A practical and reliable method of measuring blood pressure in the neonate by pulse oximetry

doi:10.1016/S0022-3476(94)70016-8

The Journal of Pediatrics

Volume 125, Issue 4, October 1994, Pages 591-595

https://doi.org/10.1016/S0022-3476(94)70016-8 Get rights and content

Abstract

Objective: We investigated the reliability of the plethysmographic waveform of the pulse oximeter to measure systolic blood pressure in sick neonates. Methods: Fifty infants admitted to the neonatal intensive care unit, with indwelling arterial catheters placed for their ongoing care, were enrolled. Median gestational age was 31 weeks (range, 24 to 40 weeks), and the mean birth weight was 1711 gm (range, 546 to 3856 gm). Blood pressure was recorded by an oscillometric method as well as from a transducer connected to an arterial catheter. Additionally, pulse oximeter blood pressures were obtained by gradually inflating an appropriately sized blood pressure cuff in increments of 2 to 5 mm Hg, on the same extremity as the oximeter probe, until the waveform just disappeared. The cuff was then rapidly inflated another 20 mm Hg and then gradually deflated in increments of 2 to 5 mm Hg until the waveform reappeared on the oximeter screen display. The pulse oximeter blood pressures were calculated both as the blood pressure noted at disappearance of the pulse oximeter waveform and as the blood pressure noted by the average pulse oximeter blood pressure at the disappearance and reappearance of the waveform. The mean intraarterial systolic blood pressure was 54 mm Hg (range, 36 to 82 mm Hg). Results: Blood pressures obtained by pulse oximetry showed a significantly better correlation with intraarterial measurements in comparison with those obtained by oscillometric instruments. Additionally, the limits of agreement (mean difference ±2 SD) between blood pressures obtained by intraarterial measurements and those obtained by pulse oximetry were within a clinically acceptable range as opposed to those obtained by the comparison of intraarterial and oscillometric methods. Conclusion: Measurements of blood pressure in the neonate by means of pulse oximetery waveform analysis are easily obtainable and more accurate than those obtained by the oscillometric method. (J PEDIATR 1994;125:591-5)

Section snippets

METHODS

Fifty-one infants admitted to the neonatal intensive care unit at the Johns Hopkins Bayview Medical Center were enrolled in the study. All infants had indwelling arterial catheters placed for their ongoing care. Size 3.5F (birth weight <1500 gm) or 5F gauge umbilical artery catheters were used. Peripheral arteries were cannulated with size 24F catheters.

An appropriately sized blood pressure cuff was placed on the extremity where the pulse oximeter (BIOX 3700; Ohmeda, Madison, Wis.) was

RESULTS

The median gestational age was 30.5 weeks (range, 24 to 40 weeks) and the mean birth weight was 1697 gm (range, 500 to 3856 gm); 48% of the infants weighed less than 1500 gm at birth. One infant was receiving a vasoactive medication (dopamine). Twenty-six infants received mechanical ventilation, four by high-frequency ventilators, and 24 received supplemental oxygen by hood or nasal continuous positive airway pressure. Intraarterial systolic blood pressure ranged from 33 to 82 mm Hg, with a

DISCUSSION

We have described a reliable, easily obtainable, and noninvasive method of measuring systolic blood pressure in neonates by the use of pulse oximetry. This method appears more accurate than the oscillometric measurements commonly used in neonatal intensive care units. Ninety-five percent of the measurements obtained by pulse oximetry will be between 6 mm Hg less than and 4 mm Hg greater than the intraarterial "gold standard." On the other hand, oscillometric measurements could differ by amounts

