Neonatal Med.  2024 Nov;31(3):65-72. 10.5385/nm.2024.31.3.65.

Correlation between Blood Pressure and Left Ventricular Function in Neonates: A Retrospective Observational Study

• Lee NM
• Yu NL
• Yi DY
• Yun SW
• Chae SA
• Kang H

• KMID: 2561518
• DOI: http://doi.org/10.5385/nm.2024.31.3.65

Abstract

Purpose
Ejection fraction, measured as the fraction of blood ejected from the ventricle in each heartbeat using M-mode echocardiography, serves as a primary indicator of left ventricular systolic function. This study explores the correlation between blood pressure and left ventricular systolic function in neonates using M-mode echocardiography.
Methods
Neonates who underwent echocardiography in the neonatal intensive care unit between January 2011 and December 2020 were retrospectively studied.
Results
Our analyses showed a significant association between ejection fraction and systolic blood pressure, but not with diastolic or mean blood pressure—both of which are more sensitive to hypotension. Ejection fraction was also not significantly associated with heart rate, urine output, or inotropic support in this study, suggesting that factors influencing urine output may not directly relate to ejection fraction. Additionally, we found that higher systolic blood pressure was correlated with advanced gestational age, the absence of patent ductus arteriosus, and no need for fentanyl administration. Notably, lower gestational age and lack of mechanical ventilation were both associated with increased hourly urine output, suggesting that developmental maturity and respiratory stability may influence renal function.
Conclusion
Neonatal hypotension occurred secondary to decreased systolic cardiac function and peripheral vascular resistance. Neonatologists should carefully monitor the individual components of blood pressure and prescribe medications accordingly, considering that systolic blood pressure is correlated with ejection function.

Keyword

Blood pressure; Echocardiography; Hypotension; Neonate

Figure

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  Figure 1. Correlations between ejection fraction (EF) and blood pressure, heart rate, urine output (UO). Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; MBP, mean blood pressure.

Reference

1. Ibrahim CP. Hypotension in preterm infants. Indian Pediatr. 2008; 45:285–94.

2. Yoon HS. Hypotension in prematurity. J Korean Soc Neonatol. 2007; 14:130–41.

3. Noori S, Seri I. Pathophysiology of newborn hypotension outside the transitional period. Early Hum Dev. 2005; 81:399–404.

4. Mertens L, Seri I, Marek J, Arlettaz R, Barker P, McNamara P, et al. Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. J Am Soc Echocardiogr. 2011; 24:1057–78.

5. Long W, Corbet A, Cotton R, Courtney S, McGuiness G, Walter D, et al. A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome: the American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group. N Engl J Med. 1991; 325:1696–703.

6. Pharande P, Watson H, Tan K, Sehgal A. Oral paracetamol for patent ductus arteriosus rescue closure. Pediatr Cardiol. 2018; 39:183–90.

7. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37:2129–200.

8. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013; 62:e147–239.

9. Redfield MM, Jacobsen SJ, Burnett JC, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003; 289:194–202.

10. Drazner MH. The progression of hypertensive heart disease. Circulation. 2011; 123:327–34.

11. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28:1–39.e14.

12. Gottesman RF, Grega MA, Bailey MM, Zeger SL, Baumgartner WA, McKhann GM, et al. Association between hypotension, low ejection fraction and cognitive performance in cardiac patients. Behav Neurol. 2010; 22:63–71.

13. Solomon SD, Claggett B, McMurray JJ, Hernandez AF, Fonarow GC. Combined neprilysin and renin-angiotensin system inhibition in heart failure with reduced ejection fraction: a metaanalysis. Eur J Heart Fail. 2016; 18:1238–43.

14. Kaminski KA, Tycinska AM, Stepek T, Szpakowicz A, Oledzka E, Dobrzycki S, et al. Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock. Adv Med Sci. 2014; 59:156–60.

15. Pladys P, Wodey E, Beuchee A, Branger B, Betremieux P. Left ventricle output and mean arterial blood pressure in preterm infants during the 1st day of life. Eur J Pediatr. 1999; 158:817–24.

16. Lopez SL, Leighton JO, Walther FJ. Supranormal cardiac output in the dopamine- and dobutamine-dependent preterm infant. Pediatr Cardiol. 1997; 18:292–6.

17. Van Hare GF, Hawkins JA, Schmidt KG, Rudolph AM. The effects of increasing mean arterial pressure on left ventricular output in newborn lambs. Circ Res. 1990; 67:78–83.

18. Belik J, Light RB. Effect of increased afterload on right ventricular function in newborn pigs. J Appl Physiol (1985). 1989; 66:863–9.

19. Kluckow M, Evans N. Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation. J Pediatr. 1996; 129:506–12.

20. Kozak-Barany A, Jokinen E, Rantonen T, Saraste M, Tuominen J, Jalonen J, et al. Efficiency of left ventricular diastolic function increases in healthy full-term infants during the first months of life: a prospective follow-up study. Early Hum Dev. 2000; 57:49–59.

21. Marijianowski MM, van der Loos CM, Mohrschladt MF, Becker AE. The neonatal heart has a relatively high content of total collagen and type I collagen, a condition that may explain the less compliant state. J Am Coll Cardiol. 1994; 23:1204–8.

22. Kozak-Barany A, Jokinen E, Saraste M, Tuominen J, Valimaki I. Development of left ventricular systolic and diastolic function in preterm infants during the first month of life: a prospective follow-up study. J Pediatr. 2001; 139:539–45.

23. Ratner I, Perelmuter B, Toews W, Whitfield J. Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant. Crit Care Med. 1985; 13:497–500.

24. Ancora G, Lago P, Garetti E, Pirelli A, Merazzi D, Mastrocola M, et al. Efficacy and safety of continuous infusion of fentanyl for pain control in preterm newborns on mechanical ventilation. J Pediatr. 2013; 163:645–51.e1.

25. Pacifici GM. Clinical pharmacology of fentanyl in preterm infants: a review. Pediatr Neonatol. 2015; 56:143–8.