Abstract
Objective:
To determine the expected systolic, mean and diastolic blood pressures at birth and respective rates of change during the first 72 h of life in infants born at <28 weeks estimated gestational age (EGA) with a favorable short-term outcome, defined as survival to 14 days with grade II or less intraventricular hemorrhage (IVH).
Study Design:
Systolic, mean and diastolic blood pressures were continuously sampled at 0.5 Hz via umbilical artery catheter from birth through 72 h. The raw data were aligned by postnatal hour and underwent error correction. For each infant, the mean values of systolic, mean and diastolic blood pressure were calculated for each postnatal hour. The slope and intercept of best-fit line for each of the three blood pressure parameters was then calculated. Infants that received inotropic medications, died in the first 14 days of life, or had IVH grade III or IV were excluded.
Result:
Using 11.9 million valid data points from 35 infants (mean EGA=25.7±1.5 weeks, mean birth weight=865±201 g), we found independent associations of African-American race (P<0.01) and a complete course of antenatal steroids (P<0.01) with higher blood pressures at birth and a slower rate of increase. Acute chorioamnionitis was independently associated (P=0.02) with lower blood pressures at birth and a faster rate of increase. EGA and birth weight were not independently predictive of blood pressure parameters.
Conclusion:
We found that (i) the estimated mean blood pressure at birth is ~33 mmHg in a cohort of very preterm infants, (ii) blood pressure gradually increases with postnatal age, (iii) systolic blood pressure increases at a faster rate than diastolic blood pressure, (iv) race, antenatal steroid exposure and chorioamnionitis are independent modulators of blood pressure whereas EGA and birth weight are not.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Bada HS, Korones SB, Perry EH, Arheart KL, Ray JD, Pourcyrous M et al. Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage. J Pediatr 1990; 117 (4): 607–614.
Miall-Allen VM, de Vries LS, Whitelaw AG . Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child 1987; 62 (10): 1068–1069.
Riddle A, Maire J, Cai V, Nguyen T, Gong X, Hansen K et al. Hemodynamic and metabolic correlates of perinatal white matter injury severity. PloS One 2013; 8 (12): e82940.
Versmold HT, Kitterman JA, Phibbs RH, Gregory GA, Tooley WH . Aortic blood pressure during the first 12 hours of life in iInfants with birth weight 610 to 4,220 grams. Pediatrics 1981; 67 (5): 607–613.
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): 470–479.
Cunningham S, Symon AG, Elton RA, Zhu C, McIntosh N . Intra-arterial blood pressure reference ranges, death and morbidity in very low birthweight infants during the first seven days of life. Early Hum Dev 1999; 56 (2–3): 151–165.
Georgieff MK, Mills MM, Gómez-Marín O, Sinaiko AR . Rate of change of blood pressure in premature and full term infants from birth to 4 months. Pediatr Nephrol 1996; 10 (2): 152–155.
Hegyi T, Carbone MT, Anwar M, Ostfeld B, Hiatt M, Koons A et al. Blood pressure ranges in premature infants. I. The first hours of life. J Pediatr 1994; 124 (4): 627–633.
Dannevig I, Dale HC, Liestøl K, Lindemann R . Blood pressure in the neonate: three non-invasive oscillometric pressure monitors compared with invasively measured blood pressure. Acta Paediatr 2005; 94: 191–196.
Lee J, Rajadurai VS, Tan KW . Blood pressure standards for very low birthweight infants during the first day of life. Arch Dis Child Fetal Neonatal Ed 1999; 81 (3): F168–F170.
Pejovic B, Peco-Antic A, Marinkovic-Eric J . Blood pressure in non-critically ill preterm and full-term neonates. Pediatr Nephrol 2006; 22 (2): 249–257.
Kent AL, Kecskes Z, Shadbolt B, Falk MC . Normative blood pressure data in the early neonatal period. Pediatr Nephrol 2007; 22 (9): 1335–1341.
Pichler G, Cheung P-Y, Binder C, O’Reilly M, Schwaberger B, Aziz K et al. Time Course Study of Blood Pressure in Term and Preterm Infants Immediately after-Birth., Huang L-M editor. PLoS One 2014; 9 (12): e114504.
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): 301–305.
Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK . Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol 2001; 21 (5): 272–278.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG . Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (2): 377–381.
Ayaz H, Izzetoglu M, Shewokis PA, Onaral B . Sliding-window motion artifact rejection for functional near-infrared spectroscopy. Conf Proc IEEE Eng Med Biol Soc 2010; 2010: 6567–6570.
Levy PT, Dioneda B, Holland MR, Sekarski TJ, Lee CK, Mathur A et al. Right ventricular function in preterm and term neonates: reference values for right ventricle areas and fractional area of change. J Am Soc Echocardiogr 2015; 28: 559–569.
Hirose A, Khoo NS, Aziz K, Al-Rajaa N, van den Boom J, Savard W et al. Evolution of left ventricular function in the preterm infant. J Am Soc Echocardiogr 2015; 28 (3): 302–308.
Sommers R, Stonestreet BS, Oh W, Laptook A, Yanowitz TD, Raker C et al. Hemodynamic effects of delayed cord clamping in premature infants. Pediatrics 2012; 129 (3): e667–e672.
Tyszczuk L, Meek J, Elwell C, Wyatt JS . Cerebral blood flow is independent of mean arterial blood pressure in preterm infants undergoing intensive care. Pediatrics 1998; 102 (2 Pt 1): 337–341.
Soul JS, Hammer PE, Tsuji M, Saul JP, Bassan H, Limperopoulos C et al. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants. Pediatr Res 2007; 61 (4): 467–473.
Alderliesten T, Lemmers PMA, Smarius JJM, van de Vosse RE, Baerts W, van Bel F . Cerebral oxygenation, extraction, and autoregulation in very preterm infants who develop peri-intraventricular hemorrhage. J Pediatr 2013; 162: e2.
Eliot RJ, Klein AH, Glatz TH, Nathanielsz PW, Fisher DA . Plasma norepinephrine, epinephrine, and dopamine concentrations in maternal and fetal sheep during spontaneous parturition and in premature sheep during cortisol-induced parturition. Endocrinology 1981; 108 (5): 1678–1682.
Acknowledgements
We wish to thank Anthony Barton for his tireless efforts at patient recruitment and data collection. Dr Vesoulis’s work was supported by an NIH Grant, KL2 TR000450-08 (NCATS). Dr Wallendorf’s work was supported an NIH grant, P30 HD062171 (NICHD), to the Intellectual and Developmental Disabilities Research Center at the Washington University, and funding from the McDonnell Centers for Systems Neuroscience and Cellular and Molecular Neurobiology.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Vesoulis, Z., El Ters, N., Wallendorf, M. et al. Empirical estimation of the normative blood pressure in infants <28 weeks gestation using a massive data approach. J Perinatol 36, 291–295 (2016). https://doi.org/10.1038/jp.2015.185
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2015.185
This article is cited by
-
Oscillometric arterial blood pressure in haemodynamically stable neonates in the first 2 weeks of life
Pediatric Nephrology (2023)
-
Blood pressure values and hypotension management in extremely preterm infants: a multi-center study
Journal of Perinatology (2022)
-
Early arterial pressure monitoring and term-equivalent age MRI findings in very preterm infants
Pediatric Research (2022)
-
The Impact of Dexmedetomidine Initiation on Cardiovascular Status and Oxygenation in Critically ill Neonates
Pediatric Cardiology (2022)
-
Blood pressure extremes and severe IVH in preterm infants
Pediatric Research (2020)