Poor adherence to early childhood blood pressure measurement guidelines in a large pediatric healthcare system

  • Lokesh ShahEmail author
  • Jobayer Hossain
  • Shirlly Xie
  • Joshua Zaritsky
Original Article



Children who were born prematurely, those with a very low birthweight, or who have survived the neonatal intensive care unit (NICU) are at risk for the development of hypertension and chronic kidney disease (CKD), and thus require blood pressure screening less than 3 years of age, per American Academy of Pediatrics (AAP) 2004 and 2017 guidelines.


We reviewed the practice patterns of a large pediatric health care system and assessed adherence to the AAP clinical practice guidelines on blood pressure measurements in children less than 3 years of age for hypertension and CKD with the following risk factors: prematurity, very low birthweight, and a neonatal intensive care setting encounter. This retrospective chart review included a total of 9965 patients with a median gestational age of 34 weeks.


Overall, 38% of patients had at least one blood pressure measured less than 3 years of age. Primary care accounted for 41% of all outpatient encounters and 4% of all blood pressure measurements. Surgical specialties (i.e., ophthalmology, otolaryngology, and orthopedics) accounted for many non-primary care visits and were less likely than medical specialties (i.e., cardiology and nephrology) to obtain a blood pressure measurement (p < 0.0001).


This study of a large healthcare system’s practice revealed a lack of basic screening for hypertension in a population known to be at risk for hypertension and CKD.


Blood pressure Pediatrics Prematurity Very low birthweight Hypertension 


Compliance with ethical standards

We obtained Institutional Review Board approval to perform a review and analysis of de-identified patient data.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© IPNA 2018

Authors and Affiliations

  1. 1.Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  3. 3.Drexel UniversityPhiladelphiaUSA

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