Definition of Normal Blood Pressure Range: The Elusive Target

Engle, William D.

doi:10.1016/b978-1-4160-3162-8.10003-x

Cited by 11 publications

(21 citation statements)

References 162 publications

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“…31 Studies comparing blood pressure measurements from upper versus lower limbs have produced conflicting results. 24 In term neonates, Park and Lee observed no difference in blood pressure between arm and calf. 32 Piazza and colleagues compared upper and lower limb systolic blood pressure in term neonates in the first 24 hours and found that higher readings in the upper versus lower limb were more common than vice versa.…”

Section: Noninvasive Measurement Of Blood Pressurementioning

confidence: 97%

“…7 The agreement between blood pressure values obtained directly and by oscillometry has generally been good. 24 However, some investigators have found that the agreement is poor, and suggested that noninvasive techniques are not sufficiently accurate for routine use. 25 Of course, when comparing direct and noninvasive methods, it is important to ensure accuracy of the reference method by performing dynamic calibration (frequency response and damping coefficient) for each infant.…”

Section: Noninvasive Measurement Of Blood Pressurementioning

confidence: 99%

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Definition of Normal Blood Pressure Range

Engle¹

2012

Hemodynamics and Cardiology: Neonatology Questions and Controversies

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Section: Noninvasive Measurement Of Blood Pressurementioning

confidence: 97%

Section: Noninvasive Measurement Of Blood Pressurementioning

confidence: 99%

Definition of Normal Blood Pressure Range

Engle¹

2012

Hemodynamics and Cardiology: Neonatology Questions and Controversies

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“…Furthermore, the absolute blood pressure values at which these thresholds occur are ill-defined and are likely to vary among individual patients and the underlying pathological processes. Thus, the information available apply to the clinical definition of hypotension 1 and to a selected group of neonates, such as very preterm infants, [12][13][14][15][16][17][18][19] and not to the physiological definition itself (Figure 1). 11 If the physiological paradigm depicted in Figure 1 is used, as blood pressure falls first, CBF autoregulation is lost, then cerebral function becomes abnormal and finally tissue ischemia occurs.…”

Section: Definition Of Hypotensionmentioning

confidence: 99%

“…1 In preterm infants, the complex physiology of the postnatal transition and the inherent immaturity of the cardiopulmonary and other organ systems present the most important challenge of establishing normative values, as continuous blood pressure monitoring in itself is insufficient to identify abnormal organ blood flow and tissue oxygen delivery in this patient population. 2 Furthermore, although there is an abundance of evidence showing improvement in blood pressure and other cardiovascular parameters, such as cardiac output, cerebral and non-vital organ blood flow and renal function, when 'hypotension' is treated during postnatal transition, [3][4][5][6][7][8][9][10] there are no data showing that treatment results in improvements in long-term outcome.…”

Section: Introductionmentioning

confidence: 99%

Definition of hypotension and assessment of hemodynamics in the preterm neonate

2009

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The complexity of postnatal cardiovascular transition has only recently been better appreciated in the very low birth weight neonate. As blood pressure in itself poorly represents systemic blood flow, especially when the fetal channels are open and the developmentally regulated vital organ assignment may not have been completed, efforts to measure systemic blood flow have resulted in a novel, yet incomplete, understanding of the principles and clinical relevance of cardiovascular adaptation during postnatal transition in this patient population. This article describes the definition of hypotension based on the principles of cardiovascular physiology, and reviews the tools available to the clinician and researcher at the bedside to examine the complex relationship among blood pressure, systemic and organ blood flow, and tissue oxygen delivery and oxygen demand in vital and non-vital organs in the very low birth weight neonate. Only after gaining an insight into these complex relationships and processes will we be able to design clinical trials of selected treatment modalities targeting relevant patient sub-populations for the management of neonatal cardiovascular compromise. Only clinical trials based on a solid understanding of developmental cardiovascular physiology tailored to the appropriate patient sub-population hold the promise of being effective and practical, and can lead to improvements in both hemodynamic parameters and clinically relevant outcome measures.

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“…These doubts derive from the modalities of measurement, from numerous variables, as the gestational age, the birth weight and the postnatal age, from the therapies practiced to the pregnant, as the same prenatal steroids, from the modality of birth, from a whole of pathological events, often complex and concomitant and from the definition and meaning to be attributed to a value of altered pressure [4].…”

Section: Introductionmentioning

confidence: 99%

The scenarios of shock in newborn infants

Giordano

Chello

Leonibus

et al. 2010

The Journal of Maternal-Fetal & Neonatal Medicine

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Shock defines a complex dysfunction of organ perfusion, that produces a status of cellular energy failure, resulting from an insufficient supply of oxygen and nutrients to tissues. The diagnosis of shock is very difficult because of the lack of sufficiently sensitive and specific clinical criteria, and is substantially based on the demonstration of an arterial hypotension, an indicator unfit to detect the organ hypoperfusion. It determines the necessity of firmly introducing in the diagnostic run the functional echocardiography, the near infrared spectroscopy and the amplitude – integrated electroencephalography, etc., in the monitoring of the critical newborn. In order to simplify the problem, the authors identify the clinical scenarios of the newborn's shock to enhance the different pathogenetic moments and to build up appropriate therapeutic algorithms, without forgetting that at present there is no evidence that treatment of shock improves outcomes, despite the large amount of the studies conducted on this topic.

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Definition of Normal Blood Pressure Range: The Elusive Target

Cited by 11 publications

References 162 publications

Definition of Normal Blood Pressure Range

Definition of Normal Blood Pressure Range

Definition of hypotension and assessment of hemodynamics in the preterm neonate

The scenarios of shock in newborn infants

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