Aortic Blood Pressure During the First 12 Hours of Life in Infants with Birth Weight

610 to 4,220 Grams

Hans T. Versmold, Joseph A. Kitterman, Roderic H. Phibbs, George A. Gregory and
William H. Tooley
Pediatrics 1981;67;607

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://pediatrics.aappublications.org/content/67/5/607

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright © 1981 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013

 ARTICLES

Aortic Blood Pressure During the First 12

Hours of Life in Infants with Birth Weight
610 to 4,220 Grams

Hans T. Versmold, MD, Joseph A. Kitterman, MD, Roderic H. Phibbs,

MD, George A. Gregory, MD, and William H. Tooley, MD

From the Cardiovascular Research Institute and Departments of Pediatrics and

Anesthesia, University of California, San Francisco

ABSTRACT. Systolic, diastolic, and mean aortic blood Since the advent of umbilical arterial catheteri-
pressure measurements taken during the first 12 hours of zation, aortic hypotension has been widely used as
life in 16 clinically stable, untransfused infants who an indicator of hypovolemia in premature 2
weighed 610 to 980 gm at birth were analyzed. These
Because values for aortic blood pressure for infants
infants were selected from 207 infants weighing <1,000
grn admitted to our hospital between 1965 and 1978. with a birth weight 1,000 gm have not been avail-
Selection criteria were pH 7.25, Paco2 <50 torr, Pao2 able, most clinicians, including ourselves, have ar-
>50 torr, hematocrit >40%, inspired oxygen 40% at 6 rived at “normal” values for these very small infants
hours of age. Blood pressures of appropriate for gesta-
by extrapolation of the parabolic relation of mean
tional age and small for gestational age infants of com-
aortic blood pressure to weight for infants with
parable weight were similar. From linear regressions of
blood pressures on birth weight, average values and 95% birth weights of 1,000 to 4,220 gm.’ This extrapola-
confidence limits for two different birth weights were tion may be inaccurate and could lead to excess
derived. For infants weighing 750 gm the mean aortic fluid administration and its complications. There-
blood pressure, measured in torr, was 33 (range 24 to 42);
fore, we thought it important to reexamine the
systolic, 44 (range 34 to 54); diastolic, 24 (range 14 to 34).
question of “normal” aortic blood pressure for very
Mean blood pressures of infants weighing 1,000 gm were
34.5 (range 25 to 44); systolic, 49 (range 39 to 59); diastolic, small infants. In this paper we report the aortic
26 (range 16 to 36). These values are lower than those blood pressures in the first 12 hours of life for 16
extrapolated from larger infants using a parabolic regres- infants with birth weight <1,000 gm and whom we
sion. Data from these 16 infants were combined with data
consider to be close to normal. In addition, we have
from 45 larger infants to compute new nomograms for
aortic blood pressures during the first 12 hours of life in
combined the data from these 16 infants with data
infants weighing 610 to 4,220 gm. The relations between from larger infants in our previous study’ and have
blood pressures and birth weights were best described by developed new nomograms for directly measured
linear regressions. The lower limits of normal mean aortic mean, systolic, and diastolic pressures and for pulse
blood pressure are 25 torr at 750 gm, 29 torr at 1,500 gm,
pressure (systolic-diastolic pressure amplitude).
and 37 torr at 3,000 gm; the lower limits of normal systolic
blood pressure are 34 torr at 750 gm, 40 torr at 1,500 gm,
and 51 torr at 3,000 gm. These extended nomograms
should replace the parabolic regression of mean aortic METHODS
blood pressure vs weight which may have inaccurately
indicated hypotension in infants ofvery low birth weights. Infants with Birth Weight <1 ,000 gm
Pediatrics 67:607-613, 1981; newborn, blood pressure,
hypotension, hypertension. Since 1965, we have routinely measured aortic
blood pressure in infants in the Intensive Care
Nursery at the University of California, San Fran-
Received for publication April 29, 1980; accepted Sept 4, 1980.
cisco, who had an umbilical arterial catheter. From
Reprint requests to (H.T.V.) Universitats-Kinderklinik, Lind-
February 1965 to February 1978, we admitted 207
wurmstr 4, I)-8000 M#{252}nchen 2, Federal Republic of Germany.
PEI)IATRICS (ISSN 0031 4005). Copyright © 1981 by the infants with birth weights <1,000 gm; 202 had um-
American Academy of Pediatrics. bilical arterial catheters. All but 16 (7.9%) were