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Method of Blood Pressure Measurement in Neonates and Infants: A Systematic Review and Analysis
2020, Journal of Pediatrics
Citation Excerpt :
Given the level of evidence in the literature, we recommend measurements be taken in the right upper arm when using an oscillometric device and cannot endorse the routine use of calf BP measurements (Table II). We identified 18 articles in which the authors had applied Bland-Altman methods to quantify the bias and agreement between different methods of measuring BP, comparing direct (intra-arterial) with indirect (oscillometric) methods.15,20,22-37 Results extracted from those articles are presented in forest plots (Figure 3, A-C) showing the bias and limits of agreement for all of the comparisons reported in the articles.
To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the literature regarding proper BP cuff size and measurement location and method.
A literature search was conducted in MEDLINE, PubMed, Embase, Cochrane Library, and CINAHL from 1946 to 2017 on BP in neonates <3 months of age (PROSPERO ID CRD42018092886). Study data were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods.
Of 3587 nonduplicate publications identified, 34 were appropriate for inclusion in the analysis. Four studies evaluating BP cuff size support a recommendation for a cuff width to arm circumference ratio of approximately 0.5. Studies investigating measurement location identified the upper arm as the most accurate and least variable location for oscillometric BP measurement. Analysis of studies using Bland-Altman methods for comparison of intra-arterial to oscillometric BP measurement show that the 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP. Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure <30 mm Hg.
Proper BP measurement is critical in neonates with naturally lower BP and attention to BP cuff size, location, and method of measurement are essential. With decreasing use of intra-arterial catheters for long-term BP monitoring in neonates, further studies are urgently needed to validate and develop oscillometric methodology with enhanced accuracy.
Neonatal hypotension: Dopamine or dobutamine?
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Although oscillometric methods of measuring blood pressure are widely used, neonatal readings are of limited accuracy, and the technique becomes least reliable when it needs to be most reliable – in babies with clinically significant hypotension. Fortunately, there is good agreement between intravascular and indirect Doppler measurements of systolic pressure, and between intravascular and pulse oximetry technique measurements throughout the blood pressure range [7,8]. What should be measured: systolic or mean pressures?
Controversy surrounds the assessment of perfusion and the methods currently utilised to define hypotension, especially blood pressure. There is growing agreement to assess heart function when selecting inotropic therapy and use bedside tools such as echocardiography for assessing at-risk infants. Both dopamine and dobutamine have comparative efficacy, and in certain disease states with immature myocardium there could be potential advantages in using dobutamine. The concomitant use of hydrocortisone has been shown to be beneficial when escalating doses of first-line inotropes are used. Other inotropes require further study through randomised trials for their safety and efficacy to be established.
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L'oxymétrie de pouls s'est imposée comme la principale technique de surveillance de la saturation d'oxygène de l'hémoglobine dans toutes les situations cliniques comportant un risque d'hypoxie. Elle est basée sur l'absorption de la lumière par le sang artériel pulsatile. L'utilisation de deux longeurs d'onde limite sa fonction à la seule détection de l'oxyhémoglobine et de l'hémoglobine réduite. En cas d'élévation de la méthémoglobine ou de la carboxyhémoglobine, les chiffres affichés par l'oxymètre de pouls ne sont pas exacts. La technique peut également être mise en défaut en cas d'hypoperfusion tissulaire. Toutefois, ces inconvénients sont mineurs et l'oxymétrie de pouls est extrêmement fiable et d'une grande simplicité d'emploi dans l'immense majorité des cas. Cet article décrit les principes physiques de l'oxymétrie de pouls, l'exactitude des mesures de la saturation d'oxygène, les particularités pédiatriques ainsi que les inconvénients et limitations cliniques de cette technique.
Pulse oximetry has become the leading technique for monitoring hemoglobin oxygen saturation whenever a risk of hypoxia exists. It is based upon the principle of light absorbance of pulsatile arterial blood. Since it uses 2 wavelengths, it can only measure oxyhemoglobin and reduced hemoglobin. Thus, in case of increased methemoglobin or carboxyhemoglobin, pulse oximetry values are not reliable. Low tissue perfusion can also be responsible for inaccurate values. Nevertheless pulse oximetry is a reliable and easy-to-use technique in most of the clinical situations. This article reviews the physical basis, the reliability, the pediatric aspects, and the limitations of the technique.
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^☆: From the Department of Neonatology, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland

^☆☆: Reprint requests: Michael Langbaum, MD, Johns Hopkins Bayview Medical Center, Neonatal Intensive Care Unit, Second Floor, 4940 Eastern Ave., Baltimore, MD 21224.

^★: 0022-3476/94/$3.00 + 0 9/23/58772

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A practical and reliable method of measuring blood pressure in the neonate by pulse oximetry☆,☆☆,★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

Am J Cardiol

Prediction of arterial blood pressure in the premature neonate using the oscillometric method

Am J Dis Child

Reliability of the Dinamap noninvasive monitor in the measurement of blood pressure in ill Asian newborns

Clin Pediatr (Phila)

Dinamap fails to detect hypotension in very low birthweight infants

Arch Dis Child

Can pulse oximetry be used to measure systolic blood pressure?

Anesth Analg

Statistical methods for assessing agreement between two methods of clinical measurement

Lancet

An automated oscillometric technique for estimating mean arterial pressure in critically ill newborns

Anesthesiology