Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Blood pressure normative values in preterm infants during postnatal transition

Pediatric Research volume 95, pages 698–704 (2024)Cite this article

Abstract

Background

The normative blood pressure values in preterm infants still not well defined during postnatal transition. We aimed to create normative blood pressure (BP) reference values in preterm infants <29 weeks gestational age recorded hourly during the postnatal transition.

Methods

We included only data from hemodynamically stable newborns. Only BP values measured by umbilical arterial catheter (UAC) were included. The regression model showed that only gestational age and postnatal age in hours determine the BP.

Results

We included 206 out of 547 admitted preterm infants. The BP increases with increasing gestational ages and overtime during the postnatal transition. We constructed 5 BP centile values for each gestational group. BP histograms show that the BP most of the time fluctuated between the 5th and 75th centile values, particularity during day one of life.

Conclusions

The BP trend values gradually increase in stable preterm infants during the postnatal transition, and preterm infants who do not follow this trend might require hemodynamics assessment.

Impact

  • The normative blood pressure is increasing gradually during the first 3 days after birth and is different with gestational ages.

  • This is first normative blood pressure centile values in stable preterm infant and based on invasive blood pressure monitoring.

  • The data enable more accurate monitoring of hemodynamics in preterm infants during postnatal transition.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Blood pressure values for 23 weeks gestational age.
Fig. 2: Blood pressure values for 24 weeks gestational age.
Fig. 3: Blood pressure values for 25 weeks gestational age.
Fig. 4: Blood pressure values for 26 weeks gestational age.
Fig. 5: Blood pressure values for 27 weeks gestational age.
Fig. 6: Blood pressure values for 28 weeks gestational age.

Similar content being viewed by others

References

  1. Stebor, A. D. Basic principles of noninvasive blood pressure measurement in infants. Adv. Neonatal Care 5, 252–261 (2005).

    Article  PubMed  Google Scholar 

  2. James, G. D. & Gerber, L. M. Measuring arterial blood pressure in humans: auscultatory and automatic measurement techniques for human biological field studies. Am. J. Hum. Biol. 30, e23063 (2018).

  3. Lurbe, E., Torro, I., Rodríguez, C., Alvarez, V. & Redón, J. Birth weight influences blood pressure values and variability in children and adolescents. Hypertension 38, 389–393 (2001).

    Article  CAS  PubMed  Google Scholar 

  4. Lang, S. M., Giuliano, J. S. Jr, Carroll, C. L., Rosenkrantz, T. S. & Eisenfeld, L. Neonatal/infant validation study of the CAS model 740 noninvasive blood pressure monitor with the Orion/MaxIQ NIBP module. Blood Press Monit. 19, 180–2 (2014).

  5. Evans, N. & Iyer, P. Change in blood pressure after treatment of patent ductus arteriosus with indomethacin. Arch. Dis. Child 68, 584–587, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1029308&tool=pmcentrez&rendertype=abstract (1993).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Doyle, L. W., Faber, B., Callanan, C. & Morley, R. Blood pressure in late adolescence and very low birth weight. Pediatrics 111, 252–257 (2003).

    Article  PubMed  Google Scholar 

  7. Kent, A. L. & Chaudhari, T. Determinants of neonatal Blood pressure. Curr. Hypertens. Rep. 15, 426–432 (2013).

    Article  PubMed  Google Scholar 

  8. Weber, F., Koning, L. & Scoones, G. P. Defining hypotension in anesthetized infants by individual awake blood pressure values: a prospective observational study. Paediatr. Anaesth. 27, 377–384 (2017).

    Article  PubMed  Google Scholar 

  9. Modanlou, H., Yeh, S. Y., Siassi, B. & Hon, E. H. Direct monitoring of arterial blood pressure in depressed and normal newborn infants during the first hour of life. J. Pediatr. 85, 553–559 (1974).

    Article  CAS  PubMed  Google Scholar 

  10. Alderliesten, T. et al. Hypotension in preterm neonates: low blood pressure alone does not affect neurodevelopmental outcome. J. Pediatr. 164, 986–991 (2014).

    Article  PubMed  Google Scholar 

  11. Fisher, D. J., Heymann, M. A. & Rudolph, A. M. Regional myocardial blood flow and oxygen delivery in fetal, newborn, and adult sheep. Am. J. Physiol. 243, H729–H731 (1982).

    CAS  PubMed  Google Scholar 

  12. Batton, B. et al. Evolving blood pressure dynamics for extremely preterm infants. J. Perinatol. 34, 301–305 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Cayabyab, R., McLean, C. W. & Seri, I. Definition of hypotension and assessment of hemodynamics in the preterm neonate. J. Perinatol. 29, S58–S62 (2009).

    Article  PubMed  Google Scholar 

  14. Shimokaze, T., Akaba, K. & Saito, E. Oscillometric and intra-arterial blood pressure in preterm and term infants: extent of discrepancy and factors associated with inaccuracy. Am. J. Perinatol. 32, 277–82 (2015).

  15. Pereira, S. S. et al. Blood pressure intervention levels in preterm infants: pilot randomised trial. Arch. Dis. Child Fetal Neonatal Ed. 104, F298–F305 (2019).

    Article  PubMed  Google Scholar 

  16. Banerjee, J., Leung, T. S. & Aladangady, N. Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants. Early Hum. Dev. 97, 1–8 (2016).

    Article  CAS  PubMed  Google Scholar 

  17. Fanaroff, J. M. & Fanaroff, A. A. Blood pressure disorders in the neonate: hypotension and hypertension. Semin. Fetal Neonatal Med. 11, 174–181 (2006).

    Article  PubMed  Google Scholar 

  18. Nelson, R. M. et al. Determination of accuracy in neonates for non-invasive blood pressure device using an improved algorithm. Blood Press Monit. 7, 123–129 (2002).

    Article  ADS  PubMed  Google Scholar 

  19. Batton, B. Neonatal blood pressure standards: what is “normal”? Clin. Perinatol. 47, 469–485 (2020).

    Article  PubMed  Google Scholar 

  20. Elsayed, Y. & Abdul Wahab, M. G. A new physiologic-based integrated algorithm in the management of neonatal hemodynamic instability. Eur. J. Pediatr. 181, 1277–1291 (2022).

    Article  PubMed  Google Scholar 

  21. Amer, R., Moddemann, D., Seshia, M., Ruben, A. & Anne, S. Neurodevelopmental outcomes of infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units based on location of birth. J. Pediatr. 196, 31–37.e1 (2018).

    Article  PubMed  Google Scholar 

  22. Eliason, S. Y., Whyte, H., Dow, K., Cronin, C. & Lee, S. Variations in transport outcomes of outborn infants among Canadian neonatal intensive care units. Am. J. Perinatol. 30, 377–382 (2013).

    Article  PubMed  Google Scholar 

  23. Binder-Heschl, C., Urlesberger, B., Schwaberger, B., Baik, N. & Pichler, G. Borderline-hypotension, how does it influence the cerebral tissue oxygenation? J. Paediatr. Child Health 51, 45 (2015).

    Google Scholar 

  24. Filippi, L. et al. Rescue treatment with terlipressin in different scenarios of refractory hypotension in newborns and infants. Pediatr. Crit. Care Med. 12, 237–241 (2011).

    Article  Google Scholar 

  25. Meyer, S., Sander, J., Gräber, S., Gottschling, S. & Gortner, L. Agreement of invasive versus non-invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age. J. Paediatr. Child Health 46, 249–254 (2010).

    Article  PubMed  Google Scholar 

  26. Rabe, H. et al. Antenatal and perinatal factors influencing neonatal blood pressure: a systematic review. J. Perinatol. 41, 2317–2329 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by a grant from iNO Therapeutics, LLC, a subsidiary of Mallinckrodt Pharmaceuticals.

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Yasser Elsayed

  2. Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada

    Faraz Ahmed

Authors
  1. Yasser Elsayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Faraz Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Y.E. conceptualized the article, conducted the background literature search, and revised the manuscript and both authors agree to the formatting and contents. F.A. collected the blood pressure values.

Corresponding author

Correspondence to Yasser Elsayed.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by the ethics board at the University of Manitoba.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elsayed, Y., Ahmed, F. Blood pressure normative values in preterm infants during postnatal transition. Pediatr Res 95, 698–704 (2024). https://doi.org/10.1038/s41390-023-02788-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-023-02788-8

Search

Advanced search

Quick links