PEDIATRICS Vol. 67 No. 5 May 1981 607

Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013

excluded from this study because of any of the Seven infants, although not in respiratory dis-
following: they survived <48 hours; they were born tress, received mechanical ventilation with frequen-
in other hospitals and admitted after 6 hours of age; cies <30 min’, peak inspiratory pressure <15 cm
they were suspected of having central nervous sys- H20, and end-expiratory pressure <5 cm H20; this
tem hemorrhage; they had prolonged birth as- has been our recent routine to prevent atelectasis
phyxia; or they had an abnormal clinical course as in infants with birth weights below 1,000 gm during
defined below. the first several days of life. All infants had normal
Clinical characteristics of the 16 infants in the heart rates (148.8 ± 12.6 min’) and arterial hema-
study group are listed in Table 1. After initial re- tocrits (47.0 ± 6.3%). Arterial pH was 7.25, Paco2
suscitation, all were stable for at least the first 18 was <50 torr, and Pao2 was >50 ton. In nine infants,
hours of life; however, two infants died later (at 53 Pao2 transiently exceeded 100 torr during the ad-
and 57 hours of age). All infants were normothermic justment of the inspired oxygen. Although higher
and had normal muscle tone, skin color, and capil- levels were often used during resuscitation, inspired
lary filling time. During the time of our evaluation oxygen at the age of 6 hours ranged from 21% to
none received albumin, plasma, packed red blood 40% (median 25%).
cells, or whole blood. All infants routinely received We measured arterial blood pressure as prey-
an infusion of 10% glucose in water (4.5 ± 1.1 [SD] ously described3 through an umbilical arterial cath-
ml . kg’ . hr’). Because of moderately severe met- eter (Argyle, St Louis, MO, size 3.5 F) using Sta-
abolic acidosis, five infants received 1 to 3 mEq. tham P23d (Statham Laboratories, Hato Ray,
kg’ of sodium bicarbonate during resuscitation and Puerto Rico) or Ailtech MS-b (Ailtech Inc, City of
two infants received 2 mEq of sodium bicarbonate Industry, CA) pressure transducers.
at 2 and 3 hours of age, respectively. We did not The catheter tip was placed in the abdominal
include the values for their blood pressures within aorta below the level of the third lumbar vertebra.
one hour after the bicarbonate infusion. Serum The systems were calibrated against a column of
sodium concentrations were normal (137.2 ± 4.9 mercury every 24 hours and the zero calibration
mEq .liter’). We gave no other vasoactive agents was checked at least every four hours; the middle
to the infants. The mothers of three infants (Nos. of the infant’s thorax was used as zero reference.
3, 11, and 15 in Table 1) had received corticosteroids The blood pressure was recorded on a polygraph
within the week prior to delivery to enhance lung (Grass Instruments, Quincy, MA) or displayed on
maturation and the mothers of two infants (No. 9, a blood pressure module (Hewlett-Packard, Palo
11) had received isoxsuprine HC1 to suppress labor. Alto, CA). Systolic, diastolic, and mean blood pres-
Eight of the infants had weights appropriate for sures were recorded every 15 minutes when the
gestational age (AGA) and eight were small for tracing was not damped as judged by the presence
gestational age (SGA).4 of a dicrotic notch.

