J Korean Soc Neonatol.
1999 May;6(1):30-36.
Effects of Blood Pressure Cuffs on the Circulatory and Respiratory Status of Infants with Persistent Pulonary Hypertension of the Newborn
- Affiliations
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- 1Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea.
Abstract
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PURPOSE: Vasodilator therapy in infants with persistent pulmonary hypertension of the newborn(PPHN) frequently causes
systemic hypotension due to non-selectivity for pulmonary vessels. Blood pressure(BP) cuffs can increase systemic
vascular resistance around which they are applied without affecting pulmonary vessels. We studied the effects of BP cuffs
on the circulatory and respiratory status of infants with PPHN receiving vasodilator therapy. METHODS: Mechanically
ventilated 16 term infants(gestational age of 39.9+ 1.3 weeks and birth weight of 3,533+/-318 gm with PPHN who had right to left
shunt on echocardiogram and survived over 5 days were included for the study. All infants received vasodilator(tolazoline)therapy.
We applied BP cuffs for neonatal use to four extremities of study infants(n=8) and inflated them to systolic pressure.
Those who received vasodilator therapy alone served as control(n=8). We analyzed systolic and mean BP, respiratory parameters,
presence of right to left shunt an clinical outcome at 1, 2, 6, 12, 24, 48, 72hr after initiation of vasodilator therapy.
RESULTS
Systolic BP increased significantly in study group(from 37+/-11 to 46+/-13 mmHg) from 6 hours after BP cuff application
compared to control group(from 39+/-8 to 40+/-13 mmHg), and this effect persisted up to 72 hour(52+/-18 vs. 46+/-16 mmHg)(P<0.05).
Mean BP also increased significantly in study group(30 +/-10 to 38+/-12 mmHg) from 6 hours compared to control group(32+/-11 to 33 15 mmHg)
and maintained up to 72 hour occurred(43+17 vs. 3715 mmHg)(P<0.05). Reversal of right to left shunt occurred significantly earlier
in study group than control group(30+/-10 vs. 52+/-18 hr)(P<0.01). Respiratory parameters such as mean airway pressure,
oxygenation index and duration of ventilator care and hospitalization were not different. Four of five infants in the study group
and five of eight in control group survived. CONCLUSION: Application of BP cuffs to the infants with PPHN treated with vasodilator resulted
in increase innd mean BP and early reversal of right to left shunt. We suggest that application of BP cuffs can play a useful role
in the management of infants with PPHN.