Topics Discussed: cardiology; hypertension; hypertension, neonatal.
Excerpt:"Problem. An infant has a systolic blood pressure (BP) >90 mm Hg. Hypertension is defined as a BP >2 standard deviations above normal values for age and weight, but the definition can vary widely (see Appendix C.). Others define neonatal hypertension as a systolic BP >95th percentile for age and sex on three separate occasions. It can also be defined as a systolic BP >90 mm Hg and a diastolic BP >60 mm Hg in full-term infants; for premature infants, the values are systolic >80 mm Hg and diastolic >50 mm Hg. The values for normal BP are given in Appendix C (infants [C-1], premature infants[C-2] and infants weighing 401–1000 g [C-3]).
Immediate questions
- How was the BP taken? Make sure the BP reading is correct and the hypertension is real. Doppler flow ultrasonography is the most reliable noninvasive method of measurement. The size of the cuff is important; it should encircle two thirds of the length of the upper extremity. If the cuff is too narrow, the BP will be falsely elevated. If measurements are taken by means of an umbilical artery catheter, be certain that the catheter is free of bubbles or clots and the transducer is calibrated; otherwise, erroneous results will occur. BP reading from an indwelling catheter is the most accurate of all methods. BP rises when the infant is feeding, sucking, or in an upright position.
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