Related Experiment Video
Updated: Jan 6, 2026
Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
Blood pressure extremes and severe IVH in preterm infants
Zachary A Vesoulis1, Abigail A Flower2, Santina Zanelli3
1Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. vesoulis_z@wustl.edu.
Insights
Extremely low or high blood pressure in preterm infants is linked to severe intraventricular hemorrhage (IVH). Monitoring mean arterial blood pressure (MABP) helps identify infants at risk for IVH.
Area of Science:
- Neonatal physiology
- Pediatric neurology
- Medical monitoring
Background:
- Optimal blood pressure ranges for preterm infants remain unknown.
- Deviations from ideal blood pressure may increase the risk of intraventricular hemorrhage (IVH).
Purpose of the Study:
- To investigate the relationship between mean arterial blood pressure (MABP) variability and severe IVH in preterm infants.
- To identify potential blood pressure thresholds associated with severe IVH.
Main Methods:
- Continuous MABP monitoring for 7 days in preterm infants (≤30 weeks GA).
- Cranial ultrasound to classify IVH severity (grade 3/4 vs. no severe IVH).
- Analysis of MABP distribution in relation to IVH outcomes.
Main Results:
- Infants with severe IVH (grade 3/4) spent more time with extreme MABP (<23 mmHg or >46 mmHg) compared to those without severe IVH (12% vs. 8%).
- A total of 85 million MABP measurements were analyzed from 157 preterm infants.
Conclusions:
- Preterm infants who develop severe IVH exhibit more unstable MABP.
- A greater duration of MABP outside the optimal range is associated with severe IVH in this population.
Background:
The optimal upper and lower limits of blood pressure in preterm infants are not known. Exceeding these thresholds may contribute to intraventricular hemorrhage (IVH).
Methods:
Preterm infants born ≤30 weeks GA were identified. Infants had continuous measurement of mean arterial blood pressure (MABP) for 7 days and cranial ultrasound imaging. IVH was classified as severe IVH (grade 3/4), no severe IVH (no IVH; grade 1/2), or no IVH. Mean ± SEM MABP values from hours 1-168 were calculated and sorted into bins 2 mm Hg wide. The normalized proportion of each recording spent in each bin was then calculated. Candidate limits were identified by comparison of MABP distribution in those with severe IVH vs. those without severe IVH.
Results:
Eighty-five million measurements were made from 157 infants. Mean EGA was 25.2 weeks; mean BW was 749 g; 65/157 female; inotrope use in 59/157; grade 3/4 IVH in 29/157. Infants with severe IVH spent significantly more time with extreme MABP measurements (<23 mm Hg or >46 mm Hg) compared to those without severe IVH (12% vs. 8% of recording, p = 0.02).
Conclusions:
Infants who developed severe IVH had substantially more unstable MABP and spent a significantly greater period of time with MABP outside of the optimal range.
Related Concept Videos
01:17Measurement of Blood Pressure
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:30Alterations in Blood Pressure
Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart...