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Correlation between Invasive and Noninvasive Blood Pressure Measurements in Extremely Low Gestational Age Newborns
Krishna Kishore Umapathi1, Maroun J Mhanna1
1Department of Pediatrics, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio.
Insights
Non-invasive blood pressure (NIBP) correlates with invasive blood pressure (IBP) in extremely low gestational age newborns (ELGANs). However, NIBP overestimates IBP in hypotensive infants, indicating poor agreement between these blood pressure monitoring methods.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Monitoring
Background:
- Accurate blood pressure monitoring is critical for extremely low gestational age newborns (ELGANs).
- Invasive blood pressure (IBP) provides precise measurements but carries risks.
- Non-invasive blood pressure (NIBP) devices offer a safer alternative, but their accuracy in ELGANs requires validation.
Purpose of the Study:
- To investigate the correlation and agreement between IBP and NIBP measurements.
- To assess the accuracy of NIBP compared to IBP in ELGANs within the first 72 hours of life.
- To determine if NIBP overestimates or underestimates IBP, particularly in hypotensive neonates.
Main Methods:
- Retrospective cohort study of ELGANs within the first 72 hours of life.
- Simultaneous IBP and NIBP measurements were recorded.
- Calculation of the percentage difference in mean arterial blood pressure (% Diff-BP) and assessment of agreement using Bland-Altman analysis.
Main Results:
- A significant correlation (Spearman Rho = 0.887, p < 0.001) was observed between IBP and NIBP.
- However, the agreement between the two methods was poor (mean difference: 0.20; 95% limits of agreement: -5.48 to 5.89).
- In hypotensive infants, NIBP demonstrated a tendency to overestimate IBP measurements.
Conclusions:
- While NIBP correlates with IBP in ELGANs, its poor agreement necessitates caution.
- NIBP may overestimate blood pressure in hypotensive ELGANs, potentially leading to misdiagnosis or inappropriate treatment.
- Further research is needed to refine NIBP use and interpretation in this vulnerable population.
Objective:
This work aimed to study the correlation between invasive blood pressure (IBP) and non-IBP (NIBP) in extremely low gestational age newborns (ELGANs) during their first 72 hours of life.
Study Design:
In a retrospective cohort study, IBP and simultaneous NIBP measurements during the first 72 hours of life were recorded in ELGANs. Medical records were reviewed for potential risk factors that affect BP. The % difference in mean arterial BP (% Diff-BP) measurements was calculated as (IBP-NIBP)/IBP. Hypotension was defined as mean arterial Bp < gestational age (GA).
Results:
In total, 236 infants and 1,340 paired IBP-NIBP measurements were studied. Infants had a (mean ± standard deviation) GA of 25.4 ± 21.6 weeks and a birth weight of 810 ± 249 g. Overall, there was a significant correlation between IBP and NIBP of 0.887 (Spearman Rho; p < 0.001). However, the agreement between IBP and NIBP was poor, with a mean difference (95% limits of agreement) of 0.20 (-5.48; 5.89). The mean % Diff-BP (±standard deviation) was 0.39 ± 8.25%. In hypotensive infants, NIBP overestimated IBP measurements, with an agreement of -0.67 (-4.17; 2.83).
Conclusion:
Mean arterial NIBP correlates with IBP in ELGANs. However, there is a poor agreement between methods. In hypotensive infants, NIBP overestimates IBP measurements.
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