Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : SC24 - SC29 Full Version

Blood Pressure Reference Values of Nigerian Full-term Neonates in the First Week of Life at a Nigerian Tertiary Hospital: A Cross-sectional Survey


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/52597.17408
Adebimpe Ajibola Afolabi, John Akintunde Okeniyi, Joshua Aderinsola Owa, Francis Folorunso Fadero, Babatunde Adeola Afolabi, Olusola Adetunji Oyedeji

1. Consultant, Department of Paediatrics and Child Health, UNIOSUN Teaching Hospital, Osogbo, Osun, Nigeria. 2. Consultant, Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile Ife, Osun, Nigeria. 3. Consultant, Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile Ife, Osun, Nigeria. 4. Consultant, Department of Paediatrics and Child Health, LAUTECH Teaching Hospital, Ogbomosho, Oyo, Nigeria. 5. Consultant, Department of Family Medicine, UNIOSUN Teaching Hospital, Osogbo, Osun, Nigeria. 6. Consultant, Department of Paediatrics and Child Health, Wesley Guild Hospital, Ilesa Osun State, Nigeria.

Correspondence Address :
Dr. Olusola Adetunji Oyedeji,
Department of Paediatrics and Child Health, Wesley Guild Hospital, Ilesa, Osun State, Nigeria.
E-mail: soltomoyedeji@yahoo.com

Abstract

Introduction: Knowledge of normative Blood Pressures (BP) is critical for appropriate neonatal care. Hypertension and hypotension are abnormalities of BP which could be a sign, outcome or complications of diseases or intervention carried out on neonates. Yet, there is a dearth of data on BP concerning Nigerian full-term neonates.

Aim: To determine BP values of apparently healthy term Nigerian neonates in relation to their weight in the first eight days of life and also to determine the BP values of apparently healthy term neonates in the first eight days and also to correlate the BP with postnatal age, weight and to generate percentile of age/sex specific BP.

Materials and Methods: This cross-sectional study was done from September 2012-April 2013, including 386 consecutive apparently healthy term newborns delivered at the UNIOSUN Teaching Hospital (UTH), Osogbo, Southwest Nigeria. Their weights and right arm Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) BPs measured using oscillometric method on days 1, 3, 5 and 8. Student’s t-test and Pearson correlation coefficient was used to statistically analyse the data.

Results: Out of 386 newborns studied, the mean birth weight were 3.10±0.38 Kg; {3.24±0.37 kg for boys and 2.97±0.33 kg for girls}. The mean values of SBP on day 1 were 67.3±5.6 mmHg; 71.0±6.0 mmHg on day 3; 73.8±5.2 mmHg on day 5 and 77.2±2.9 mmHg on day 8, respectively. A similar trend was also noticed in the mean values of DBP with 36.9±5.0 mmHg on day 1; 41.5±5.2 mmHg on day 3; 43.7±5.3 mmHg on day 5 and 46.4±4.7 mmHg on day 8, respectively, the rise being significant (p-value <0.001). There were a positive correlations between the weight and DBP on the 5th day (r=0.128; p-value =0.012), between weight and SBP at 49-72 hours and on day 8 (r=0.105; r=0.168, respectively) as well as weight and MAP on day 8 (r=0.166).

Conclusion: Neonatal BP in the first eight days following birth correlated positively to weight and age without significant gender differences.

Keywords

Hypertension, Hypotension, Mean arterial pressure, Newborn

The BP is a vital sign and an indicator of clinical stability, in addition to other clinical signs like respiratory rate, heart rate and temperature. BP is not routinely measured in apparently healthy newborn. This might be partly explained by the fact that indirect BP measurement was not practicable in newborn before the development of the oscillometric technology. The oscillometric method is the current indirect method of BP measurement in modern neonatal practice (1). Previous studies have reported hypotension in 16-50% of babies admitted into a Neonatal Intensive Care Unit (NICU) in Philadephia, USA (2),(3). Also, hypertension is increasingly being diagnosed in other NICUs with 0.2-2.6% of neonates discharged from such units having hypertension (4),(5),(6). Hypotension and hypertension can lead to irreversible damage of cellular metabolism, severe disease and death during the neonatal period and early infancy. Thus, there is the need for routine measurement of BP in neonates and infants in order to be able to diagnose its abnormalities. The advances in the practice of neonatology in general and particularly in the identification, evaluation and care of infants with hypertension have led to an increase in the awareness of the existence of hypertension in modern ICUs, however there is a paucity of data on BP normogram in developing countries and this is partly due to lack of appropriate facilities for measuring BP in this age group (7). In the absence of appropriate facilities for measuring BP, diagnosis will be presumptive.

