Therapies for hypotension in very preterm infants are among the most common interventions given to these fragile patients. The proportion of very low birth weight infants who receive potent and potentially toxic interventions varies dramatically from one NICU to another.1
A prospective cohort study of extremely low gestational age newborns (the ELGAN study), results of which are published in this issue of Pediatrics,2 shows even greater variation in interventions for hypotension than previously reported. The proportion of infants under 28 weeks' gestation who were treated ranged from 32% to 98%, and the proportion that received either hydrocortisone or vasopressor agents ranged from 8% to 86%. The investigators examined the reasons for these variations and were unable to show that hypotension was more frequent or severe in the high-intervention centers. Indeed, the only consistent factor associated with intervention was the NICU in which the infant was. It is...
