author":"B Batton","year":"2013","journal-title":"Pediatrics"},{"issue":"8","key":"pone.0309520.ref004","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/sj.jp.7211774","article-title":"Treating hypotension in the preterm infant: when and with what: a critical and systematic review","volume":"27","author":"EM Dempsey","year":"2007","journal-title":"J Perinatol"},{"issue":"1","key":"pone.0309520.ref005","doi-asserted-by":"crossref","first-page":"65-9.e1","DOI":"10.1016\/j.jpeds.2012.01.014","article-title":"Feasibility study of early blood pressure management in extremely preterm infants","volume":"161","author":"BJ Batton","year":"2012","journal-title":"J Pediatr"},{"issue":"4","key":"pone.0309520.ref006","doi-asserted-by":"crossref","first-page":"765","DOI":"10.3349\/ymj.2012.53.4.765","article-title":"Permissive hypotension in extremely low birth weight infants (\u22641000 gm)","volume":"53","author":"SY Ahn","year":"2012","journal-title":"Yonsei Med J"},{"key":"pone.0309520.ref007","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3310\/nihropenres.13357.1","article-title":"Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants","volume":"3","author":"N Aladangady","year":"2023","journal-title":"NIHR Open Res"},{"issue":"5","key":"pone.0309520.ref008","doi-asserted-by":"crossref","first-page":"F388","DOI":"10.1136\/archdischild-2014-306483","article-title":"Neocirculation project and the German Neonatal Network (GNN). 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