Optimal Blood Pressure in Preterm Infants

Abstract

Many neonatologists routinely treat infants whose mean arterial blood pressurein mm Hg is less than their gestational age in weeks (GA) but there is uncertaintyregarding diagnosis and treatment of hypotension. This addresses the definitionof permissive hypotension based on the principles of cardiovascular physiology,and reviews the tools available at the bedside to examine the complex relationshipamong blood pressure, systemic organ blood flow, and tissue oxygen delivery andoxygen demand in preterm infants (skin color, capillary refill time, urine output,serum lactate level, and acidosis). Importantly, absolute blood pressure values areonly one indicator of circulatory status and this review confirms that a mean bloodpressure less than gestational age in weeks alone is not a predictor of poor outcome.Global assessment of cardiovascular status and intervention for hypotension restrictedto infants with poor perfusion may be associated with good clinical outcomes andshould be further evaluated.