Abstract
BackgroundThe agreement between invasive and non-invasive blood pressure (BP) readings in the first days of life of preterm infants is contentiously debated.ObjectiveTo compare mean, systolic and diastolic invasive (IBP) and non-invasive BP (NBP) readings obtained during routine care in the first four weeks of life of extremely preterm infants.MethodsWe extracted pairs of IBP and NBP readings obtained from preterm infants born below 28 weeks of gestation from the local database. After exclusion of erroneous measurements, we investigated the repeated measures correlation and analyzed the agreement (bias) and precision adjusted for multiple measurements per individual.ResultsAmong 335 pairs of IBP and NBP readings obtained from 128 patients, we found correlation coefficients >0.65 for mean, systolic and diastolic BP values. The bias for mean BP readings was -0.4 mmHg (SD 6.1), for systolic BP readings 6.2 mmHg (SD 8.1), and for diastolic BP readings -4.3 mmHg (SD 6.5). Overestimation of systolic IBP and underestimation of diastolic IBP by the non-invasive measurement were found both in the group with gestational age from 23 to 25.9 weeks and in the group with gestational age from 26 to 27.9 weeks. Systolic NBP readings tended to exceed invasive readings in the range <50 mmHg (bias 9.9 mmHg) whereas diastolic NBP readings were lower than invasive values particularly in the range >30 mmHg (bias -5.5 mmHg).ConclusionThe disagreement between invasive and non-invasive BP readings in infants extends to the first four weeks of life. Biases differ for mean, systolic and diastolic BP values. Our observation implies that they may depend on the range of the blood pressure. Awareness of these biases and preemptive concomitant use of IBP and NPB readings may contribute to reducing over- or under-treatment.
Highlights
In extremely preterm infants, continuous blood pressure (BP) monitoring via an arterial line immediately after birth remains standard [1]
Among 335 pairs of invasive blood pressure (IBP) and noninvasive blood pressure (NBP) readings obtained from 128 patients, we found correlation coefficients >0.65 for mean, systolic and diastolic BP values
Overestimation of systolic IBP and underestimation of diastolic IBP by the non-invasive measurement were found both in the group with gestational age from 23 to 25.9 weeks and in the group with gestational age from 26 to 27.9 weeks
Summary
Continuous blood pressure (BP) monitoring via an arterial line immediately after birth remains standard [1]. The few studies on the agreement between invasive blood pressure (IBP) and noninvasive blood pressure (NBP) readings in the early life of preterm infants report partly inconsistent results [4,5,6,7,8]. They only considered mean BP [4,5,6, 8] and/or were restricted to the first days of life [4, 6,7,8].
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