Abstract
Introduction: Normative blood pressure (BP) values on preterm infants exist but are based on small cohorts of infants. Utilizing electronic medical records (EMR), we can explore earlier gestational ages (GA) and follow their progression to 40 weeks corrected gestational age (CGA). Methods: A retrospective cohort study of infants within the SSM Health System from July 1, 2013 through June 30, 2023. Infants born at >22 0/7 weeks but <41 weeks GA were included if any BP measurements existed (n = 29,323 infants, 1.4 million BPs). Data were extracted electronically from EMR using Microsoft SQL. Systolic BP (SBP), mean arterial pressures (MAP), and diastolic BP (DBP) were determined for each week of life from birth and percentile ranges (1st to 99th) for infants alive at CGA, and BP patterns for GA determined. Results: Percentiles for SBP, DBP, and MAP are provided. There is a rapid increase in BP at all gestations during the first 2 weeks, thus BP values are higher at any CGA in infants born at an earlier GA than infants born at that GA. For MAP values between the 5th and 10th percentile, the GA is appropriate for first week and then use CGA + 5 mm Hg. After the first week, 2.8 X CGA is between 90 and 95 percentile for SBP. Conclusions: The BP is dependent on the GA at birth and the CGA when it is measured. SBP, MAP, and DBP all increase rapidly in the 2 weeks of life prior to a gradual increase over time.
Journal Section:
Research Article
References
1.
Kent
AL
, Meskell
S
, Falk
MC
, Shadbolt
B
. Normative blood pressure data in non-ventilated premature neonates from 28-36 weeks gestation
. Pediatr Nephrol
. 2009
;24
(1
):141
–6
. 2.
Dionne
JM
. Determinants of blood pressure in neonates and infants: predictable variability
. Hypertension
. 2021
;77
(3
):781
–7
. 3.
Pejovic
B
, Peco-Antic
A
, Marinkovic-Eric
J
. Blood pressure in non-critically ill preterm and full-term neonates
. Pediatr Nephrol
. 2007
;22
(2
):249
–57
. 4.
Alonzo
CJ
, Nagraj
VP
, Zschaebitz
JV
, Lake
DE
, Moorman
JR
, Spaeder
MC
. Blood pressure ranges via non-invasive and invasive monitoring techniques in premature neonates using high resolution physiologic data
. J Neonatal Perinatal Med
. 2020
;13
(3
):351
–8
. 5.
Zubrow
AB
, Hulman
S
, Kushner
H
, Falkner
B
. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group
. J Perinatol
. 1995
;15
(6
):470
–9
.6.
Dionne
JM
, Abitbol
CL
, Flynn
JT
. Hypertension in infancy: diagnosis, management and outcome
. Pediatr Nephrol
. 2012
;27
(1
):17
–32
. 7.
Lalan
SP
, Warady
BA
. Discrepancies in the normative neonatal blood pressure reference ranges
. Blood Press Monit
. 2015
;20
(4
):171
–7
. 8.
Vesoulis
ZA
, El Ters
NM
, Wallendorf
M
, Mathur
AM
. Empirical estimation of the normative blood pressure in infants <28 weeks gestation using a massive data approach
. J Perinatol
. 2016
;36
(4
):291
–5
. 9.
Batton
B
. Neonatal blood pressure standards: what is “normal”
. Clin Perinatol
. 2020
;47
(3
):469
–85
. 10.
Sharma
D
, Farahbakhsh
N
, Shastri
S
, Sharma
P
. Neonatal hypertension
. J Matern Fetal Neonatal Med
. 2017
;30
(5
):540
–50
. 11.
van Zadelhoff
AC
, Poppe
JA
, Willemsen
S
, Mauff
K
, van Weteringen
W
, Goos
TG
, et al. Age-dependent changes in arterial blood pressure in neonates during the first week of life: reference values and development of a model
. Br J Anaesth
. 2023
;130
(5
):585
–94
. 12.
American Academy of Pediatrics Committee on Fetus And Newborn
. Levels of neonatal care
. Pediatrics
. 2012
;130
(3
):587
–97
. 13.
Becker
SA
, Kothe
TB
, Josephsen
JB
, Jackson
K
, Williams
HL
, Hillman
NH
. Early physiological and adrenal effects of budesonide mixed with surfactant in large observational preterm cohort study
. Neonatology
. 2022
;119
(4
):474
–82
. 14.
Dionne
JM
, Bremner
SA
, Baygani
SK
, Batton
B
, Ergenekon
E
, Bhatt-Mehta
V
, et al. Method of blood pressure measurement in neonates and infants: a systematic review and analysis
. J Pediatr
. 2020
;221
:23
–31.e5
. 15.
Kiss
JK
, Gajda
A
, Mari
J
, Nemeth
J
, Bereczki
C
. Oscillometric arterial blood pressure in haemodynamically stable neonates in the first 2 weeks of life
. Pediatr Nephrol
. 2023
;38
(10
):3369
–78
. 16.
Batton
B
, Batton
D
, Riggs
T
. Blood pressure during the first 7 days in premature infants born at postmenstrual age 23 to 25 weeks
. Am J Perinatol
. 2007
;24
(2
):107
–15
. 17.
Dizon
S
, Hoffman
SB
. Postnatal blood pressure in the preterm small for gestational age neonate
. J Neonatal Perinatal Med
. 2018
;11
(4
):371
–7
. 18.
Batton
B
, Li
L
, Newman
NS
, Das
A
, Watterberg
KL
, Yoder
BA
, et al. Evolving blood pressure dynamics for extremely preterm infants
. J Perinatol
. 2014
;34
(4
):301
–5
. 19.
Petersen
RY
, Clermont
D
, Williams
HL
, Buchanan
P
, Hillman
NH
. Oral sodium supplementation on growth and hypertension in preterm infants: an observational cohort study
. J Perinatol
. 2024
;44
(10
):1515
–22
. 20.
Rabe
H
, Bhatt-Mehta
V
, Bremner
SA
, Ahluwalia
A
, McFarlane
R
, Baygani
S
, et al. Antenatal and perinatal factors influencing neonatal blood pressure: a systematic review
. J Perinatol
. 2021
;41
(9
):2317
–29
. 21.
Holanda
NSO
, da Cruz
MCL
, Xavier
C
, de Almeida
VA
, Moran
CA
, Azevedo
IG
, et al. Trajectory of systemic blood pressure in early life: a cohort study
. Glob Pediatr Health
. 2023
;10
:2333794X231201261
. 22.
Dionne
JM
, Flynn
JT
. Management of severe hypertension in the newborn
. Arch Dis Child
. 2017
;102
(12
):1176
–9
. 23.
Hjorten
R
, Flynn
JT
. Neonatal hypertension
. Clin Perinatol
. 2022
;49
(1
):27
–42
. 24.
Pereira
SS
, Sinha
AK
, Morris
JK
, Wertheim
DF
, Shah
DK
, Kempley
ST
. Blood pressure intervention levels in preterm infants: pilot randomised trial
. Arch Dis Child Fetal Neonatal Ed
. 2019
;104
(3
):F298
–305
. 25.
Batton
B
, Li
L
, Newman
NS
, Das
A
, Watterberg
KL
, Yoder
BA
, et al. Early blood pressure, antihypotensive therapy and outcomes at 18-22 months’ corrected age in extremely preterm infants
. Arch Dis Child Fetal Neonatal Ed
. 2016
;101
(3
):F201
–6
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