Abstract
Many neonatologists routinely treat infants whose mean arterial blood pressure in mm Hg is less than their gestational age in weeks (GA) but there is uncertainty regarding diagnosis and treatment of hypotension. This addresses the definition of permissive hypotension based on the principles of cardiovascular physiology, and reviews the tools available at the bedside to examine the complex relationship among blood pressure, systemic organ blood flow, and tissue oxygen delivery and oxygen demand in preterm infants (skin color, capillary refill time, urine output, serum lactate level, and acidosis). Importantly, absolute blood pressure values are only one indicator of circulatory status and this review confirms that a mean blood pressure less than gestational age in weeks alone is not a predictor of poor outcome. Global assessment of cardiovascular status and intervention for hypotension restricted to infants with poor perfusion may be associated with good clinical outcomes and should be further evaluated.
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