Method of Blood Pressure Measurement in Neonates and Infants
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This study aimed to determine the recommended blood pressure (BP) measurement methods in neonates after systematically analyzing the literature regarding proper BP cuff size and measurement location and method.

A literature search was conducted in on BP in neonates <3 months of age. Study data were extracted and analyzed with separate analysis of Bland-Altman studies comparing measurement methods.

- Of 3587 nonduplicate publications identified, 34 were appropriate for inclusion in the analysis.
- Four studies evaluating BP cuff size support a recommendation for a cuff width to arm circumference ratio of approximately 0.5.
- Studies investigating measurement location identified the upper arm as the most accurate and least variable location for oscillometric BP measurement.
- Analysis of studies using Bland-Altman methods for comparison of intra-arterial to oscillometric BP measurement show that the 2 methods correlate best for mean arterial pressure, whereas systolic BP by the oscillometric method tends to overestimate intra-arterial systolic BP.
- Compared with intra-arterial methods, systolic BP, diastolic BP, and mean arterial pressure by oscillometric methods are less accurate and precise, especially in neonates with a mean arterial pressure <30 mm Hg.

Conclusively, Proper BP measurement is critical in neonates with naturally lower BP and attention to BP cuff size, location, and method of measurement are essential. With decreasing use of intra-arterial catheters for long-term BP monitoring in neonates, further studies are urgently needed to validate and develop oscillometric methodology with enhanced accuracy.