TABLE 1 . Clini cal Data of Infants Studied*

Infantt Sex Birth Gestational SGA/ Race Type Apgar Score IPPV +
Wt Age AGA of at 1 and 5 PEEP
(gm) (wk) Delivery mm
1 F 610 25 AGA W V 1/5 -

2A F 665 27 SGA B V /6 -

3 F 720 26 AGA W V 2/4 +

4 F 750 27 AGA 0 B /6 -

5 M 820 26 AGA W V 5/7 +

6 F 825 26 AGA W V 3/7 +
7 F 840 26 AGA W V 6/9 -

8 M 860 32 SGA W CS 4/7 -

9A F 890 26 AGA W V 1/5 -

10 M 900 32 SGA W CS 6/6 +

11 F 935 32 SGA 0 CS 5/8 +
12 F 940 30 SGA W B 3/5 +
13B M 960 30 SGA W V 1/5 -

14 F 965 31 SGA W B 1/6 -

15A M 970 26 AGA W V 4/7 +

16A F 980 30 SGA W V 5/8 -

* Abbreviations used are: SGA, small for gestational age; AGA, appropriate for gestational
age; W, white; B, black; 0, Oriental; V, vertex; B, breech; CS, cesarean section; IPPV,
intermittent positive pressure ventilation (peak pressure <15 cm H20, rate 30 min’);
PEEP, positive end-expiratory pressure (<5 cm H20).
t Infants 1 and 4 died at 53 and 57 hours of age, respectively; A and B indicate twins.

608 AORTIC BLOOD PRESSURE

Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013

 For our analysis, we used the mean, systolic, and TABLE 2. Aortic Blood Pressures (torr)* in AGA In-
diastolic aortic blood pressures recorded each hour fants with Low Birth Weights
during the first 12 hours of life beginning at 1 hour 750 gm 1 ,000 gm

of age or as soon thereafter as the infant was judged Mean 33 (24-42) 34.5 (25-44)
to be stable. A total of 143 pressure sets were Systolic 44 (34-54) 49 (39-59)
Diastolic 24 (14-34) 26 (16-36)
evaluated with a maximum of 12 values per infant.
* Mean values (95% confidence limits).
Because of damping, eight sets of systolic and dia-
stolic pressures were discarded. Linear regressions
of blood pressure vs postnatal age, Paco2, pH, and 60

hematocrit were calculated for each infant and the 0 MEA N

respective slopes were compared by analysis of co- 1’J

a:
variance. We combined the data to calculate linear 3
(I)
(I) 40
regressions and 95% confidence limits of blood pres- 02
a:
sure related to birth weight and of blood pressure 0.

related to gestational age for all infants as well as a

0
0
for AGA and SGA infants separately. 2
w 20
As
a control group for our SGA infants of 30 to 0
0 464
. 564
32 weeks gestation (mean birth weight 933.6 ± 41.1 a:
0 Y26.87” 8.99X
gm) we reanalyzed the
AGA infants of 30 to 32 .0
it/ /43
weeks gestation (mean birth weight 1,528.3 ± 279.4 0 L _______
1 1
gm) from the study group of Kitterman et al.3 06 0.7 0.8 0.9 tO

BIRTH WEIGHT (kg)

Infants with Birth Weight 610 to 4,220 gm Fig 1 . Regression ofmean aortic blood pressure on birth
weight during hours 1 to 12 of age in eight appropriate
For this analysis, we reevaluated 300 sets of aortic for gestational age (AGA) and eight small for gestational
blood pressures from 45 infants (birth weight 1,050 age (SGA) infants with birth weight <1,000 gm. The
to 4,220 gm, gestational age 26 to 41 weeks) studied regression line and 95% confidence limits are shown.
from 1965 to 1969. Blood pressures were measured
as described above except that size 5F catheters 60
were used for infants weighing >1,500 gm. The data
0
from these 45 infants were combined with data from
the 16 infants who weighed <1,000 gm. Clinical and 02
ix:
laboratory selection criteria were similar for both 3 40 $ o_ 8#{149}I 0
(1,
C’)
groups. LiJ
a:
During the first 12 hours of life, the mean, sys- a-
tolic, and diastolic blood pressures and pulse pres- a
0 0 464
0
sure (systolic-diastolic pressure amplitude) were -J 20h- SYSTOLIC . 564

evaluated each hour beginning with hour 1 of age. 0

Y32. /71-/5.93x
N/35
For each individual infant, linear regressions were I-
a:
0
calculated for these blood pressures related to post- .0