Sadoh WE and Ibhanesebhor SE found mean SBP, DBP and MAP of 66.8, 38.5 and 47.9 mmHg, respectively, on day 1, however the subjects included both small for gestational age and large for gestational age as well as post-term babies, hence it cannot be used as a reference standard for appropriate for gestational age babies (8). Nwokye IC et al., on the other hand used appropriate for gestational age babies and found mean SBP, DBP and MAP of 63.3, 36.8 and 46.4 mmHg, respectively on day 1 but their study ended on day 2 (9). The generated data has been used to generate percentile charts but contrary to what obtained in developed nations (8),(9); data on BP in neonates are very scanty in Nigeria as well as in Africa.

Hence, present study was conducted to determine the BP values of apparently healthy term neonates in the first eight days and also to correlate the BP with postnatal age, weight and to generate percentile of age/sex specific BP.

Material and Methods

The present cross-sectional study was done over a period of eight months, from September 2012-April 2013 at UTH, a tertiary healthcare centre, Osogbo, south-western Nigeria. Ethical clearance was obtained from the Institutional Ethical Committee (IEC) of the hospital (IEC no LTH/REC/11/03/14/83). Informed written consent was obtained from the mother or parents before enrolling the subjects into the study.

Inclusion criteria: Healthy term (37-41 weeks) newborn, weighing between 2.5-4.0 Kg, with normal Appearance, Pulse, Grimace, Activity, and Respiration (APGAR score ≥ 7 and between the ages of 1 and 8 days in the postnatal ward were included in the study. This was determined by mother’s last menstrual period and modified Ballard’s score for those whose mothers were unsure of their date.

b#Ebxclusion criteria: Babies with obvious congenital anomaly and other morbidities and babies of mothers with high BP, diabetes mellitus and substance abuse were excluded from the study.

Sample size: Sample size was determined by the formula n=Z2xS2/d2, which is 1.962x7.72/0.852=316. “n” is the minimum sample size, Z is the critical value of the standard normal deviate in a two tailed test, which is 1.96, which corresponds to the 95% confidence interval. The sample size came to 348 after adding 10% to the 316 sample size for possible attrition. However the sample size was increased to 386 to increase the significance of findings.

Data collection: Neonatal demographic data were recorded including the gestational age, birth weight, length, systemic examination was also done. BP measurement was determined using the oscillometric technique (STELLAR 300). An appropriate sized cuff was used to measure BP on the right arm in supine position when subject was at rest or sleeping, half hour after feeding. The newborn was left for 10-15 minutes after cuff application to ensure quietness. Measurement started from 6 hours in the first 24 hours and on day 3, 5 and 8. Three BP measurements at two minutes interval were measured and the mean of the values was recorded as the BP. This procedure was adopted from standard protocol for assessment of BP measurement in newborns (10). Measurements were taken at age 0-24 hour, 48-72 hours, 96-121 hours and 168-192 hours. The infant’s weight was measured with the baby placed naked using on an infants’ weighing scale (sensitivity-0.05 Kg, SALTER, Model-180 England). The scale was checked for zero error before and after each reading. Follow-up was continued in each subject’s home amongst those discharged before the 8th day. Percentile charts were generated for age and sex using Tukey’s Hinge (weighted average) (11).

Statistical Analysis

Data were statistically analysed using Statistical Package for Social Sciences (SPSS) version 18. Means, Standard Deviations (SD) and ranges were generated and compared using Student’s t-test and then related to weight and age using Pearson correlation coefficient (r). Statistical significance was established when values of probability ‘p’ were <0.05.

Results

Out of total 649 babies delivered in the labour ward during the eight-month study period, 386 (59.5%) met the inclusion criteria; 187 boys and 199 girls giving a male: female ratio of 0.94:1, were enrolled in the study. Maximum babies 106 (27.5%) were born at 39 weeks, followed by 80 (20.7%) each at 40 weeks and 38 weeks (Table/Fig 1).

