Blood pressure levels at follow-up of infants with and without chronic lung disease

Neonatal Blood Pressure Standards: What Is "Normal"?

Blood pressure (BP) is routinely measured in newborn infants. Published BP nomograms demonstrate a rise in BP following delivery in healthy infants at all gestational ages (GA) and evidence that BP values are higher with increasing birth weight and GA. However, the complex physiology that occurs in newborn infants and range of BP values observed at all GA make it difficult to identify "normal" BP for a specific infant at a specific time under specific conditions. As such, complete hemodynamic assessment should include the physical examination, perinatal history, other vital signs, and laboratory values in addition to BP values.

Randomized, controlled trial of dexamethasone in neonatal chronic lung disease: 13- to 17-year follow-up study: II. Respiratory status, growth, and blood pressure

OBJECTIVES

To study the growth, health status, and respiratory outcomes at 13 to 17 years of infants enrolled in a double-blind, randomized, controlled trial of dexamethasone for the treatment of neonatal chronic lung disease.

PARTICIPANTS

A total of 287 infants who were chronically dependent on supplementary oxygen between 2 and 12 weeks of age were recruited from 31 centers in 6 countries to a double-blind, randomized, controlled trial of dexamethasone base (0.5 mg/kg per day for 1 week) or placebo, and survivors were evaluated at 3 years. Children from the 25 British and Irish centers were traced for reassessment at 13 to 17 years of age.

OUTCOME MEASURES

Respiratory symptoms, lung-function testing, height, weight, head circumference, blood pressure, health resource usage, and school absences.

RESULTS

There was no significant difference in respiratory outcomes between the dexamethasone and placebo groups. Lung function was impaired but with no difference between the 2 groups. Growth was also impaired in both groups, with height z score of -0.7, weight z score of -0.4, and head circumference z score of -1.1. Systolic blood pressure was >95th percentile for age and height for 15% of children, but with no difference between the 2 groups. There was no difference in the numbers of hospital admissions for respiratory causes or other causes.

CONCLUSIONS

Despite a shorter duration of neonatal assisted ventilation, there is no evidence that dexamethasone use is associated with long-term improvement in lung function. Impaired growth and poor health status are long-term consequences of neonatal chronic lung disease, irrespective of exposure to neonatal dexamethasone.