Non-invasive oscillometric measurement of systolic, mean and diastolic blood pressure in infants with congenital heart defects after operation. A comparison with direct blood pressure measurements

Pilossoff, Vladimir; Schöber, J. G.; Peters, Dorothea M.; Bühlmeyer, K

doi:10.1007/bf00441772

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…38 39The technique should not be used in neonates merely because it is easy and convenient to use when other cheaper and more reliable non-invasive methods are available, as this study again shows. While the technique seems to work reasonably well in older children,34 44 it may not always reliably recognise hypertension 40. The Doppler technique used in our study has been found reliable by others,15 17-19 38 but automated devices that use a sensor placed under the pressure cuff46-48 seem less reliable 49.…”

Section: Discussionmentioning

confidence: 57%

“…Although oscillometric methods of measuring blood pressure14 34-45 are now widely used, neonatal readings are of limited accuracy. Errors of 10 mm Hg are not uncommon,40 42 43 and bias develops when pressure is low (fig 4). The technique becomes least reliable precisely when it needs to be at its most reliable—in babies with clinically significant hypo tension 42…”

Section: Discussionmentioning

confidence: 99%

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Systolic blood pressure in babies of less than 32 weeks gestation in the first year of life

Initiative

1999

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Aim-To define the normal range of systolic blood pressure in a non-selective population based sample of babies of low gestation throughout early infancy. Methods-Daily measurements of systolic blood pressure were made in all the babies of less than 32 weeks gestation born in the North of England in 1990 and 1991 during the first 10 days of life. Additional measurements were obtained from 135 of these babies throughout the first year of life. Systolic pressure was measured by sensing arterial flow with a Doppler ultrasound probe. It was assumed that blood pressure had never been pathologically abnormal in the neonatal period if the child was alive and free from severe disability two years later. Data of adequate quality were available from 398 such children. Additional data were collected, for comparative purposes, from 123 babies of 32, 36, or 40 weeks of gestation. Results-Systolic pressure correlated with weight and gestation at birth, and rose progressively during the first 10 days of life. The coeYcient of variation did not vary with gestational or postnatal age (mean value 17%), the relation with gestation being closer than with birthweight. Systolic pressure rose 20% during the first 10 days from an initial mean of 42 mm Hg in babies of 24 weeks gestation, and by 42% from an initial mean of 48 mm Hg in babies of 31 weeks gestation. These findings were not altered by the exclusion of data from 14 babies who had inotropic support during this time. Simultaneous measurements in three centres using an oscillometric technique revealed that this technique tended to overestimate systolic pressure when this was below average. Systolic pressure finally stabilised at a mean of 92 (95% CI 72-112) mm Hg at a postconceptional age of 44-48 weeks irrespective of gestation at birth. Conclusion-Systolic blood pressure 4-24 hours after birth was less than gestational age (in weeks) in only 3% of non-disabled long term survivors. Systolic pressure rose with increasing gestation and increasing postnatal age, but stabilised some six weeks after term, regardless of gestation at birth. (Arch Dis Child Fetal Neonatal Ed 1999;80:F38-F42)

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Systolic blood pressure in babies of less than 32 weeks gestation in the first year of life

Initiative

1999

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…Most importantly, numerous studies have demonstrated that oscillometric BP readings in neonates are inconsistent with intra-arterial BP measurements, the latter being the gold standard for BP monitoring in this population [28][29][30][31]. Many studies that have reported a good correlation between intra-arterial and oscillometric readings have not conducted an appropriate evaluation for the agreement between the two methods, thus incorrectly attributing correlation as being equivalent to comparability or agreement [32][33][34][35][36]. Other studies in which agreement between the two methods of BP measurement have been evaluated have 'overlooked' the wide ranges of the data, once again incorrectly concluding that these two methods provide similar BP measurements [30,[37][38][39].…”

Section: Challenges With Blood Pressure Measurementsmentioning

confidence: 99%

Discrepancies in the normative neonatal blood pressure reference ranges

Lalan

Warady²

2015

Blood Pressure Monitoring

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Numerous normative blood pressure (BP) reference ranges with considerable variation in the data have been published for neonates. This poses unique challenges for the definition and management of BP abnormalities in neonates. The aim of this study was to investigate the factors that have led to varying normative BP reference ranges in the studies conducted to date and to discuss potential study designs that would help better define the normative data. An electronic literature search was performed in 'PubMed' for articles published in English between January 1965 and February 2014 related to neonatal BP reference ranges. Common limitations found in the published studies included small sample sizes, combined use of oscillometric and intra-arterial BP measurements, lack of consideration of potentially influential factors such as postconception age, daily weight and medications, and use of data from individuals with wide ranges of gestational age, birth weight, and postconception age. Inconsistencies in the published neonatal BP reference ranges are likely due to a combination of factors related to study design. Attention to these issues should be considered when designing future multicenter studies on this topic.