There were 386 mothers and maternal age ranged between 18 and 42 years with mean age of 29.7±4.4 years maximum 222 (57.5%) were aged between 21-30 years, followed by 149 (38.6%), aged between 31-40 years. 147 (38.1%) delivered per vagina and 239 (61.9%) by caesarean section (Table/Fig 2).

The weights on the first day ranged from 2.500 to 3.900 Kg with mean (SD) 3.10±0.38Kg. The length of babies ranged between 41 to 56 cm with a mean of 48.3±2.4 cm. The mean weight, length of males was significantly higher than the mean length and weight for females (p-value <0.001), but there was no statistically significant difference among males and females regarding head circumference (p-value=0.955) (Table/Fig 3).

The SBP, DBP and MAP at the age of 6-24 hours ranged between 53 and 91, 30 and 52 and 39 and 64 mmHg, respectively. The values for DBP and MAP for females were higher than those for males; and this difference were statistically significant (0.005 and 0.004, respectively), but there was no statistical difference was found among males and females for SBP (p-value=0.936) (Table/Fig 4).

The SBP, DBP and MAP values at the age of 48-72 hours range between 53 and 87, 31 and 53 and 39 and 65 mmHg, respectively. The was no significant difference among males and females for SBP, DBP and MAP at 48-72 hours. The ranges of the SBP, DBP and MAP values at the 96-121 hours were between 58 and 92, 31 and 59 and 40 and 71 mmHg, respectively. The means of SBP, DBP and MAP for males were higher than that of females but the differences was not statistically significant (Table/Fig 5).

The SBP, DBP and MAP of the subjects at the 168-192 hours ranged from 65 to 91, 35 to 56 and 46 to 67 mmHg, respectively. The mean SBP, DBP and MAP of males were higher than those of the females. The differences were statistically significant for SBP and MAP (p-value=0.004 and 0.007, respectively) (Table/Fig 6).

The SBP, DBP and MAP increased from 6-24 hours to 168-192 hours and this difference was found to be statistically significant (p-value <0.001) (Table/Fig 7).

The 5th, 50th and 95th percentiles of the SBP were 57, 68 and 76 mmHg, respectively. The corresponding values for DBP were 31, 36, 45 mmHg, respectively while those for MAP were 40, 48 and 57 mmHg, respectively (Table/Fig 8).

The 5th, 50th and 95th percentiles of the SBP at 48-72 hours were 63, 70 and 84 mmHg, respectively, while the 5th, 50th and 95th percentiles of the DBP were 33, 41 and 50 mmHg. The corresponding values for MAP were 43, 51and 60 mmHg, respectively (Table/Fig 9).

The 5th, 50th and 95th percentiles of the SBP on fifth day were 66, 74 and 84 mmHg respectively. For the DBP, the 5th, 50th and 95th, percentiles were 34, 45 and 52 mmHg, respectively while the 5th, 50th, and 95th percentiles for the MAP were 46, 54, 63 mmHg, respectively (Table/Fig 10).

The 5th, 50th, and 95th, percentiles of the SBP on the eighth day were 69, 76 and 86 mmHg, respectively. The 5th, 50th and 95th percentiles for the DBP were 37, 47, and 53 mmHg, respectively, while the consecutive 5th, 50th and 95th percentiles for the MAP were 49, 55 and 62 mmHg, respectively (Table/Fig 11).

The 5th percentile of the SBP for females on the first, third, fifth and eighth days were 59.33, 60.67, 66 and 67 mmHg, respectively. The corresponding values for 5th percentile for males were 55.67, 63.27, 66 and 70 mmHg, respectively and that of the 95th percentile values were 76, 83.67, 85.33 and 86.67 mmHg (Table/Fig 12).

The 5th percentile of the DBP for females on the 1st, 3rd, 5th and 8th days were 30.67, 34, 35 and 37 mmHg, respectively while the corresponding values for the 95th percentiles were 45.67, 48.67, 50 and 52 mmHg, respectively. For the males, the 5th percentiles BP values were 30.33, 32, 33.33 and 35.67 mmHg, respectively and that of the 95th percentile were 45.33, 51.33, 57.33 and 54.33 mmHg (Table/Fig 13).

