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Early arterial pressure monitoring and term-equivalent age MRI findings in very preterm infants



Variability of arterial blood pressure (ABP) has been associated with intraventricular hemorrhage in very preterm neonates (VPT) and may predict other brain lesions assessed at term-equivalent of age (TEA).


This was a prospective single-center study including VPT with early invasive continuous ABP monitoring and assessed at TEA using brain magnetic resonance imaging (TEA-MRI). The association between early mean ABP (MABP) and TEA-MRI findings was modeled by multivariate logistic regression analysis using covariates selected by the LASSO method.


Among 99 VPT, the LASSO procedure selected consecutive periods of lowest MABP of 30 min on day 1 (d1) and 10 min on day 2 (d2) as the most relevant durations to predict TEA-MRI findings (OR [95% CI], 1.11 [1.02–1.23], p = 0.03 and 1.13 [1.01–1.27], p = 0.03, respectively). ROC curve analysis showed optimal thresholds at 30.25 mmHg on d1 and 33.25 mmHg on d2. This significant association persisted after adjustment with covariates including birthweight, gestational age, sex, and inotrope exposure. Final models selected by LASSO included the decile of the birthweight and lowest MABP for 30 min on d1 and 10 min on d2, for which the areas under the ROC curve were 74% and 75%, respectively.


Early continuous ABP monitoring may predict brain TEA-MRI findings in VPT.


  • Early arterial blood pressure monitoring may contribute to predicting brain damage upon MRI at term-equivalent of age for infants born very preterm.

  • Careful blood pressure continuous monitoring in very preterm infants may identify infants at risk of long-term brain damage.

  • Umbilical artery catheterization provides the best option for continuously monitoring arterial blood pressure in very preterm infants.

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Fig. 1
Fig. 2: Trends in MABP values recorded during the first 72 postnatal hours in infants with normal (in blue) and abnormal (in red) TEA-MRI.
Fig. 3: Multivariable logistic regression analysis of the association between MABP and normal brain TEA-MRI.


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This work was funded by Department of Pediatrics, University Hospitals, Geneva.

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Conception and design, acquisition of data, or analysis and interpretation of data: R.B., C.H., A.H., F.B.-M., S.H., A.B., and O.B. Drafting of the article or critical revision for important intellectual content: R.B., A.B., and O.B. Final approval of the version to be published: all.

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Correspondence to Olivier Baud.

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The authors declare no competing interests.

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A form providing written consent was collected from the parents of all patients at admission and the study was approved by the Swiss National Ethics Committee (BASEC No. 2018-00738).

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Butticci, R., Habre, C., Hernandez, A. et al. Early arterial pressure monitoring and term-equivalent age MRI findings in very preterm infants. Pediatr Res 92, 822–828 (2022).

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