0
natal age. For all infants, linear and parabolic d6 O7 08 .9 I0
regressions were calculated for the pressures related BIRTH WEIGHT ( kg)
to birth weight, and to gestational age. Fig 2. Regression of systolic aortic blood pressure on
Individual correlations of blood pressures vs age birth weight during hours 1 to 12 of age in eight AGA
were compared by analysis of covariance. Linear and eight SGA infants with birth weight <1,000 gm. The
regressions of blood pressures vs weight were com- regression line and 95% confidence limits are shown.

pared to parabolic regressions for best fit by least

squares analysis. In AGA and SGA infants of comparable weight,
aortic blood pressures were similar; therefore, we
RESULTS pooled the data of AGA and SGA infants. The
linear relationships between birth weight and mean,
Infants with Birth Weight <1 ,000 gm
systolic, and diastolic aortic blood pressures are
Mean, systolic, and diastolic aortic blood pres- shown in Figs 1 to 3. The correlations were not
sures increased with increasing birth weight. For statistically significant.
AGA infants, average values and 95% confidence Blood pressures were similar in AGA and SGA
limits at 750 to 1,000 gm of birth weight, derived infants of comparable weight, but they were lower
from linear regressions, are given in Table 2. in SGA than in AGA infants at equivalent gesta-

ARTICLES 609
Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013
 60 0 464 ual infants, blood pressures did not correlate with
-: O/4510L/C 564
#{149}
- Y-/8.32*8.78x
postnatal age.
t/:/35 Although pulse pressure also showed a significant
a:L
02
3
U)
I positive correlation with birth weight (Fig 5), the
40k-
C’)
02 I magnitude of change with increasing birth weight
a: I
a- I is small in comparison to the changes in mean,
a systolic, and diastolic pressures. This implies that
0
0
2 I pulse pressure, although lower in absolute terms at
a 20F-
0 low birth weights, was proportionally higher than
I mean or systolic blood pressures in the smallest
a: -
0 I
.0
infants.
0 .L I I I I
06 07 0.8 0.9 1.0
DISCUSSION
BIRTH WEIGHT (kg)