The 5th percentiles for the MBP for females on the 1st, 3rd, 5th and 8th days were 40.67, 43.33, 46 and 49 mmHg, respectively. The corresponding values for 95th percentiles were 57.67, 58.33, 60.67 and 61.67 mmHg, respectively. The corresponding 5th percentiles values for males were 39, 42.8, 45 and 48.67 mmHg, respectively and that of the 95th percentile were 57, 62.67, 66.33 and 62.33 mmHg (Table/Fig 14).

On the whole, there were weak but positive correlation, between the weights and BP readings in all the age groups with correlation coefficients (r) ranging between 0.059 and 0.168 for SBP. Even for the highest r-value of 0.168, the coefficient of determination r2= 0.1682 was 0.028 or 2.8% (Table/Fig 15).

Discussion

The present study has provided normative BP values of an apparently healthy cohort of Nigerian neonates. A similar result was obtained from the second of such studies by Sadoh WE and Ibhanesebhor SE in a study of term neonates at the postnatal ward in UBTH, Benin (8). They used the oscillometric method to measure the SBP, DBP and the MAP from day 1 to day 4. The characteristics of neonates in the present study had some similarities with the population studied in Benin city (8). In that and the present studies, full-term normal babies were evaluated in the postnatal ward from day one, and their mothers did not have confounding factors such as diabetes and hypertension. However, present study followed-up at home till the eighth day of life. Nwokye IC et al., also did a similar study at Enugu using newborns of similar characteristics; however, BP was measured at 0-24 hours and 25-48 hours (9).

Comparison between the BP values were recorded by Youmbissi TJ et al., and that of the present study should be taken with caution because of the differences in the types of equipment used (12). The mean SBP value at birth reported by Youmbissi TJ et al., was 65.1±1.30 mmHg which was lower than that 68.1±5.8 mmHg in the present study (12). Different devices for measuring BP may have accounted for the differences in BP values. Higher BP values have previously been recorded by oscillometer as compared with mercury sphygmomanometer (13),(14). Part of the difficulties in the use of mercury sphygmomanometer is that it is only SBP that is easy to measure due to limitations with the equipment in determining the fourth or fifth Korotkoff sounds which are faint in the newborn and therefore difficult to auscultate. The use of the oscillometric devices eliminates this difficulty and provides SBP, DBP and MAP arterial readings. Further advances are still being made to mitigate the various difficulty and improve sensitivity of the various devices being used in the measurement and monitoring of BP (15).

The BP values (SBP, DBP and MAP) obtained in the present study when compared with the study of Sadoh WE and Ibhanesebhor SE at Benin showed some slight differences: the values obtained in the present study were slightly higher than the values obtained by Sadoh WE and Ibhanesebhor SE (8). The reason for this is not very clear. The difference may be partly due to the difference in the time of recording of the BP. Sadoh WE and Ibhanesebhor SE measured the BP of the neonates at specific time interval of 11.00-13.00 hours every day, irrespective of the postnatal age (8). The mean birthweight of subjects in the Benin study was higher than the mean birthweight in the present study. This was expected to result in a higher mean value of BP for the subject in their study since higher body weight is associated with higher BP as documented by some researchers (8),(16). This effect may have been masked by the effect of postnatal age, weight having a weaker influence on BP than age.

The present study documented BP values up to the eighth day of life, whereas that of Nwokye IC et al., was limited to the second day of life (9); while Sadoh WE and Ibhanesebhor SE was limited to the fourth day of life (8). This does not allow comparison with the Benin study beyond the fourth day. In a recent similar study conducted in Australia by Kent AL et al., using a different model of oscillometric device, and recording only the median BP values reported the BP ranges of between 46 and 94, 24 and 57, and 31 and 63 mmHg for SBP, DBP and MAP on day one and day three respectively (7). These median values were however comparable to means of BP values in the present study.

In contrast to the present study, some of the previous studies (17),(18) evaluated high-risk neonates in the neonatal wards, some of whom were preterm babies. The ranges of the BP in these studies were however comparable with the BP values of the present study. This would suggest that normative BP values obtained in apparently healthy neonates may be applied to high-risk newborns that are otherwise well.

