Top

Intensive Care Medicine

Published in:

01-04-2012 | Pediatric Original

Accuracy of non-invasive blood pressure monitoring in very preterm infants

Authors: Kai König, Dan M. Casalaz, Emily J. Burke, Andrew Watkins

Published in: Intensive Care Medicine | Issue 4/2012

Abstract

Purpose

Blood pressure (BP) monitoring is an essential procedure in intensive care. There is controversy about the reliability of non-invasive BP measurements in very preterm infants. This prospective trial compared non-invasive BP monitoring with BP monitoring via an umbilical arterial catheter (UAC) in this population.

Methods

Preterm infants born at less than 32 weeks gestation requiring a UAC for clinical management were eligible. Enrolled infants had up to three BP measurements on the right arm (RA) and right leg (RL) when in a resting state. UAC-BP measurements were noted immediately after the non-invasive BP was displayed on the monitor. Measurements were analysed in subgroups according to birth weight: no greater than 750 g, 751–1,000 g, above 1,000 g. Statistical analysis reports median, range, and Bland–Altman analysis.

Results

Sixty infants were included. Median (range) gestational age was 26.4 weeks (23.6, 31.2); birth weight 924 g (581, 1,518). A total of 1,865 measurements were performed (RA: 935, RL: 930). Mean difference (95% limits of agreement) for infants no greater than 750 g: RA 2.53 mmHg (−11.18, 16.24), RL −0.804 mmHg (−12.65, 11.04); for infants 751–1,000 g: RA 3.535 mmHg (−9.6, 16.7), RL −1.239 mmHg (–13.14, 10.66); for infants above 1,000 g: RA −1.65 mmHg (−13.47, 10.17), RL −4.101 mmHg (−14.17, 5.96).

Conclusions

Although the average differences between invasive and non-invasive BP measurements are acceptable, the range of under- and overestimation of non-invasive BP measurements is large and not consistent, making reliance on non-invasive modalities to guide circulatory management problematic. If arterial BP monitoring is not available, our results suggest measuring non-invasive BP on the leg in preterm infants with a birth weight no greater than 1,000 g.

Available only for authorised users

Kluckow M, Evans N (2000) Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 82:F182–F187PubMedCrossRef

Kluckow M, Evans N (2000) Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 82:F188–F194PubMedCrossRef

Hunt RW, Evans N, Rieger I, Kluckow M (2004) Low superior vena cava flow and neurodevelopment at 3 years in very preterm infants. J Pediatr 145:588–592PubMedCrossRef

Osborn DA, Evans N, Kluckow M (2004) Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference. Arch Dis Child Fetal Neonatal Ed 89:F168–F173PubMedCrossRef

Kluckow M, Evans N (2001) Low systemic blood flow and hyperkalemia in preterm infants. J Pediatr 139:227–232PubMedCrossRef

Miall-Allen VM, de Vries LS, Whitelaw AG (1987) Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child 62:1068–1069PubMedCrossRef

Watkins AM, West CR, Cooke RW (1989) Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev 19:103–110PubMedCrossRef

Low JA, Froese AB, Galbraith RS, Smith JT, Sauerbrei EE, Derrick EJ (1993) The association between preterm newborn hypotension and hypoxemia and outcome during the first year. Acta Paediatr 82:433–437PubMedCrossRef

Goldstein RF, Thompson RJ Jr, Oehler JM, Brazy JE (1995) Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants. Pediatrics 95:238–243PubMed

10.

Cunningham S, Symon AG, Elton RA, Zhu C, McIntosh N (1999) Intra-arterial blood pressure reference ranges, death and morbidity in very low birthweight infants during the first seven days of life. Early Hum Dev 56:151–165PubMedCrossRef

11.

Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK (2001) Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol 21:272–278PubMedCrossRef

12.

Synnes AR, Chien LY, Peliowski A, Baboolal R, Lee SK (2001) Variations in intraventricular hemorrhage incidence rates among Canadian neonatal intensive care units. J Pediatr 138:525–531PubMedCrossRef

13.

