Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Evolving blood pressure dynamics for extremely preterm infants

Abstract

Objective:

To examine changes in arterial blood pressure (ABP) after birth in extremely preterm infants.

Study Design:

Prospective observational study of infants 230/7 to 266/7 weeks gestational age (GA). Antihypotensive therapy use and ABP measurements were recorded for the first 24 h.

Result:

A cohort of 367 infants had 18 709 ABP measurements recorded. ABP decreased for the first 3 h, reached a nadir at 4 to 5 h and then increased at an average rate of 0.2 mm Hg h−1. The rise in ABP from hour 4 to 24 was similar for untreated infants (n=164) and infants given any antihypotensive therapy (n=203), a fluid bolus (n=135) or dopamine (n=92). GA-specific trends were similar. ABP tended to be lower as GA decreased, but varied widely at each GA.

Conclusion:

ABP increased spontaneously over the first 24 postnatal hours for extremely preterm infants. The rate of rise in ABP did not change with antihypotensive therapy.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Laughon M, Bose C, Allred E, O'Shea T, Van Marter L, Bednarek F et al. Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week. Pediatrics 2007; 119: 273–280.

    Article  PubMed  Google Scholar 

  2. Fanaroff J, Wilson-Costello D, Newman N, Montpetite M, Fanaroff A . Symptomatic hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics 2006; 117: 1131–1135.

    Article  PubMed  Google Scholar 

  3. Hall R, Oliver T . Aortic blood pressure in infants admitted to a neonatal intensive care unit. Am J Dis Child 1971; 121: 145–147.

    CAS  PubMed  Google Scholar 

  4. Versmold H, Kitterman J, Phibbs R, Gregory G, Tooley W . Aortic blood pressure during the first 12 hours of life in infants with birth weight 610 to 4,220 grams. Pediatrics 1981; 67: 607–613.

    CAS  PubMed  Google Scholar 

  5. Watkins A, West C, Cooke R . Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev 1989; 19: 103–110.

    Article  CAS  PubMed  Google Scholar 

  6. Cunningham S, Symon A, Elton R, Changqing Z, McIntosh N . Intra-arterial blood pressure reference ranges, death and morbidity in very low birthweight infants during the first seven days of life. Early Hum Dev 1999; 56: 151–165.

    Article  CAS  PubMed  Google Scholar 

  7. Short B, Van Meurs K, Evans J . Summary proceedings from the cardiology group on cardiovascular instability in preterm infants. Pediatrics 2006; 117: S34–S39.

    Article  PubMed  Google Scholar 

  8. Dempsey E, Barrington K . Treating hypotension in the preterm infant: when and with what: a critical and systematic review. J Perinatol 2007; 27: 469–478.

    Article  CAS  PubMed  Google Scholar 

  9. Zhang J, Penny D, Kim N, Yu H, Smolich J . Mechanisms of blood pressure increase induced by dopamine in hypotensive preterm neonates. Arch Dis Child Fetal Neonat Ed 1999; 81: F99–F104.

    Article  CAS  Google Scholar 

  10. Lundstrom K, Pryds O, Greisen G . The haemodynamic effects of dopamine and volume expansion in sick preterm infants. Early Hum Dev 2000; 57: 157–163.

    Article  CAS  PubMed  Google Scholar 

  11. Ng P, Lee C, Bnur F, Chan I, Lee A, Wong E . A double-blind randomized, control study of a ‘stress dose’ of hydrocortisone for rescue treatment of refractory hypotension in preterm infants. Pediatrics 2006; 117: 367–375.

    Article  PubMed  Google Scholar 

  12. Noori S, Friedlich P, Wong P, Ebrahimi M, Siassi B, Seri I . Hemodynamic changes after low dosage hydrocortisone administration in vasopressor treated preterm and term neonates. Pediatrics 2006; 118: 1456–1465.

    Article  PubMed  Google Scholar 

  13. Batton B, Batton D, Riggs T . Blood pressure in the first 7 days in premature infants born at postmenstrual age 23 to 25 weeks. Am J Perinatol 2007; 24: 107–115.

    Article  PubMed  Google Scholar 

  14. Batton B, Li L, Newman N, Das A, Watterberg K, Yoder B et al. Prospective study of blood pressure management in extremely preterm infants. Pediatrics 2013; 131: e1865–e1873.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fitzmaurice G, Laird N, Ware J . Applied Longitudinal Analysis. John Wiley & Sons, Inc: Hoboken, New Jersey, 2004.

    Google Scholar 

  16. Spinazzola R, Harper R, de Soler M, Lesser M . Blood pressure values in 500- to 750-gram birthweight infants in the first week of life. J Perinatol 1991; 11: 147–151.

    CAS  PubMed  Google Scholar 

  17. Cordero L, Timan C, Waters H, Sachs L . Mean arterial pressures during the first 24 hours of life in 600-gram birth weight infants. J Perinatol 2002; 22: 348–353.

    Article  PubMed  Google Scholar 

  18. Demarini S, Dollberg S, Hoath S, Ho M, Donovan E . Effects of antenatal corticosteroids on blood pressure in very low birth weight infants during the first 24 hours of life. J Perinatol 1999; 19: 419–425.

    Article  CAS  PubMed  Google Scholar 

  19. Noori S, Seri I . Neonatal blood pressure support: the use of inotropes, lusitropes, and other vasopressor agents. Clin Perinatol 2012; 39: 221–238.

    Article  PubMed  Google Scholar 

  20. Bhatt-Mehta V, Nahata M, McClead R, Menke J . Dopamine pharmoacokinetics in critically ill newborn infants. Eur J Clin Pharmacol 1991; 40: 593–597.

