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A Comparison of Blood Pressure Measurements in Newborns
Abstract
Blood pressure monitoring is an essential component of neonatal intensive care. We compared invasive and noninvasive (Dinamap, Marquette, and Dash) recordings in newborns and also noninvasive values obtained from upper and lower limbs. Infants' blood pressure was recorded every 6 hours for 72 hours using three noninvasive devices and compared with invasive readings taken simultaneously. Twenty-five babies were enrolled in the study, with birth weights of 560 to 4500 g and gestation 24 + 1 to 40 + 5 weeks. Three hundred thirty-two recordings were obtained. Comparison between invasive and noninvasive readings revealed that all three noninvasive monitors overread mean blood pressure. There was no significant difference between the cuff recordings obtained from the upper or lower limbs. All three noninvasive devices overestimated mean blood pressure values compared with invasive monitoring. Clinicians may be falsely reassured by noninvasive monitoring. Mean blood pressure values obtained from the upper and lower limb are similar.
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“Cuff-based blood pressure measurements with sphygmomanometers fail to provide continuous measurement, overestimate blood pressure in premature neonates (32), and pose a direct risk for pressure-related injuries (33).”
From Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care (2019) · cites this paper as [32]
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Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care
Chung, H. U., Kim, B. H., Lee, J. Y., Lee, J., Xie, Z., Ibler, E. M., Lee, K., Banks, A., Jeong, J. Y., Kim, J., et al. (2019) · Science · doi:10.1126/science.aau0780 · Cited by 807
“Cuff-based blood pressure measurements with sphygmomanometers fail to provide continuous measurement, overestimate blood pressure in premature neonates (32), and pose a direct risk for pressure-related injuries (33).”
BackgroundHypertension in infancy: diagnosis, management and outcome
Dionne, J. M., Abitbol, C. L., & Flynn, J. T. (2011) · Pediatric Nephrology · doi:10.1007/s00467-010-1755-z · Cited by 279
The Effects of Umbilical Cord Milking on Hemodynamics and Neonatal Outcomes in Premature Neonates
Katheria, A. C., Leone, T. A., Woelkers, D. A., et al. (2014) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2014.01.024 · Cited by 128
Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment
McCann, M. E., & Schouten, A. N. J. (2013) · Pediatric Anesthesia · doi:10.1111/pan.12310 · Cited by 105
Method of Blood Pressure Measurement in Neonates and Infants: A Systematic Review and Analysis
Dionne, J. M., Bremner, S. A., Baygani, S., Batton, B., Ergenekon, E., Bhatt‐Mehta, V., Dempsey, E. M., Kluckow, M. R., Koplowitz, L. P., Apele‐Freimane, D., et al. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.02.072 · Cited by 99
“Measurement Method Studies Using Bland-Altman Methods Weidentified18 articles inwhich the authors had appliedBlandAltman methods to quantify the bias and agreement between different methods of measuring BP, comparing direct (intraarterial) with indirect (oscillometric) methods.(15,20,22-37) Results extracted from thos…”
MethodInfluentialSelf-citationLogan, J. W., O'Shea, T. M., Allred, E. N., Laughon, M. M., Bose, C. L., Dammann, O., Batton, D. G., Engelke, S. C., Leviton, A., & for the ELGAN Study Investigators (2010) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2010.183335 · Cited by 65
“A potential limitation of our study is the lack of a consistent method for obtaining MAP. Some MAP measurements were obtained by intra-arterial catheters, others by oscillometry. The latter method overestimates blood pressure.”
MethodNeonatal hypertension: cases, causes, and clinical approach
Starr, M. C., & Flynn, J. T. (2018) · Pediatric Nephrology · doi:10.1007/s00467-018-3977-4 · Cited by 60
“After initial stabilization, the infant’s BPs are noted to be as high as 125/85, with none below 100/68.”
InfluentialTakçı, Ş., Yiğit, Ş., Korkmaz, A., & Yurdakök, M. (2011) · Acta Paediatrica · doi:10.1111/j.1651-2227.2011.02458.x · Cited by 49
“O’Shea and Dempsey (16) reported monitor-specific overestimation of mean BP levels ranging from 3.”
