Should Blood Pressure Be Measured in Newborn Infants?

Mary L. Puchalski, MS, APN, NNP-BC, RNC


May 04, 2011


Does evidence support measuring blood pressure in the immediate care of the normal/healthy term newborn? Does blood pressure aid in screening for congenital heart disease?

Response from Mary L. Puchalski, MS, APN, NNP-BC, RNC
Instructor, Neonatal Nurse Practitioner Program, Rush University College of Nursing; Neonatal Nurse Practitioner, Rush University Medical Center, Chicago, Illinois

Blood Pressure Measurement in the Newborn

A newborn infant, even if apparently healthy, should be carefully and systematically evaluated for disease or illness. The evaluation should encompass a review of the mother's health history (general health, obstetric, intrapartum, and delivery) for risk factors for neonatal disease or illness and a thorough physical examination of the newborn, including biometric measurements (head circumference, weight, and length) and vital signs (temperature, apical heart rate, and respiratory rate). A vital sign that is not consistently measured in the neonate, as it is in other hospitalized populations, is blood pressure.

Blood pressure measurement can be difficult to perform on the neonate. Artifact is common as a result of movement and crying of the newborn. In addition, normal values vary depending on gestational age and weight. Most importantly, blood pressure change is not a good method of screening for illness, because a fall or change in blood pressure is most often a late sign of critical illness and impending organ failure.

If blood pressure is measured, it should be done properly. Although blood pressure is most accurately measured directly (intra-arterially), noninvasive blood pressure measurement is commonly used when direct measurement is either unavailable or impractical. Blood pressure should always be measured with the infant in a quiet state and with the correct sized blood pressure cuff. Using an appropriately sized neonatal cuff is critical, whether blood pressure is determined by palpation, Doppler ultrasound, or oscillometry (eg, electronic recording). The preferred site for blood pressure measurement is the right arm; however, other sites, such as the forearm, calf, or thigh, may be used as long as the cuff width is 40% of the circumference of the limb on which the cuff is placed.[1]


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