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“…The accuracy of the device in reflecting a direct arterial pressure has been demonstrated in neo nates [28], infants and children [27], and adults [29]. However, a study in infants in postoperative status [30] shows less promising accuracy than reported previously, and the accuracy of this device has been questioned in premature neonates whose BPs are in low ranges [31,32], There are some advantages of the device over other noninvasive methods of blood pressure determination [27]: (1) since it detects pressure oscillation, not sounds, it can be used in the neonate and small infant in whom Korotkoff sounds are usually too weak to give accurate readings; (2) it can be used in a noisy environment or by a person with hearing impairment; (3) the observerrelated variation is eliminated; (4) the diastolic pressure is also obtained which is not possible by the Doppler method, and (5) it also gives mean pressure and heart rate which are not ordinarily provided by other methods. An important disadvantage of this device is its relatively high cost: a Dinamap monitor without integrated printer costs approximately US$ 2,800.…”

Section: Site Of the Arterial Cannulamentioning

confidence: 99%

“…Values for ages 10-13 years have been extrapolated from these two studies using age-related increments from other studies. important for the following reasons: (1) indirect BP measured with a cuff selected by the thickness criterion agrees well with direct intra-arterial pressure in new borns, infants, children, and adults [11,13,[28][29][30]; (2) continuity of method from childhood to the adult is an important consideration for long-term follow-up of the natural history of BP and in the 'tracking' of an indi vidual patient, and (3) even if BP readings obtained by this method are not different from those obtained by the use of the length criterion, the use of length criterion does not conform with the physical principles of indirect BP measurement [8,17], Normal BP values published by the 1987 NIH Task Force [5] are probably lower than true BP values, as they were obtained with too large a cuff, 75 % of the length of the upper arm. We are in need of a more reliable set of normative BP values in children.…”

Section: Recommendations For Indirect Bp Measurementmentioning

confidence: 99%

Accurate Blood Pressure Measurement in Children

Park¹,

Guntheroth²

1989

Am J Noninvas Cardiol

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Accurate blood pressure determination is crucial in the management of critically ill infants and children, in detecting secondary hypertension amenable to surgical correction, and in the early detection of essential hypertension. However, the pediatric literature consists of contradictory methodology and extreme variations in the ‘limits of normal’. An indirect blood pressure measuring device requires validation against a direct arterial pressure. Although intra-arterial pressure is accepted as the reference standard, careful attention to technique is required: relatively short, stiff tubing, without compliant elements, and the elimination of blood clots and even microscopic air bubbles. An arterial line in an extremity, particularly the foot, will register a higher pressure than is present in the aorta due to systolic amplification, especially in patients who are vasoconstricted. Indirect blood pressure measurements by any of several methods is affected by multiple variables. This is reflected in conflicting recommendations for the upper limit of normal for systolic blood pressure that vary as much as 30 mm Hg. Selection of blood pressure cuff size is the major source of this variance. The laws of physics, supported by careful intra-arterial measurements, indicate that the correct cuff size is based on the diameter (or circumference) of the limb, not the length. Using the length may produce adequate readings if the subject is of normal weight/height relationship, but will result in hypertensive readings in obese subjects who are actually normotensive and in mildly low readings for thin subjects. The correct cuff width is 125-155 % of the diameter of the limb, whether arm or leg, or 40-50% of the circumference. We offer a working guide to normal blood pressure values derived from data collected with appropriate-sized cuffs with minor extrapolations.

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Non-invasive oscillometric measurement of systolic, mean and diastolic blood pressure in infants with congenital heart defects after operation. A comparison with direct blood pressure measurements

Cited by 18 publications

References 22 publications

Systolic blood pressure in babies of less than 32 weeks gestation in the first year of life

Systolic blood pressure in babies of less than 32 weeks gestation in the first year of life

Discrepancies in the normative neonatal blood pressure reference ranges

Accurate Blood Pressure Measurement in Children

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