Should Blood Pressure Be Measured in Newborn Infants?

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

Disclosures

May 04, 2011

Evaluation for Congenital Heart Disease

Some defects, disorders, and diseases of the newborn will be very obvious at birth, and others can present very subtly. Evaluation for congenital heart disease (CHD) can be an elusive disorder and not easy to identify on the first or second day of life. The presentation of CHD is extremely variable, with some of the most serious defects having little to no symptoms in the first 24-72 hours after birth, or even longer. Many of these are "ductal-dependent" disorders, and symptoms present when the ductus arteriosus starts to functionally close. One of the only symptoms that may be detectable, although often not until oxygenation reaches a critical level, is cyanosis. Other symptoms include difficulty in feeding, tachypnea, sweating, and the presence of a heart murmur.

Because CHD affects 7-8 per 1000 live-born infants and accounts for 3% of all infant deaths, the question becomes what is the most evidence-based approach to screen for CHD in the early neonatal period? Ideally, screening should be implemented to ensure identification of a disorder and prevent morbidity or mortality. Blood pressure is not a reliable method of screening for CHD, although it should be performed on all 4 extremities in any infant who appears ill or in whom CHD is suspected. A difference of more than 20 mm Hg between upper and lower systolic pressure may indicate some forms of ductal-dependent CHD (eg, coarctation of the aorta or interrupted aortic arch).

A more promising noninvasive method of screening for CHD is pulse oximetry. A number of recent studies,[2,3,4] as well as a systematic review,[5] have found pulse oximetry to be a very sensitive test for CHD. However, as with all screening measures, it should be performed within a carefully designed protocol by nurses who are trained to perform it and evaluate the results. The American Academy of Pediatrics has not yet endorsed pulse oximetry as a screening measure; however, it has published a report that recommends further studies to evaluate the efficacy of pulse oximetry as a screening method for neonatal CHD.[6]

In addition, the Advisory Committee on Heritable Disorders in Newborns and Children of the United States Department of Health and Human Services, Health Resources and Services Administration, has recommended screening with pulse oximetry become a standard of care.[7]

In conclusion, although blood pressure measurement is not a good screening method for CHD, when performed and interpreted by trained medical personnel, it can provide valuable information. If the intention is to screen for CHD, pulse oximetry might be a better methodology.

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