PEDIATRICS Vol. 85 No. 5 May 1990, pp. 727-732
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Blood Pressure Increases, Birth Weight-Dependent Stability Boundary, and Intraventricular Hemorrhage

Edward H. Perry PhD1, Henrietta S. Bada MD1, John D. Ray PhD1, Sheldon B. Korones MD1, Kris Arheart MS1, and H. Lynn Magill MD1

1 From the Departments of Pediatrics, Obstetrics and Gynecology, Biostatistics and Epidemiology, and Radiology, University of Tennessee, and the Mechanical Engineering Department, Memphis State University, Memphis, Tennessee

The blood pressure (BP) and transcutaneous Po2, (TcPo2) changes associated with intensive care procedures were evaluated to determine whether responses differ between babies with and without periventricular-intraventricular hemorrhage (PV-IVH). Fifty-three inborn babies le1500 g were studied using a microcomputer-based monitoring system. With almost any procedure including a seemingly benign one such as a diaper change, peak systolic BP increased and TcPo2 decreased. However, responses to interventions did not differ between babies with PV-IVH and those without PV-IVH. Neither did these responses differ between those with birth weight le1000 g and >1000 g. When each baby's record was scanned for the highest peak systolic BP before diagnosis of PV-IVH or within 48 hours in those with no PV-IVH and their BP points plotted against birth weight, a stable region was evident wherein PV-IVH occurred at a lower incidence (13%). When peak systolic BP was beyond this stable region, the incidence of PV-IVH was significantly higher, 70% (P < .0001). The stability boundary for the maximum systolic BP is birth weight-dependent; the limit for the highest tolerable peak systolic BP is lower for the low-birth-weight infant. In over 70% of instances the highest peak systolic BP was associated with motor activities either induced by nursery procedures or spontaneous. We speculate that decreasing the frequency of intensive care interventions may decrease episodic BP increases to levels beyond the birth weight-dependent stability boundary where PV-IVH is likely to occur.

Key Words: blood pressure • premature • intraventricular hemorrhage • TcPo2 • intensive care procedures

Submitted on April 7, 1989
Accepted on June 29, 1989




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