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

Abstract

on behalf of the International Neonatal Consortium 15 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.

Comparing oscillometric noninvasive and invasive intra‐arterial blood pressure monitoring in term neonates under general anesthesia: A retrospective study

“…The secondary outcome was the agreement of each value assessed during periods of high or low BP. Low BP was defined as an intra-arterial mean BP ≤30 mm Hg, 6,7 and high BP was defined as an intra-arterial mean BP ≥60 mm Hg. In addition, we assessed the tracking ability of each BP value (within 2 minutes) between both methods as the concordance rate.…”

“…Similarly, Agnes et al compared oscillometric noninvasive BP with invasive intra-arterial BP in children with a median (IQR) age of 6 (5)(6)(7)(8)(9)(10)(11) months and demonstrated that noninvasive BP measurements were higher than the intra-arterial BP measurements during hypotension (mean intra-arterial BP ≤45 mm Hg), while the bias (SD) of the systolic and mean BP were −13 (9) and −9 (5) mm Hg, respectively. 4 Our study showed similar findings in term neonates.…”

“…2 However, the chosen values and methods used to assess hemodynamics depend on the individual anesthesiologist. Agreement between the two BP measurement methods has been reported in adults, 3,4 children, 5 and infants, 6 but rarely in neonates, especially under general anesthesia.…”

“…However, the chosen values and methods used to assess hemodynamics depend on the individual anesthesiologist. Agreement between the two BP measurement methods has been reported in adults, 3,4 children, 5 and infants, 6 but rarely in neonates, especially under general anesthesia. Studies have demonstrated that an acceptable correlation between both methods has been confirmed within the normal BP range; however, during hypotension and hypertension, the discrepancy between the two methods increases 3‐5 .…”

Advances in Non-Invasive Blood Pressure Monitoring

“…Moreover, frequent use of cuff devices can cause skin or nerve damage [ 52 , 53 , 54 ]. Importantly, like conventional cuff-based methods, these devices lose accuracy when mean arterial pressure (MAP) is <30 mmHg [ 83 ], a level very common in sick neonates. Some of these devices meet guidelines for accuracy cited by the US Food and Drug Administration (FDA) and the European Union (EU), i.e., a mean average error (MAE) or mean difference <±5 mmHg and standard deviation (sd) <8 mmHg [ 84 , 85 ].…”