BackgroundInfluentialThe Pathophysiology of Low Systemic Blood Flow in the Preterm Infant
Kluckow, M. R. (2018) · Frontiers in Pediatrics · doi:10.3389/fped.2018.00029 · Cited by 48
Logan, J. W., O’Shea, T. M., Allred, E. N., Laughon, M. M., Bose, C. L., Dammann, O., Batton, D. G., Kuban, K., Paneth, N., Leviton, A., et al. (2011) · Journal of Perinatology · doi:10.1038/jp.2010.201 · Cited by 44
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Flynn, J. T. (2012) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e32834f8329 · Cited by 39
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Dionne, J. M., & Flynn, J. T. (2017) · Archives of Disease in Childhood · doi:10.1136/archdischild-2015-309740 · Cited by 37
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Prediction of recurrent coarctation by early postoperative blood pressure gradient
Kumar, T. K. S., Zurakowski, D., Sharma, R., et al. (2011) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2011.02.048 · Cited by 31
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Batton, B. (2020) · Clinics in Perinatology · doi:10.1016/j.clp.2020.05.008 · Cited by 31
Adamson, G. T., Karamlou, T., Moore, P., et al. (2017) · Pediatric Cardiology · doi:10.1007/s00246-017-1651-4 · Cited by 30
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König, K., Casalaz, D. M., Burke, E. J., et al. (2012) · Intensive Care Medicine · doi:10.1007/s00134-012-2499-y · Cited by 28
“However Dempsey and Barrington [16] recently reviewed BP thresholds for adverse outcome and treatment options for hypotension and concluded that there was little evidence to support common approaches to the management of low blood pressure in preterm infants.”
BackgroundResultInfluentialNeonatal hypertension: an educational review
Harer, M. W., & Kent, A. (2018) · Pediatric Nephrology · doi:10.1007/s00467-018-3996-1 · Cited by 25
“Specifically with regard to hypertension, one study showed that mean BP values are overestimated regardless of the brand used [21].”
BackgroundKiss, J. K., Gajda, A., Mari, J., Nemeth, J., & Bereczki, C. (2023) · Pediatric Nephrology · doi:10.1007/s00467-023-05979-x · Cited by 18
“The unit used the GE Dash 3000 multiparameter monitor system with the GE DINAMAP blood pressure algorithm for blood pressure measurements [19].”
MethodComparison of noninvasive and central arterial blood pressure measurements in ELBW infants
Troy, R., Doron, M. W., Laughon, M. M., et al. (2009) · Journal of Perinatology · doi:10.1038/jp.2009.86 · Cited by 20
Does measurement of four-limb blood pressures at birth improve detection of aortic arch anomalies?
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“However, O’Shea et al noted a tendency toward falsely elevated NIBP values in this patient population despite development of newer, more sophisticated NIBP devices, even when possible confounding factors such as cuff size and level of activity were eliminated.(9) Further studies have evaluated BP measurements in criti…”
BackgroundWerther, T., Aichhorn, L., Baumgartner, S., Berger, A., Klebermaß-Schrehof, K., & Salzer‐Muhar, U. E. (2018) · PLoS ONE · doi:10.1371/journal.pone.0209831 · Cited by 7
Shah, S. S., Kaul, A., Khandare, J., et al. (2021) · Journal of Tropical Pediatrics · doi:10.1093/tropej/fmab109 · Cited by 6
Pharande, P., Sehgal, A., & Menahem, S. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11080233 · Cited by 5
“There is a good correlation between invasive monitoring and oscillometric assessment; however, the latter tends to overestimate BP [133].”
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Flynn, J. T. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-53367-6.00016-9 · Cited by 4
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“Also, BP was measured noninvasively, which has been proven a less accurate estimate in comparison to invasive methods [29].”
ResultThe Need for Noninvasive Biomarkers for Drug Safety in Neonatal Circulation
Rabe, H. (2010) · Biomarkers in Medicine · doi:10.2217/bmm.10.88 · Cited by 2
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Self-citationBlood Pressure Management in the Very Preterm Infant: More than Just Millimetres
Dempsey, E. M., & Kooi, E. M. W. (2020) · Springer eBooks · doi:10.1007/978-3-030-28829-7_17 · Cited by 1
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Vallevik, E. Ø., Holten-Andersen, M., Carlsen, K. C. L., et al. (2026) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2026-004761
Metadata
- Authors
- O'Shea, J., & Dempsey, E.
- Affiliations
- Coombe Women & Infants University Hospital (IE)
- ORCID
- Dempsey, Eugene
- Venue
- American Journal of Perinatology
- Publisher
- Georg Thieme Verlag KG
- Published
- 2008-11-19
- Volume
- 26
- Issue
- 02
- Pages
- 113-116
- ISSN
- 0735-1631 (ISSN-L)
- 1098-8785
- OpenAlex
- W1996545684
- Cited by
- 49
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 5 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 3 · 2013: 4 · 2012: 3
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Perinatology (publishedVersion)
- PubMed (publishedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- blood pressure measurement, neonates, non-invasive blood pressure monitoring, invasive blood pressure monitoring, neonatal intensive care, arterial catheterization
- MeSH terms
- Blood Pressure, Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Male, Blood Pressure Monitors, Blood Pressure Monitoring, Ambulatory
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