Method of blood pressure measurement in neonates and infants: a systematic review and analysis

Dionne, Janis M, Bremner, Stephen A, Baygani, Simin K, Batton, Beau, Ergenekon, Ebru, Bhatt-Mehta, Varsha, Dempsey, Eugene, Kluckow, Martin, Koplowitz, Luana Pesco, Apele-Freimane, Dina, Iwami, Hiroko, Klein, Agnes, Turner, Mark and Rabe, Heike (2020) Method of blood pressure measurement in neonates and infants: a systematic review and analysis. Journal of Pediatrics, 221. 21-31.e5. ISSN 0022-3476

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Objectives: To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the international literature regarding proper BP cuff size and measurement location and method.
Study Design: A literature search was conducted in MEDLINE, PubMed, Embase, Cochrane Library and CINAHL from 1946 to 2017 on BP in neonates < 3 months of age (PROSPERO ID CRD42018092886). Study data was extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods.
Results: Of 3587 non-duplicate publications identified, 34 were appropriate for inclusion in the analysis. Four studies evaluating BP cuff size support a recommendation for a cuff width to arm circumference ratio of ~0.5. Studies investigating measurement location identified the upper arm as the most accurate and least variable location for oscillometric BP measurement. Analysis of studies using Bland-Altman methods for comparison of intra-arterial to oscillometric BP measurement show that the two methods correlate best for mean arterial pressure (MAP) whereas systolic BP (SBP) by the oscillometric method tends to over-estimate intra-arterial SBP. Compared to intra-arterial methods, SBP, diastolic BP, and MAP by oscillometric methods are less accurate and precise, especially in neonates with a MAP <30mmHg.
Conclusions: Proper BP measurement is critical in neonates with naturally lower BP and attention to BP cuff size, location, and method of measurement are essential. With decreasing use of intra-arterial catheters for long term BP monitoring in neonates, further studies are urgently needed to validate and develop oscillometric methodology with enhanced accuracy.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Clinical and Experimental Medicine
Brighton and Sussex Medical School > Primary Care and Public Health
Subjects: R Medicine > RJ Pediatrics > RJ0251 Newborn infants Including physiology, care, treatment, diseases
Depositing User: Katie Isaac
Date Deposited: 26 May 2020 07:01
Last Modified: 21 May 2021 01:00

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