The systolic, diastolic and mean arterial BP's in the present study showed progressive increases from the first day to the eighth day. This trend was consistent with reports of other studies from Benin City in Nigeria (8), Australia (7) and America (16). In the present study, there was a higher increase in the BP in the first five days as compared with the fifth to eighth day. The progressive increase in the values of BP obtained from the first day to the eighth day was statistically significant. The higher rise in BP trend in the first five days was similar to that documented in Brompton, London by de Sweit M et al., (18). Possible reasons for the increases in the postnatal BP may be related to the increase in peripheral vascular resistance which occurs at delivery with cord clamping and lung expansion. This trend is known to occur throughout the first six weeks of life (19),(20).

The mean value of SBP on the 5th day in the present study was lower than the value obtained by de Sweit M et al., who measured only SBP using a doppler ultrasound (18). The difference in the results may be due to the difference in the instruments used in measuring BP, as oscillometers have been found to record higher BP than other indirect methods of measuring BP (21),(22),(23). Other differences in the methodology such as the use of the mean of the total BP values obtained over 4 to 6 days documented by de Sweit M et al., could have skewed their findings (18).

The present study showed very weak but positive correlation between SBP and birthweight on the first day, lower than the finding in the study of Sadoh WE and Ibhanesebhor SE who also found a weak positive but statistically significant correlation between SBP and birthweight (8). The slight difference may be explained by the difference in sample size. Kent AL et al., Lalan SP and Warady BA in Brazil and in Australia also documented weak and no statistically significant correlation between SBP and birthweight (7),(24). On the other hand, a study done in Scotland reported a statistically significant correlation between SBP and birthweight but did not give the mean weight or the range in weight (25). de Sweit M et al., reported significant correlation between weight and BP among newborn weighing between 2,800 to 3,800 g (18). The authors however described the correlation coefficient as “low’’ although statistically significant and recommended further investigation. This also agreed with the study of Sadoh WE and Ibhanesebhor SE in Benin city (8).

The mean values of systolic, diastolic and MAP for females in the present study were higher than that for males at 6-24 hours. This was similar to the findings of Sadoh WE and Ibhanesebhor SE (8). The mean values of SBP, DBP and MAP for males became higher than that of females from 48-72 hours to the eighth day in the present study. The difference in BP was found to be statistically significant on the day-5. This finding was different from the finding in the study of Kent AL et al., who found slightly higher but not statistically significant values in females than males. The reason for the difference is not very clear but may be due to the fact that Kent AL et al., used medians values (7).

The higher BP documented for the males might be attributed to the higher body weight of males as compared to females, as documented in some previous studies (7),(25). This cannot however explain the difference noticed on the first day. Males have been found to have higher levels of carboxyhaemoglobin in the first 72 hours, and this has been associated with lower BP (26). Sadoh WE and Ibhanesebhor SE as well as O’Sullivan MJ et al., documented similar findings (8),(27).

The ranges of SBP, DBP and MAP in the present study were also similar to what were documented previous by authors as well as the changes in BP from day one to day eight (7),(8),(16). The present study showed a steady rise in SBP, DBP and MAP with increasing postnatal age. The BP values obtained in the first eight days were used to construct BP normograms of each day. As expected, 90% of the BP values lie within the 5th and 95th percentile range with 5% lying below and above the 5th and 95th lines respectively because the normogram was generated from the raw data of the study population. A few of the study subjects had values of BP which were noticed to be outliers. This was especially so on the first day DBP normogram where some of the study subjects had BP values which were below the 5th percentile line.

The BP values along the percentile lines were comparable with the values obtained by Sadoh WE and Ibhanesebhor SE but lower than the values other workers in the developed countries (8),(28). The lower values may be attributed to the lower weight of the subjects in the present study to that of other workers (28). In addition, the differences in ethnicity, genetic and environmental factors could have contributed to the difference observed.

Limitation(s)

The BP pattern over the entire neonatal period was not evaluated for logistic reasons. The time available for the study and cost were major constraints.

Conclusion

The study provided BP normogram for a healthy population of Nigerian neonates in the first eight days of life. It was found that newborn boys have slightly higher BP than females. BP in the first eight days following birth correlate to weight and age without significant gender difference and also the BP of Nigerian newborn are lower than the values obtained for Caucasian newborns. It is recommended that these normograms be used as a guide in evaluating the BP of Nigerian neonates in the first eight days of life.

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DOI and Others

DOI: 10.7860/JCDR/2023/52597.17408

Date of Submission: Sep 27, 2021
Date of Peer Review: Dec 02, 2021
Date of Acceptance: Nov 23, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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