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Published on: May 11, 2015
Effect of blood pressure cuffs on neonatal circulation: their potential application to newborns with persistent
J Rhodes1, J T Wung, F Z Bierman
1Tufts University School of Medicine, Division of Pediatric Cardiology, Boston, MA 02111, USA.
Insights
Blood pressure cuffs can selectively increase systemic vascular resistance without affecting pulmonary vascular resistance. This method offers a safe way to manage infants with primary pulmonary hypertension of the newborn (PPHN), improving oxygenation and allowing vasodilator use.
Area of Science:
- Neonatal Cardiology
- Pediatric Pulmonology
- Medical Devices
Background:
- Vasoactive agents for primary pulmonary hypertension of the newborn (PPHN) lack vascular selectivity.
- Blood pressure (BP) cuffs offer localized control over systemic vascular resistance.
Purpose of the Study:
- To evaluate the hemodynamic effects of BP cuffs in neonates.
- To assess the utility of BP cuffs in managing infants with PPHN.
Main Methods:
- BP cuffs were applied to nine healthy neonates and three infants with PPHN.
- Hemodynamic parameters were measured in healthy neonates during cuff inflation.
- Transcutaneous arterial oxygen tensions were monitored in PPHN infants with and without vasodilators.
Main Results:
- In healthy neonates, cuff inflation to systolic pressure increased systemic vascular resistance.
- In PPHN infants, BP cuffs increased transcutaneous arterial oxygen tensions.
- Co-administration of tolazoline with BP cuffs in PPHN patients did not cause hypotension.
Conclusions:
- BP cuffs can selectively increase systemic vascular resistance in neonates.
- BP cuffs show promise as an adjunct therapy for PPHN management.
- This technique may enhance the safety of vasodilator use in PPHN.
Abstract:
The contribution of vasoactive pharmacologic agents to the care of the infant with primary pulmonary hypertension of the newborn (PPHN) is hampered by their limited ability to act selectively on different vascular beds. In contrast, blood pressure (BP) cuffs decrease flow and increase resistance only in the extremities around which they are applied. They therefore offer a means of increasing systemic vascular resistance without affecting pulmonary vascular resistance, a hemodynamic effect that may be particularly desirable among PPHN patients receiving vasodilators. We studied the effect of BP cuffs on the circulation of nine healthy neonates and three infants with severe PPHN. Among the healthy neonates, inflation of the cuffs to 20 mmHg had no discernible hemodynamic effect. Inflation to systolic pressures, however, caused the left ventricular preejection period to increase from 36 +/- 9 ms to 45 +/- 10 ms, the end-diastolic dimension to increase from 1.80 +/- 0.16 cm to 1.92 +/- 0.16 cm, and the cardiac output to fall to 87 +/- 12% of baseline (all p < 0.05)--changes indicative of an increase in systemic vascular resistance. Application of BP cuffs to the patients with PPHN was associated with 10-25 mmHg increases in transcutaneous arterial oxygen tensions. Administration of tolazoline to these patients while the cuffs were inflated resulted in additional 10-20 mmHg increases and did not precipitate hypotension. These observations suggest that BP cuffs can play a useful role in the management of patients with PPHN.
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