Age-dependent changes in arterial blood pressure in neonates during the first week of life

Age-dependent changes in arterial blood pressure in neonates during the first week of life: reference values and development of a model

van Zadelhoff, Arjan C. (Erasmus MC)
Poppe, Jarinda A. (Erasmus MC)
Willemsen, Sten (Erasmus MC)
Mauff, Katya (Erasmus MC)
van Weteringen, Willem (Erasmus MC)
Goos, T.G. (TU Delft Medical Instruments & Bio-Inspired Technology; Erasmus MC)
Reiss, Irwin K.M. (Erasmus MC)
Vermeulen, Marijn J. (Erasmus MC)
de Graaff, Jurgen C. (Erasmus MC)

2023

Background: Arterial pressure measurements are important to monitor vital function in neonates, and values are known to be dependent of gestational and postnatal age. Current reference ranges for mean arterial pressure in neonates have been derived from small samples and combined data of noninvasive and invasive measurements. We aimed to define reference values for noninvasive mean, systolic, and diastolic blood pressure during the first week of life in otherwise healthy preterm and term neonates defined by gestational and postnatal age. Methods: In this retrospective cohort study in a neonatal intensive care unit (NICU) in a Dutch tertiary paediatric hospital, we included the noninvasive blood pressures of neonates admitted between 2016 and 2018, with exclusion of those with severe comorbidities (major cardiac malformations, intracerebral haemorrhage, and tracheal intubation >6 h). We defined the median (P50) with −2 standard deviations (SD) (P0.23), −1 SD (P16), +1 SD (P84), and +2 SD (P97.7) for gestational age and postnatal age using quantile regression, percentiles provided online (http://bloodpressure-neonate.com/). Results: A total of 607 neonates, with 5885 measurements, fulfilled the inclusion criteria. The P50 values of mean noninvasive arterial blood pressure in extreme preterm infants steeply increased during the first day after birth and gradually increased within a week from 27 to 49 mm Hg at 24 h of gestational age, and from 49 to 61 mm Hg at 41 weeks of gestational age. Conclusions: These reference values for noninvasive blood pressure in neonates in the NICU for various gestational age groups provide guidance for clinical decision-making in healthy and diseased neonates during anaesthesia and sedation.

arterial pressure
haemodynamics
neonatal intensive care
paediatric anaesthesia
premature birth
reference values

http://resolver.tudelft.nl/uuid:6b3550cf-8381-426d-87bf-0f9d68daad91

https://doi.org/10.1016/j.bja.2023.01.024

0007-0912

British Journal of Anaesthesia, 130 (5), 585-594

Institutional Repository

journal article

© 2023 Arjan C. van Zadelhoff, Jarinda A. Poppe, Sten Willemsen, Katya Mauff, Willem van Weteringen, T.G. Goos, Irwin K.M. Reiss, Marijn J. Vermeulen, Jurgen C. de Graaff