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ARTICLES: Andrea F. Duncan, Charles R. Rosenfeld, Janet S. Morgan, Naveed Ahmad, and Roy J. Heyne Interrater Reliability and Effect of State on Blood Pressure Measurements in Infants 1 to 3 Years of Age Pediatrics 2008; 122: e590-e594 [Abstract] [Full text] [PDF]

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Effect of State on Blood Pressure Measurements in Infants

Vincenzo Zanardo, Diana Gharapetian, Daniele Trevisanuto, Giovanni Montini   (20 September 2008)

Effect of State on Blood Pressure Measurements in Infants 20 September 2008
Vincenzo Zanardo, Aggregated Professor of Pediatrics Department of Pediatris, Padua University, Padua, Italy, Diana Gharapetian, Daniele Trevisanuto, Giovanni Montini Send letter to journal: Re: Effect of State on Blood Pressure Measurements in Infants zanardo{at}pediatria.unipd.it Vincenzo Zanardo, et al.	We read with much interest the paper by Duncan and colleagues [1] about the effect of systolic blood pressure measurements in infants at 1, 2, and 3 years. They found that systolic blood pressure can be accurately measured in the first 3 years after birth but state (1.sleeping; 2.awake 3.calm awake and fussy/restless and 4. awake and vigorously crying/screaming) modifies systolic blood pressure. This is relevant, considering that non calm state was associated with an elevated systolic blood pressure and that infants born at <36 weeks estimated gestational age were found at risk for an elevated systolic blood pressure. The reason why prematurity was frequently associated with an elevated systolic blood pressure in childhood, adolescence, and adulthood has not yet been clarified, however, the correlations between preterm birth or intrauterine growth retardation or a combination of both and higher blood pressure and adverse cardiovascular outcome are currently a major focus of research [2–5]. We are studying by 24-hour Holter (TM 2430 Intermed, San Giuliano Milanese, MI, Italy) the contribution of preterm birth, RDS, and PDA to later risk of hypertension, in a historical cohort of 84 school age premature infants (<32 weeks of gestation) discharged to the level III NICU of Department of Pediatrics of Padua University in Padua Italy between January 1998 and December 1999. We found that the 66.66% of them had nightly and/or daily hypertension, while in 8 (9.6%) with neurodisability, anxiety and restless surrounding Holter application did not consent accurate blood pressure determinations. Although anxiety is known to elevate BP measurements, unlike Duncan and colleagues, we did not separate infant subgroups with distinct state characteristics as predictors of elevate blood pressure. Nevertheless, our study results indicate that the feasibility, accuracy, interrater variability of blood pressure follow up in premature infants may account of effect of patient state induced by neurodisability characteristics. Vincenzo Zanardo, MD Diana Gharapetian, MD Daniele Trevisanuto, MD Giovanni Montini, MD REFERENCES 1. Duncan AF, Interrater Reliability and Effect of State on Blood Pressure Measurements in Infants 1 to 3 Years of Age Pediatrics Pediatrics 2008;122:e590–e5947. 2. Barker DJ. Adult consequences of fetal growth restriction. Clin Obstet Gynecol 2006;49:270–283. 3. Law CM, Shiell AW, Newsome CA, Syddall HE, Shinebourne EA, Fayers PM, Martyn CN, de Swiet M. Fetal, infant, and childhood growth and adult blood pressure: a longitudinal study from birth to 22 years of age. Circulation 2002;105:1088–1092. 4. Doyle LW, Faber B, Callanan C, Morley R. Blood pressure in late adolescence and very low birth weight. Pediatrics 2003;111:252–257. 5. Kaijser M, Bonamy AK, Akre O, Cnattingius S, Granath F, Norman M, Ekbom A. Perinatal risk factors for ischemic heart disease: disentangling the roles of birth weight and preterm birth. Circulation 2008;117:405–410. Conflict of Interest: None declared