Interrater Reliability and Effect of State on Blood Pressure Measurements in Infants 1 to 3 Years of Age

Abstract

Systolic blood pressure can be accurately measured in the first 3 years after birth, but state modifies systolic blood pressure and must be determined at the time of measurement. Infants born at </=36 weeks' estimated gestational age may be at risk for an elevated systolic blood pressure, but this requires additional study.

Elevated systolic blood pressure in preterm very-low-birth-weight infants ≤3 years of life

“…Infant state was recorded as calm versus noncalm at the time of each measurement. In a previous study [13], we validated the reproducibility and accuracy of this method and demonstrated the elevating effects of a noncalm state on SBP measurements. Inter-and intra-rater reliability for this method is excellent in infants aged 1-3 years [13].…”

“…In a previous study [13], we validated the reproducibility and accuracy of this method and demonstrated the elevating effects of a noncalm state on SBP measurements. Inter-and intra-rater reliability for this method is excellent in infants aged 1-3 years [13]. Only SBP was measured since the pulse is detectable to 0 mmHg with Doppler amplification, and the association between SBP and cardiovascular disease is more robust than diastolic or mean BP [16].…”

“…Exclusion criteria included major congenital anomalies, congenital adrenal hyperplasia and short bowel syndrome requiring total parenteral nutrition after hospital discharge. After consent, two measurements of SBP were obtained 5 min apart by the same individual with an appropriately sized cuff for the upper arm using Doppler amplification to facilitate the manual read-out on an aneroid sphygmomanometer [12][13][14][15]. Infant state was recorded as calm versus noncalm at the time of each measurement.…”

“…This hesitancy in measuring BP may reflect concern for the accuracy and reproducibility of infant measurements or insufficient evidence to raise the concern of clinicians. In an earlier study [13], we examined manual SBP measurements using Doppler amplification and demonstrated their accuracy and reproducibility in infants ≤3 years of age when state, i.e., calm versus noncalm, is accounted for at the time of measurement. Although the study was not powered to examine the effects of EGA on SBP, infants born preterm had a significantly higher SBP after accounting for state than did term infants.…”

Hypertension in infancy: diagnosis, management and outcome

“…The most consistent change is an increase in BP by as much as 20 mmHg when an infant is feeding, although even sucking on a pacifier/soother can increase the pressure by up to 10 mmHg. The reliability of repeat BP measurements on infants also decreases when infants are in a non-calm state [20]. As in older children, use of the proper cuff size is important and has been determined in neonates to be a cuff width to arm circumference ratio in the range of 0.45-0.55 [14,21].…”