    CAS  PubMed  Google Scholar 

  21. Troy R, Doron M, Laughon M, Tolleson-Rinehart S, Price W . Comparison of noninvasive and central arterial blood pressure measurements in ELBW infants. J Perinatol 2009; 29: 744–749.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support, including funding from the Best Pharmaceuticals for Children Act, for the Neonatal Research Network’s Early Blood Pressure Observational Study.

Data collected at participating sites of the NICHD Neonatal Research Network (NRN) were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, Drs Abhik Das (DCC Principal Investigator) and Lei Li (DCC Statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.

We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to the authors, participated in this study:

NRN Steering Committee Chair: Michael S Caplan, MD, University of Chicago, Pritzker School of Medicine (2006 to 2011).

Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island (U10 HD27904)—Abbot R Laptook, MD; William Oh, MD; Angelita M Hensman, RNC-NIC BSN; Kristin Basso, RN MaT.

Case Western Reserve University, Rainbow Babies and Children’s Hospital (U10 HD21364)—Avroy A Fanaroff, MD; Bonnie S Siner, RN; Deanne E Wilson-Costello, MD.

Cincinnati Children’s Hospital Medical Center, University Hospital, and Good Samaritan Hospital (U10 HD27853)—Kurt Schibler, MD; Barbara Alexander, RN; Cathy Grisby, BSN CCRC; Lenora Jackson, CRC; Kristin Kirker, CRC; Estelle E Fischer, MHSA MBA.

Duke University School of Medicine, University Hospital, Alamance Regional Medical Center, and Durham Regional Hospital (U10 HD40492)—Ronald N Goldberg, MD; C Michael Cotten, MD MHS; Kimberley A Fisher, PhD FNP-BC IBCLC; Sandy Grimes, RN BSN.

Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (U10 HD27851, UL1 RR25008)—David P Carlton, MD; Ellen C Hale, RN BS CCRC.

Eunice Kennedy Shriver National Institute of Child Health and Human Development—Stephanie Wilson Archer, MA.

Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services (U10 HD27856)—Brenda B Poindexter, MD MS; Leslie D Wilson, BSN CCRC; Dianne E Herron, RN; Cassandra Stahlke, BS CCRC.

RTI International (U10 HD36790)—Dennis Wallace, PhD; Jeanette O’Donnell Auman, BS; Margaret Cunningham, BS; Carolyn M Petrie Huitema, MS; James W Pickett II, BS; Kristin M Zaterka-Baxter, RN BSN.

Stanford University, Lucile Packard Children’s Hospital (U10 HD27880)—Krisa P Van Meurs, MD; David K Stevenson, MD; M Bethany Ball, BS CCRC; Melinda S Proud, RCP.

Tufts Medical Center, Floating Hospital for Children (U10 HD53119)—Ivan D Frantz III, MD; John M Fiascone, MD; Anne Furey, MPH; Brenda L MacKinnon, RNC; Ellen Nylen, RN BSN.

University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (U10 HD34216)—Waldemar A Carlo, MD; Namasivayam Ambalavanan, MD; Monica V Collins, RN BSN MaEd; Shirley S Cosby, RN BSN.

University of Iowa Children’s Hospital and Mercy Medical Center (U10 HD53109, UL1 RR24979)—Edward F Bell, MD; Dan L Ellsbury, MD; Karen J Johnson, RN BSN; Donia D Campbell, RNC-NIC; Rachael M Hyland, BA.

University of New Mexico Health Sciences Center (U10 HD53089)—Robin K Ohls, MD; Conra Backstrom Lacy, RN; Sandra Brown, BSN.

University of North Carolina at Chapel Hill (UL1 RR25747)—Carl L Bose, MD; Gennie Bose, RN; Janice Bernhardt, MS RN; Cindy Clark, RN.

University of Texas Southwestern Medical Center at Dallas, Parkland Health and Hospital System, and Children’s Medical Center Dallas (U10 HD40689, M01 RR633)—Pablo J Sánchez, MD; Luc P Brion, MD; Lizette E Torres, RN; Diana M Vasil, RNC-NIC; Lijun Chen, RN PhD; Alicia Guzman.

University of Texas Health Science Center at Houston Medical School, Children’s Memorial Hermann Hospital—Kathleen A Kennedy, MD MPH; Jon E Tyson, MD MPH; Georgia E McDavid, RN; Patti L Pierce Tate, RCP; Sharon L Wright, MT (ASCP).

University of Utah, University Hospital, Intermountain Medical Center, and Primary Children’s Medical Center (U10 HD53124, UL1 RR25764)—Karen A Osborne, RN BSN CCRC; Jill Burnett, RNC; Cynthia Spencer, RNC; Kimberlee Weaver-Lewis, RN BSN; Karie Bird, RN; Karen Zanetti, RN; Laura Cole, RN.

Wayne State University, University of Michigan, Hutzel Women’s Hospital and Children’s Hospital of Michigan (U10 HD21385)—Seetha Shankaran, MD; Beena G Sood, MD MS; Rebecca Bara, RN BSN; Mary Johnson, RN BSN.

Yale University, Yale-New Haven Children’s Hospital (U10 HD27871, UL1 RR24139)—Richard A Ehrenkranz, MD; Monica Konstantino, RN BSN; JoAnn Poulsen, RN.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to B Batton.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Batton, B., Li, L., Newman, N. et al. Evolving blood pressure dynamics for extremely preterm infants. J Perinatol 34, 301–305 (2014). https://doi.org/10.1038/jp.2014.6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.6

Keywords

This article is cited by

Search

Quick links