Blood Pressures

Gompers, BSN, RN · Oct 10, 2006

The mean BP should be equal to the baby's current gestational age. If it's a little higher, that's fine - we prefer the mean BP of our newborns to be equal to or 10 points higher than their gestational age. But if it's lower, we consider that hypotensive. Do your monitors provide the mean reading with every BP check? Our will say, for example, 40/20 (30) with the 30 being the mean. If the baby is 30 weeks, fine. If the baby is 34 weeks, then we'll try a saline bolus or two to see if that brings up the BP. If it doesn't, or if it drops again afterwards, we'll start dopamine and titrate to keep the mean BP about 34-44 for a 34 weeker.

I've heard this isn't as accurate after the first week or two of life. In that case, we'll follow the baby clinically and use perfusion to guide us in how we treat them.

Basically, a newborn with a mean below its gestational age or any baby with capillary refill more than 3 seconds warrents a call to the docs. Likewise, a baby whose mean BP is lots higher than their gestational age should be checked out as well. Often with steroid use we see very high BPs and have to administer hydralazine to keep them in check.

RainDreamer, BSN, RN · Oct 10, 2006

Thanks Gompers. Does that really only apply to the premies? or to the term kiddos too? I ask because the other day I had a term baby (39 wks) that we were transitioning for respiratory distress and the BP mean was in the 50s and 60s and the docs were ok with that.

EricJRN, MSN, RN · Oct 10, 2006

There is a neo named Zubrow who has done a lot of research into neonatal BP and I believe has even come up with a chart for normal/abnormal. There are a couple of his articles cited at Neoreviews, but I can't access them without a subscription and I didn't have any luck with other search engines.

RainDreamer, BSN, RN · Oct 10, 2006

Thanks Eric. I'll see if I can find any kind of chart relating to that name. I know I found a few charts but there were a ton of them ..... a chart for preterms, SGAs, LGAs, term, weeks/months old, etc.

dawngloves, BSN, RN · Oct 10, 2006

Thanks Gompers. Does that really only apply to the premies? or to the term kiddos too? I ask because the other day I had a term baby (39 wks) that we were transitioning for respiratory distress and the BP mean was in the 50s and 60s and the docs were ok with that.

Was it isolated? Was the kid freaking out? How about the other extremities? HTN is rare in a neonate so unless there are other factors in play we don't worry about MAPs in the 50s.

Gompers, BSN, RN · Oct 10, 2006

Thanks Gompers. Does that really only apply to the premies? or to the term kiddos too? I ask because the other day I had a term baby (39 wks) that we were transitioning for respiratory distress and the BP mean was in the 50s and 60s and the docs were ok with that.

Overall, I think they're more worried about hypotension than hypertension, because as dawngloves mentioned, it's rare for a newborn to have HTN so we're not too worried about it. If a term baby has a mean of 30, that's more of an issue than if he/she has a mean of 50-60. It's when a preterm baby has a sky-high BP that we get more worried since they have a much higher chance of IVH than a term baby.

Overall, though, I'd worry more about a low BP than a high one.

The only times I've seen bad hypertension in babies have been steroid-related.

SteveNNP, MSN, NP · Oct 10, 2006

Usually a high mean BP is related to the kid screaming/squirming while you're trying to hold their leg/arm still enough to get a reading. I try to slip the cuff on while they're sleeping, before I mess with them, or just leave it on loosely with the connection unplugged and sticking out the bottom of the blanket.

RainDreamer, BSN, RN · Oct 17, 2006

She was awake, but wasn't freaking out. But she had been crying and I had calmed her down .... she was moving around a bit, so she was a bit more active than I usually like when I get a BP. But I had to get a BP before they sent her down to the regular nursery just because I had just come on shift and hadn't gotten one yet for my shift.

Thanks everyone for the information about hypotension being more of a concern than hypertension. I've seen kids come in with high BPs but they're always transferred to us as a "cardiac kid". I've seen two kids that have come in as a "cardiac kid" with high BPs and both time the echo would show that they had no cardiac issue, but they had a clot in their aorta, causing the high BP. I know that's not common and like you said .... rare. But I guess I'm just wondering how they knew these kids had problems? I'm sure they were getting internal readings from the art lines, but these kids were term, so I'm not even sure why they put in an art line in the first place.