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Published on: January 27, 2023
Determinants of Blood Pressure in Neonates and Infants: Predictable Variability
1Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
Insights
Neonatal blood pressure (BP) fluctuates significantly, influenced by maternal, perinatal, and infant factors. Understanding these influences is key to identifying potential BP abnormalities in newborns, especially premature infants.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Perinatal Medicine
Background:
- Neonatal blood pressure (BP) exhibits rapid changes in early life, particularly in premature infants.
- Maternal health, perinatal events, and infant-specific factors can significantly impact neonatal BP.
- Existing research on these influences is often limited by small sample sizes or conflicting results.
Purpose of the Study:
- To review the evidence linking maternal conditions, perinatal events, and infant factors to neonatal BP.
- To elucidate the patterns of BP changes in neonates, including preterm infants.
- To enhance understanding of hemodynamic adaptation and cardiovascular responses in neonates.
Main Methods:
- Systematic review of existing literature on factors affecting neonatal blood pressure.
- Analysis of physiological mechanisms of hemodynamic adaptation to extrauterine life.
- Examination of compensatory cardiovascular responses in the neonatal period.
Main Results:
- Gestational age, birth weight, and postmenstrual age are primary determinants of neonatal BP.
- Maternal and perinatal factors have variable and sometimes conflicting effects on neonatal BP.
- Physiological adaptation processes help explain expected and unexpected vascular responses in neonates.
Conclusions:
- Accurate assessment of neonatal BP requires understanding expected patterns and influencing factors.
- Further research is needed to clarify the impact of maternal and perinatal conditions.
- A comprehensive understanding of neonatal hemodynamics aids in predicting BP variability.
Abstract:
The blood pressure (BP) of neonates, especially those born premature, changes rapidly over the first days and weeks of life. Neonatal BPs may be affected by maternal factors, perinatal factors or events, and intrinsic or extrinsic infant factors. Unfortunately, the effect of many maternal health and disease states has only been studied in small numbers or has shown conflicting results. Many events around the time of delivery have the potential to influence the neonatal BP, and while definitive studies are often lacking, some observational data support physiological expectations. The strongest determinants of neonatal BP are the infant factors of gestational age at birth, birth weight, and postmenstrual age. Understanding the expected pattern of BP changes, identifying the potential influencing factors, and accurately measuring the BP are all essential to determine whether there is a BP abnormality present but are also more complex in the neonatal population. This review describes the evidence for maternal conditions, perinatal events, and infant factors to affect neonatal BP. It also explains what is currently known about the changing BP patterns in neonates including those born preterm. In addition, by examining the physiological process of hemodynamic adaptation to the extrauterine environment and compensatory cardiovascular responses, we can gain insight into the expected and unexpected vascular responses, making the variability of neonatal BP seem a little more predictable.
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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.