• Janis M Dionne, Stephen A Bremner, Simin K Baygani, Beau Batton, Ebru Ergenekon, Varsha Bhatt-Mehta, Eugene Dempsey, Martin Kluckow, Luana Pesco Koplowitz, Dina Apele-Freimane, Hiroko Iwami, Agnes Klein, Mark Turner, Heike Rabe, and International Neonatal Consortium.
• Division of Nephrology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada. Electronic address: jdionne@cw.bc.ca.
• J. Pediatr. 2020 Jun 1; 221: 23-31.e5.

ObjectivesTo determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the literature regarding proper BP cuff size and measurement location and method.Study DesignA literature search was conducted in MEDLINE, PubMed, Embase, Cochrane Library, and CINAHL from 1946 to 2017 on BP in neonates <3 months of age (PROSPERO ID CRD42018092886). Study data were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods.ResultsOf 3587 nonduplicate publications identified, 34 were appropriate for inclusion in the analysis. Four studies evaluating BP cuff size support a recommendation for a cuff width to arm circumference ratio of approximately 0.5. Studies investigating measurement location identified the upper arm as the most accurate and least variable location for oscillometric BP measurement. Analysis of studies using Bland-Altman methods for comparison of intra-arterial to oscillometric BP measurement show that the 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP. Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure <30 mm Hg.ConclusionsProper BP measurement is critical in neonates with naturally lower BP and attention to BP cuff size, location, and method of measurement are essential. With decreasing use of intra-arterial catheters for long-term BP monitoring in neonates, further studies are urgently needed to validate and develop oscillometric methodology with enhanced accuracy.Copyright © 2020 Elsevier Inc. All rights reserved.

8 keywords...

hide…