Fig 3. Regression of diastolic aortic blood pressure on Infants with Birth Weight <1 ,000 gm
birth weight during hours 1 to 12 of age in eight AGA
and eight SGA infants with birth weight <1,000 gm. The In a previous report, we gave the mean aortic
regression line and 95% confidence limits are shown. blood pressures for the first 12 hours of life for
normal infants who had a birth weight >1,000 gm.’
That study included values for only eight infants
tional ages. At 30 to 32 weeks, mean aortic blood
with birth weights between 1,000 and 1,500 gm.
pressure was an average of 2.75 torr lower in SGA
Since then, there have been several reports of aortic
infants than in AGA infants (P < .01); however,
blood pressures in sick infants.58 However, the
when evaluated by analysis of covariance, the slopes
judgement of whether infants of very low birth
of the regressions (mean blood pressure vs gesta-
weight were hypotensive or hypertensive had pre-
tional age at 30 to 32 weeks) were not significantly
viously been made by comparison with data ob-
different for SGA and AGA infants.
tamed from larger infants or by comparing the
For each infant, the aortic blood pressures varied
blood pressure to data obtained by indirect
considerably (Figs 1 to 3). These individual varia-
methods.9
tions were not related to the age of the infant or to
It is not surprising that normal aortic blood pres-
variations in Paco2, pH, hematocrit, or fluid intake.
sures for this weight group are still lacking. Is any
The aortic blood pressures for the two infants who
infant “normal” who has a birth weight below 1,000
died after 48 hours of age, for those with five-minute
gm? The infants in this study may not be strictly
Apgar scores 5, or for those who received mechan-
normal (Table 1); however, we believe our selection
ical ventilation, did not differ from those of the
criteria allow us to use this group of infants to
other infants.
establish clinically applicable normal values of aor-
tic blood pressures. A potential bias is that we
Infants with Birth Weight 610 to 4,220 gm
systematically excluded infants who had been
Figs 4 and 5 show the linear regressions and 95% transfused for low blood pressure when they might,
confidence limits of systolic, diastolic, and mean in fact, have been normotensive. Thus, we may
aortic blood pressures and for pulse pressure on have selected a population of infants for analysis
birth weight for the range of birth weights from 610 who had relatively high blood pressures. If this were
to 4,220 gm. These correlations are based on 443 so, the range of normal aortic blood pressure might
mean pressure measurements or 415 phasic pres- be even lower than that displayed in Figs 1 to 3.
sure measurements in 61 infants from 1 to 12 hours Measurement of systolic and diastolic pressure
of age. Thirty sets of phasic pressure measurements may be affected by damping. However, we do not
were discarded because of damping. The correla- believe that damping biased these results because
tions are unaffected when data of eight SGA infants we excluded all measurements in which the tracing
(665 to 980 gm) are excluded. did not show a dicrotic notch. The narrow lumen
Although both linear and parabolic regressions umbilical arterial catheters (size 3.5 F) used in these
relating mean and phasic blood pressures to birth small infants does not damp the pressure tracings
weight were highly significant (P < .001 for all), the because its frequency response in vitro is about the
linear regressions fit the data best. Also, blood same as that of the larger 5 F
pressures of AGA infants showed a close correlation We included SGA babies in this study because
with gestational age (P < .001) (Table 3); however, they represent a large proportion of the very low-
for all pressures the correlation was closer with birth-weight infants who do well in our neonatal
birth weight than with gestational age. For individ- intensive care unit. These, and the AGA infants of

610 AORTIC BLOOD PRESSURE

Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013
 .-
I I I I
+

-C

I
0’
a,
\\\E 00

-C

. C’)
II
k. II
CL

I [ L
n II
0 0 0 0 0 0
D ‘3’ c’J .a II

ha P4
- LC)
Cl)’.
WO .O -
-
Q--

I I r--t

0’

