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Oscillatory Blood Pressure Values in Newborn Infants: Observational Data Over Gestational Ages
Noah H Hillman1,2, Howard L Williams1, Rebecca Y Petersen1,2
1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Insights
Blood pressure (BP) in preterm infants is influenced by gestational age (GA) at birth and corrected gestational age (CGA). BP rapidly increases in the first two weeks of life, then gradually rises over time.
Area of Science:
- Neonatal physiology
- Pediatric cardiology
- Clinical data science
Background:
- Existing normative blood pressure (BP) values for preterm infants are limited by small cohort sizes.
- Electronic medical records (EMR) offer a valuable resource for studying BP trends in larger, more diverse infant populations.
- Investigating BP progression from early gestational ages (GA) to 40 weeks corrected gestational age (CGA) is crucial for understanding infant cardiovascular health.
Purpose of the Study:
- To establish normative blood pressure percentiles for preterm infants from birth up to 40 weeks corrected gestational age (CGA).
- To analyze the relationship between gestational age at birth and blood pressure trajectories throughout infancy.
- To provide updated, data-driven reference ranges for systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) in preterm infants.
Main Methods:
- A retrospective cohort study utilized data from 29,323 infants (1.4 million BP measurements) within the SSM Health System (2013-2023).
- Infants born between >22 0/7 and <41 weeks GA with available BP data were included.
- Systolic BP, diastolic BP, and mean arterial pressure were extracted from EMR and analyzed weekly from birth to 40 weeks CGA.
Main Results:
- Normative percentile ranges (1st-99th) for SBP, DBP, and MAP were generated for infants up to 40 weeks CGA.
- A rapid BP increase was observed during the first two weeks of life across all gestational ages.
- BP values at any given CGA were higher for infants born at an earlier GA, highlighting the impact of birth GA on BP trends.
Conclusions:
- Infant blood pressure is significantly dependent on both gestational age at birth and corrected gestational age at the time of measurement.
- Rapid increases in SBP, MAP, and DBP occur within the first two weeks post-birth, followed by a more gradual rise.
- These findings provide essential updated reference ranges for monitoring preterm infant cardiovascular health.
Introduction:
Normative blood pressure (BP) values on preterm infants exist but are based on small cohorts of infants. Utilizing electronic medical records (EMR), we can explore earlier gestational ages (GA) and follow their progression to 40 weeks corrected gestational age (CGA).
Methods:
A retrospective cohort study of infants within the SSM Health System from July 1, 2013 through June 30, 2023. Infants born at >22 0/7 weeks but <41 weeks GA were included if any BP measurements existed (n = 29,323 infants, 1.4 million BPs). Data were extracted electronically from EMR using Microsoft SQL. Systolic BP (SBP), mean arterial pressures (MAP), and diastolic BP (DBP) were determined for each week of life from birth and percentile ranges (1st to 99th) for infants alive at CGA, and BP patterns for GA determined.
Results:
Percentiles for SBP, DBP, and MAP are provided. There is a rapid increase in BP at all gestations during the first 2 weeks, thus BP values are higher at any CGA in infants born at an earlier GA than infants born at that GA. For MAP values between the 5th and 10th percentile, the GA is appropriate for first week and then use CGA + 5 mm Hg. After the first week, 2.8 X CGA is between 90 and 95 percentile for SBP.
Conclusions:
The BP is dependent on the GA at birth and the CGA when it is measured. SBP, MAP, and DBP all increase rapidly in the 2 weeks of life prior to a gradual increase over time.
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