Percentile Charts of Neonatal Blood Pressure Values at a Tertiary Iranian Hospital

Document Type: Original Article

Authors

1 Ali-asghar Clinical Research Development Center (AACRDC), Aliasghar children hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran

2 Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran

3 Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran

4 MS in nursing of neonatal intensive care. Ali Asghar Hospital Clinical Research Development Unit, Iran University of Medical Sciences(IUMS), Tehran, Iran.

10.22038/ijn.2020.42619.1708

Abstract

Background: Blood pressure (BP) is an important vital sign and indicator of clinical stability. Therefore, the accurate measurement and interpretation of this physiological signal is essential for the optimal management of ill newborns. In this regard, the present study aimed to determine BP values and percentiles in stable newborns in the first weeks of life and evaluate the relevant factors.
Methods: This prospective observational study was conducted on 320 term and preterm newborns between 26 and 42 weeks gestational age (GA) within 2015-2017. The exclusion criteria entailed: 1) birth asphyxia,2) preeclampsia, 3) gestational diabetes mellitus (GDM) type I, 4) illicit substance use, and 5) major congenital anomaly. The oscillometric technique was used for BP measurement and systolic and diastolic BPs were analyzed by regression analysis for various percentiles (5th to 95th).
Results: The neonates in the current study consisted of 185 (57.8%) males and 135 (42.2%) females with mean (SD) birth weight of 2058.3±582.5grams. Mean (SD) gestational age was reported as 32.95(3.97) weeks. 69.1 % of neonates were delivered via cesarean section. Percentile charts (5th- 95th values) which were developed for systolic (SBP) and diastolic (DBP) demonstrated a steady rise on the respective days that were comparable between different groups. Term neonates were found to have higher BPs, compared to their preterm counterparts on the respective days. Moreover, the neonates who were delivered vaginally had higher mean BP values than neonates delivered via cesarean section.
Conclusion: The current study provided normative BP values among neonates, especially in the first two weeks of life. Data presented in this study which include delivery-mode-specific BP percentile curves using an oscillometric method serve as a valuable reference for physicians in the management of newborns in the neonatal unit.

Keywords


1. Hulman S, Edwards R, Chen YQ, Polansky M, Falkner B. Blood pressure patterns in the first three days of life. J Perinatol. 1991; 11(3):231-4.
2. Dasgupta SJ, Gill AB. Hypotension in the very low birthweight infant: the old, the new, and the uncertain. Arch Dis Child Fetal Neonatal Ed. 2003; 88(6):F450-4.
3. Skalina ME, Annable WL, Kliegman RM, Fanaroff AA. Hypertensive retinopathy in the newborn infant. J Pediatr. 1983; 103(5):781-6.
4. Cachat F, Bogaru A, Micheli JL, Lepori D, Guignard JP. Severe hypertension and massive proteinuria in a newborn with renal artery stenosis. Pediatr Nephrol. 2004; 19(5):544-6.
5. Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008; 117(25):3171-80.
6. Kent AL, Meskell S, Falk MC, Shadbolt B. Normative blood pressure data in non-ventilated premature neonates from 28–36 weeks gestation. Pediatr Nephrol. 2009; 24(1):141-6.
7. Jones JE, Jose PA. Neonatal blood pressure regulation. Semin Perinatol. 2004; 28(2):141-8.
8. Hegyi T, Carbone MT, Anwar M, Ostfeld B, Hiatt M, Koons A, et al. Blood pressure ranges in premature infants. I. The first hours of life. J Pediatr. 1994; 124(4):627-33.
9. Cantinotti M, Giordano R, Scalese M, Molinaro S, Murzi B, Assanta N, et al. Strengths and limitations of current pediatric blood pressure nomograms: a global overview with a special emphasis on regional differences in neonates and infants. Hypertens Res. 2015; 38(9):577-87.
10. Park MK, Lee DH. Normative arm and calf blood pressure values in the newborn. Pediatrics. 1989; 83(2):240-3.
11. Sadoh WE, Ibhanesehbor SE, Monguno AM, Gubler DJ. Predictors of newborn systolic blood pressure. West Afr J Med. 2010; 29(2):86-90.
12. Alves JG, Vilarim JN, Figueiroa JN. Fetal influences on neonatal blood pressure. J Perinatol. 1999; 19(8 Pt 1):593-5.
13. Lee YH, Rosner B, Gould JB, Lowe EW, Kass EH. Familial aggregation of blood pressures of newborn infants and their mothers. Pediatrics. 1976; 58(5):722-9.
14. Versmold HT, Kitterman JA, Phibbs RH, Gregory GA, Tooley WH. Aortic blood pressure during the first 12 hours of life in infants with birth weight 610 to 4,220 grams. Pediatrics. 1981; 67(5):607-13.
15. Tan KL. Blood pressure in full-term healthy neonates. Clin Pediatr (Phila). 1987; 26(1):21-4.
16. Nwokoye IC, Uleanya ND, Ibeziako NS, Ikefuna AN, Eze JC, Ibe JC. Blood pressure values in healthy term newborns at a tertiary health facility in Enugu, Nigeria. Niger J Clin Pract. 2015; 18(5):584-8.
17. Sadoh WE, Ibhanesebhor SE. Oscillometric blood pressure reference values of African full-term neonates in their first days postpartum. Cardiovasc J Afr. 2009; 20(6):344-7.
18. Gemelli M, Manganaro R, Mami C, De Luca F. Longitudinal study of blood pressure during the 1st year of life. Eur J Pediatr. 1990; 149(5):318-20.
19. Holland WW, Young IM. Neonatal blood pressure in relation to maturity, mode of delivery, and condition at birth. Br Med J. 1956; 2(5005):1331-3.
20. Nascimento MC, Xavier CC, Goulart EM. Arterial blood pressure of term newborns during the first week of life. Braz J Med Biol Res. 2002; 35(8):905-11.
21. Earley A, Fayers P, Ng S, Shinebourne EA, de Swiet M. Blood pressure in the first 6 weeks of life. Arch Dis Child. 1980; 55(10):755-7.
22. Salihoğlu Ö, Can E, Beşkardeş A, Koç BŞ, Tan İ, Can G, et al. Delivery room blood pressure percentiles of healthy, singleton, liveborn neonates. Pediatr Int. 2012; 54(2):182-9.
23. Kent AL, Kecskes Z, Shadbolt B, Falk MC. Blood pressure in the first year of life in healthy infants born at term. Pediatr Nephrol. 2007; 22(10):1743-9.