-C
0’
a,

-C

0
: 0 0 0 0

_
tO ‘3’ C’J

0 0
- L=
0. 0’.
- ‘- -
COO COO
>- u

ARTICLES 611

Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013

TABLE 3. Correlation of Aortic Blood Pressure (BP, over the range of 105 to 180 cm of height and 15 to
torr) with Gestational Age (GA, weeks) in 53 Healthy 90 kg of weight, respectively.’6 When we extrapolate
AGA Infants During First 12 Hours of Life
from the height-related regression down to 50 cm
y = Slope . x + Intercept n r of length, we obtain a systolic blood pressure of
MeanBP = 1.01 . GA + 7.94 371 .70t about 65 torr, which is well within our normal range
Systolic BP = 1.32 . GA + 11.63 331 .72t for term newborn infants. However, when we ex-
Diastolic BP = 0.88 . GA + 2.97 331 .64f
trapolate from the logarithm of weight-related
tP< .001. regression down to 3.0 kg of weight, we obtain a
value below our 95% confidence limit. Thus, systolic
comparable weight, had similar aortic blood pres- blood pressure may be more closely related to lean
sures (Figs 1 to 3) so that we can use the same body mass than to weight.
weight-related blood pressure norms for AGA and In the smallest infants, pulse pressure was rela-
SGA infants. On the other hand, the SGA babies of tively high; also the range of diastolic pressures was
30 to 32 weeks of gestation were relatively hypoten- relatively large, including values as low as 15 torr.
sive compared to AGA babies of comparable ges- This may indicate that the ductus arteriosus was
tational age. This agrees with the observation of stifi patent in some of the infants. However, it is of
Bucci et al9 that indirectly measured systolic blood interest that neither diastolic blood pressure nor
pressures were related to weight independently of pulse pressure during the first 12 hours of life dif-
gestational age. fered between those infants who did, and those who
In this study, the lower limits of normal for mean did not, later show signs of a clinically important
aortic blood pressure of infants with birth weights patent ductus arteriosus.
of 1,000 gm and of 750 gm were 3 ton and 4 torr The nomograms describe normal levels of aortic
lower, respectively, than values extrapolated from blood pressure for only the first 12 hours of life, the
the parabolic regression of normal AGA infants time when most manipulations of blood volume are
weighing >1,000 gm.’ However, these new data, for likely to occur. Because blood pressure rises pro-
infants weighing <1,000 gm, fit well with an extrap- gressively after the first day oflife,’7 the nomograms
olated linear regression of those old data. In addi- may not be applicable to older infants.
tion, mean arterial blood pressures for human fe- We hope that the new, extended nomograms for
tuses weighing 104 to 225 gm also fit well with the mean, systolic, and diastolic blood pressures and
extrapolated linear regression.’ ‘ It seems, therefore, pulse pressure presented here wifi lead to more
that when the parabolic regression3 has been used accurate assessment of the cardiovascular state in
to predict “normal” blood pressure in infants with newborn infants, particularly in those born very
birth weights <1000 gm, the value has been over- prematurely. For this group, the lower limits of
estimated. As a consequence, in very small infants normal mean aortic blood pressure are lower than
hypovolemia was probably overdiagnosed when those predicted by extrapolation from data of larger
blood pressure alone was used to indicate its pres- infants. Because fluid overload may lead to serious
ence. Such mistakes in diagnosis probably led to clinical disorders,’2’5 more accurate definition of
overtransfusion with its hazards of delayed absorp- normal blood pressure in very small infants should
tion of lung fluid,’2 pulmonary edema, and patency lead to improved care of these patients.
of the ductus arteriosus.’3’5

Infants with Birth Weight 610 to 4,220 gm

This analysis provides updated normal values, for ACKNOWLEDGMENTS

mean aortic blood pressure of newborn infants, that
This work was supported in part by Public Health
extend to infants with birth weights <1,000 gm. In
Service Grants HL-14201 (Pulmonary SCOR) and HL-
addition, new nomograms are given for systolic and 19185 (Pulmonary SCOR).
diastolic aortic blood pressures and for pulse pres- Dr Versmold was a Visiting Scientist at the Cardiovas-
sure. Except for a study on indirectly measured cular Research Institute and was supported by Deutsche
Forschungsgemeinschaft (Ve 32/3).
systolic blood pressures,9 no such data have been
We thank Ms Mureen Schlueter for her help in gath-
available for healthy preterm and term newborn
ering the data; Drs A. M. Rudolph, M. A. Heymann, and
infants. J. I. E. Hoffmann for helpful discussion and criticism; Dr
The systolic aortic blood pressures reported here J. I. E. Hoffmann and Ms Laura Cheloke for their help in
are similar to those measured indirectly in clinically the statistical analyses; and Mrs Marilyn Biagini, Mrs
Maureen Adkinson, and Mrs Rita Schubert for prepara-
normal infants by Bucci et al.9 In older children,
tion of the manuscript. We are grateful to the nursing
systolic and diastolic blood pressures are linearly staff of the Intensive Care Nursery for their assistance in
related to height and to the logarithm of weight, making the blood pressure measurements.

612 AORTIC BLOOD PRESSURE

Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013

REFERENCES 9. Bucci G, Scalamandr#{233} A, Savignoni PG, et al: The systemic
blood pressure ofnewborns with low birth weight: A multiple
1. Phibbs R: What is the evidence that blood pressure moni- regression analysis. Acta Paediatr ScaM 229(suppl):1, 1972
toring is useful, in Problems of Neonatal Intensive Care
10. Wilkinson AR, Phibbs RH, Gregory GA: Continuous mea-
Units. Report of the Fifty-ninth Ross Conference on Pedi- surement of oxygen saturation in sick newborn infants. J
atric Research. Columbus, OH, Ross Laboratories, 1969, pp Pediatr 93:1017, 1978
81-89 1 1. Rudolph AM, Heymann MA, Teramo KAW, et al: Studies
2. Klaus MH, Fanaroff AA: Care of the High-Risk Neonate. on the circulation of the previable human fetus. Pediatr Res
Philadelphia, WB Saunders, 1973 5:452, 1971
3. Kitterman JA, Phibbs RH, Tooley WH: Aortic blood pres- 12. Bland RD, McMillan DD: Lung fluid dynamics in awake
sure in normal newborn infants during the first 12 hours of newborn lambs. J Clin Invest 60:1 107, 1977
life. Pediatrics 44:959, 1969 13. Stevenson JG: Fluid administration in the association of
4. Usher R, McLean F: Intrauterine growth of liveborn cauca- patent ductus arteriosus complicating respiratory distress
sian infants at sea level: Standards obtained from measure- syndrome. J Pediatr 90:257, 1977
ments in 7 dimensions of infants born between 25 and 44 14. Tooley WH: Patent ductus arteriosus-Clinical considera-
weeks of gestation. J Pediatr 74:901, 1969 tions, in The Ductus Arteriosus. Report of the Seventy-fifth
5. Hall RT, Oliver TK: Aortic blood pressure in infants admit- Ross Conference on Pediatric Research. Columbus, OH,
ted to a neonatal intensive care unit. Am J Dis Child 121: Ross Laboratories, 1979, pp 72-77
145, 1971 15. Bell EF, Warburton D, Stonestreet BS, et al: Effect of fluid
6. Stahlman M, Blankenship WJ, Shepard FM, et al: Circula- administration on the
development of symptomatic patent
tory studies in clinical hyaline membrane disease. Biol Ne- ductus arteriosus and congestive heart failure in premature
onate 20:300, 1972 infants. N Engi J Med 302:599, 1980
7. Brown EG, Krouskop RW, McDonnell FE, et al: Blood 16. Vorrs AW, Webber LS, Berenson GS: Epidemiology of es-
volume and blood pressure in infants with respiratory dis- sential hypertension in youth: Implications for clinical prac-
tress. 1975
JPediatr87:1133, tice. Pediatr Clin North Am 25:15, 1978
8. Barr PA, Bailey PE, Sumners J, et al: Relation between 17. Levison H, Kidd BSL, Gemmell P, et al: Blood pressure in
arterial blood pressure and blood volume and effect of in- normal full term and premature infants. Am J Dis Child 111:
fused albumin in sick preterm infants. Pediatrics 60:282, 374, 1966
1977

ARTICLES 613
Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013
Aortic Blood Pressure During the First 12 Hours of Life in Infants with Birth Weight
610 to 4,220 Grams
Hans T. Versmold, Joseph A. Kitterman, Roderic H. Phibbs, George A. Gregory and
William H. Tooley
Pediatrics 1981;67;607
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/67/5/607
Citations This article has been cited by 21 HighWire-hosted articles:
http://pediatrics.aappublications.org/content/67/5/607#related-urls
Permissions & Licensing Information about reproducing this article in parts (figures, tables)
or in its entirety can be found online at:
http://pediatrics.aappublications.org/site/misc/Permissions.xhtml
Reprints Information about ordering reprints can be found online:
http://pediatrics.aappublications.org/site/misc/reprints.xhtml

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright © 1981 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Health Internetwork on August 23, 2013