The pulse pressure in a premature infant less than 37 weeks gestational age with a patent ductus arteriosus

Cristina Vega-Barrera, Jonathan Muraskas, Rong Guo, Brooke Ray

Illinois Mathematics and Science Academy, Aurora, USA.
Neonatal Intensive Care Unit, Loyola University Medical Center, Maywood, USA.
Statistics Department, Loyola University Medical Center, Maywood, USA.

DOI: 10.4236/ojped.2013.32019                

Abstract

A widened pulse pressure could be a sign of a patent ductus arteriosus in an infant. This is defined as a difference between systolic and diastolic blood pressure of greater than 15 to 25 mmHg, in premature infants and greater than 25 mmHg in term infants [1]. It is thought that diastolic runoff from blood flow shunting across the aorta to the pulmonary artery, through the patent ductus arteriosus, will produce a lower diastolic pressure and therefore widen the pulse pressure in the affected infant [1]. In our retrospective chart review, 116 premature infants were identified with a patent ductus arteriosus and compared to 42 premature infants without a patent ductus arteriosus. The blood pressures obtained were recorded for the first 7 days of life of the patients. Our studies revealed that premature infants with a patent ductus arteriosus had a mean pulse pressure of19 mmHg (p-value 0.129) when compared to infants without a patent ductus arteriosus,16 mmHg, on day 1 of life. The mean pulse pressures were ~20 mmHg in both groups on days 2 - 3. On days 4 - 7 mean pulse pressures were greater than20 mmHg for both groups (p-values 0.35, 0.19, 0.74, 0.8). It was noticed that mean pulse pressures in the patent ductus arteriosus group were within 0-4 mmHg when compared to the group without a patent ductus arteriosus and therefore not clinically relevant or statistically significant.

Keywords

Patent Ductus Arteriosus; Widened Pulse Pressure; Premature

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Long, W.A. (1990) Fetal and neonatal cardiology. W.B. Saunders Company, Philadelphia.
[2]	Zahka, K.G. and Erenberg, F. (2010) Fanaroff and Martin’s neonatal-perinatal medicine, diseases of the Fetus and newborn (Chapter 45. Part 7 Congenital Defects). 9th Edition, Missouri, St. Louis.
[3]	Bancalari, E.H. and Walsh, M.C. (2010) Fanaroff and Martin’s neonatal-perinatal medicine, diseases of the Fetus and newborn (Chapter 44. Part 7 Bronchopulmonary Dysplasia). 9th Edition, Missouri, St. Louis.
[4]	Ratner, I. (1985) Association of low systolic and diastolic blood pressure with significant patent ductus arteriosus in the very low birth weight infant. Critical Care Medicine, 13, 497-499.
[5]	Evans, N. (1993) Diagnosis of patent ductus arteriosus in the preterm newborn. Archives of Disease in Childhood, 68, 58-61. doi:10.1136/adc.68.1_Spec_No.58
[6]	Evans, N., et al. (1992) Effect of patency of the patent ductus arteriosus on blood pressure in very preterm infants. Archives of Disease in Childhood, 67, 169-173. doi:10.1136/adc.6 7.10_Spec_No.1169
[7]	Mohrman, D.E. and Heller, L.J. (2010). Regulation of arterial pressure (Chapter 9). In: Mohrman, D.E. and Heller, L.J. (Eds), Cardiovascular Physiology, 7th Edition, McGraw-Hill Company, New York. http://www.accessmedicine.com/content.aspx?aID=6553984
[8]	Bray, J.J., Cragg, P.A., Macknight, A.D.C., Mills, R.G. and Taylor, D.W. (1989) Blood pressure. Lecture notes on human physiology. Blackwell, Oxford, 427-428.