Martens SE, Rijken M, Stoelhorst GM, van Zwieten PH, Zwinderman AH, Wit JM, Hadders-Algra M, Veen S (2003) Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants? Early Hum Dev 75:79–89PubMedCrossRef

14.

Fanaroff JM, Wilson-Costello DE, Newman NS, Montpetite MM, Fanaroff AA (2006) Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics 117:1131–1135PubMedCrossRef

15.

Batton B, Zhu X, Fanaroff J, Kirchner HL, Berlin S, Wilson-Costello D, Walsh M (2009) Blood pressure, anti-hypotensive therapy, and neurodevelopment in extremely preterm infants. J Pediatr 154:351–357 357 e351PubMedCrossRef

16.

Dempsey EM, Barrington KJ (2007) Treating hypotension in the preterm infant: when and with what: a critical and systematic review. J Perinatol 27:469–478PubMedCrossRef

17.

Dempsey EM, Al Hazzani F, Barrington KJ (2009) Permissive hypotension in the extremely low birthweight infant with signs of good perfusion. Arch Dis Child Fetal Neonatal Ed 94:F241–F244PubMedCrossRef

18.

Logan JW, O’Shea TM, Allred EN, Laughon MM, Bose CL, Dammann O, Batton DG, Engelke SC, Leviton A (2011) Early postnatal hypotension and developmental delay at 24 months of age among extremely low gestational age newborns. Arch Dis Child Fetal Neonatal Ed 96:F321–F328PubMedCrossRef

19.

Hermansen MC, Hermansen MG (2005) Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol 32:141–156 viiPubMedCrossRef

20.

Diprose GK, Evans DH, Archer LN, Levene MI (1986) Dinamap fails to detect hypotension in very low birthweight infants. Arch Dis Child 61:771–773PubMedCrossRef

21.

Chia F, Ang AT, Wong TW, Tan KW, Fung KP, Lee J, Khin K (1990) Reliability of the Dinamap non-invasive monitor in the measurement of blood pressure of ill Asian newborns. Clin Pediatr (Phila) 29:262–267CrossRef

22.

Dannevig I, Dale HC, Liestol K, Lindemann R (2005) Blood pressure in the neonate: three non-invasive oscillometric pressure monitors compared with invasively measured blood pressure. Acta Paediatr 94:191–196PubMedCrossRef

23.

O’Shea J, Dempsey EM (2009) A comparison of blood pressure measurements in newborns. Am J Perinatol 26:113–116PubMedCrossRef

24.

Raab E, Seri I (2006) Diagnosis and treatment of the hypotensive very low birth weight infant during postnatal transition. J Perinatol 26:657–659PubMedCrossRef

25.

Dempsey EM, Barrington KJ (2009) Evaluation and treatment of hypotension in the preterm infant. Clin Perinatol 36:75–85PubMedCrossRef

26.

Meyer S, Sander J, Graber S, Gottschling S, Gortner L (2010) Agreement of invasive versus non-invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age. J Paediatr Child Health 46:249–254PubMedCrossRef

27.

Papadopoulos G, Mieke S, Elisaf M (1999) Assessment of the performances of three oscillometric blood pressure monitors for neonates using a simulator. Blood Press Monit 4:27–33PubMedCrossRef

28.

Weindling AM (1989) Blood pressure monitoring in the newborn. Arch Dis Child 64:444–447PubMedCrossRef

29.

Kunk R, McCain GC (1996) Comparison of upper arm and calf oscillometric blood pressure measurement in preterm infants. J Perinatol 16:89–92PubMed

Title: Accuracy of non-invasive blood pressure monitoring in very preterm infants
Authors: Kai König
Dan M. Casalaz
Emily J. Burke
Andrew Watkins
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2499-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Accuracy of non-invasive blood pressure monitoring in very preterm infants

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2012

Diffuse digestive bezoar: a rare and severe complication of enteral nutrition in the intensive care unit (ICU)

Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit in Japan

International evidence-based recommendations for point-of-care lung ultrasound

Effect of do-not-resuscitate orders on the penumbra of care

Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis

Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness