Janis M Dionne1, Stephen A Bremner2, Simin K Baygani3, Beau Batton4, Ebru Ergenekon5, Varsha Bhatt-Mehta6, Eugene Dempsey7, Martin Kluckow8, Luana Pesco Koplowitz9, Dina Apele-Freimane10, Hiroko Iwami11, Agnes Klein12, Mark Turner13, Heike Rabe14. 1. Division of Nephrology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada. Electronic address: jdionne@cw.bc.ca. 2. Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom. 3. Global Statistical Science, Eli Lilly and Company, Indianapolis, IN. 4. Department of Pediatrics, Southern Illinois University School of Medicine (SOM), Springfield, IL. 5. Division of Newborn Medicine, Gazi University, Ankara, Turkey. 6. Department of Clinical Pharmacology, College of Pharmacy and Department of Pediatrics, University of Michigan, Ann Arbor, MI. 7. INFANT Research Centre & Department of Pediatrics and Child Health, University College Cork, Cork, Ireland. 8. University of Sydney & Department of Neonatology Royal North Shore Hospital, Sydney, Australia. 9. Translational Medicine, Clinical Pharmacology and Nonclinical Development, DUCK FLATS Pharma, LLC, Elbridge, New York, NY. 10. Neonatal Intensive Care, Women and Child Health Clinic, Pauls Stradins Clinical University Hospital, Riga, Latvia. 11. Department of Neonatology, Osaka City General Hospital, Japan. 12. Biologic and Radiopharmaceutical Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, Canada. 13. Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom. 14. Academic Department of Paediatrics, Brighton and Sussex Medical School, Brighton, United Kingdom.
Abstract
OBJECTIVES: To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the 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 were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods. RESULTS: Of 3587 nonduplicate 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 approximately 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 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP. Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure <30 mm Hg. 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.
OBJECTIVES: To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the 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 were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods. RESULTS: Of 3587 nonduplicate 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 approximately 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 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP. Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure <30 mm Hg. 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.