Elsevier

The Journal of Pediatrics

Volume 221, June 2020, Pages 23-31.e5
The Journal of Pediatrics

Original Article
Method of Blood Pressure Measurement in Neonates and Infants: A Systematic Review and Analysis

https://doi.org/10.1016/j.jpeds.2020.02.072Get rights and content

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.

Section snippets

Methods

A literature search was conducted by a professional librarian in MEDLINE, PubMed, Embase, the Cochrane Library, and CINAHL. The search terms were (blood pressure OR hypertension OR hypotension) AND (infant OR newborn OR neonate) AND infant [MeSH] AND (measurement OR normative) AND humans [MeSH]. Study design inclusion criteria were prospective or retrospective, cohort, case series, and randomized controlled trials. Study design exclusion criteria: absence of extractable data in letters,

Results

The systematic search identified 5299 reports. After removing duplicates, 3587 titles and abstracts were reviewed by 11 members of the working group (Figure 1). 602 articles were reviewed and data extracted according to predefined criteria (in spreadsheet). A total of 401 were excluded leaving 201 for further consideration. These articles were identified as being pertinent to ≥1 of the 3 primary research questions of the working group; 34 were identified as relevant to the current research

Discussion

The ideal BP measurement method is the one that provides the most accurate readings, with the least variability, and lowest potential for side effects or complications. The technique is even more important in neonates because expected MAP values are lower than older children and adults and may be in the 30-50 mm Hg range. Our systematic review of the literature identified some important measurement practices for accurate readings, but also some areas of uncertainty. Implementing a standardized

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  • Cited by (0)

    Funded by International Neonatal Consortium industry member dues and in part by the Food and Drug Administration (U18 FD 005320). The views expressed in publications do not necessarily reflect the official policies of the Department of Health and Human Services; nor does any mention of trade names, commercial practices, or organization imply endorsement by the United States Government. The authors declare no conflicts of interest.

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