Association between age-based blood pressure parameters and outcomes after intracerebral hemorrhage in children

Little is known regarding blood pressure (BP) targets in pediatric intracerebral hemorrhage (ICH). We sought to explore associations between BP and outcomes in these children.

We conducted a single-center retrospective review of patients admitted to the pediatric intensive care unit (PICU) with ICH between January 2017 and August 2024. Hemodynamic parameters examined were percent time in systolic hypotension and percent time above stage I systolic hypertension, stage II systolic hypertension, 95^th percentile mean arterial pressure (MAP), and 99^th percentile MAP in the first 48 h of PICU admission. Outcomes observed were in-hospital mortality and unfavorable functional outcome (modified Rankin Scale > 2) among survivors 90 days after discharge. Association between BP and outcomes were assessed with univariate and multivariable analyses, adjusting for clinical covariates.

Seventy-three patients (1- to 17-years-old) were included. Most had brain arteriovenous malformations (57.5%) or cavernous malformations (20.5%); 32.9% presented with a Glasgow Coma Scale score < 9. Percent time in hypotension (p = .007), above 95^th percentile for MAP (p = .012), above 99^th percentile for MAP (p = .024), and presenting GCS < 9 (p = .01) were associated with in-hospital mortality, and percent time in hypotension (p = .002) was associated with unfavorable 90-day outcome in univariate analysis. In multivariable regression, no BP variable reached significance. Children who experienced both hypotension and hypertension more frequently had an unfavorable outcome compared to those who only experienced hypertension.

Time spent in hypotension or greater than 95^th percentile MAP was associated with outcomes, though associations were not significant after adjustment for other clinical factors.