Method of blood pressure measurement in neonates and infants: a systematic review and analysis

Abstract

Objectives: To determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the international literature regarding proper BP cuff size and measurement location and method. Study Design: 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 was extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods. Results: Of 3587 non-duplicate 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 ~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 two methods correlate best for mean arterial pressure (MAP) whereas systolic BP (SBP) by the oscillometric method tends to over-estimate intra-arterial SBP. Compared to intra-arterial methods, SBP, diastolic BP, and MAP by oscillometric methods are less accurate and precise, especially in neonates with a MAP <30mmHg. Conclusions: 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