Cyclical variation of blood pressure and heart rate in neonates

Using a computerised physiological monitoring system a cyclical variation in blood pressure (waves), with associated changes in heart rate and transcutaneous oxygen, was observed. Twenty five episodes were seen in 10 neonates, with a median gestation of 33 weeks (range 28-42 weeks). Eight neonates had an asphyxial injury. Blood pressure waves had a mean (SD) amplitude of 11.6 (5.6) mm Hg with a mean wavelength of 9.0 (5.2) minutes. Both amplitude and frequency were independent of gestation. In neonates of less than 34 weeks an inverse phase relation existed between heart rate and blood pressure waves (blood pressure rose as heart rate fell); in infants with a gestation greater than 34 weeks a direct phase relationship occurred (blood pressure and heart rate rose together). It is postulated that hypertensive blood pressure waves may cause or exacerbate cerebral pathology in neonates with a pressure passive cerebral circulation.