Hypotension In Infants

WHAT YOU SHOULD KNOW:

• Hypotension is when your infant's blood pressure (BP) is lower than it should be. BP is the pressure inside your infant's blood vessel walls, created by the blood flowing through them. Organs, including the brain, kidneys, and intestines (bowels), need enough blood and oxygen to work properly. With hypotension, your infant's organs may not get enough blood to work well. The cause of your infant's hypotension may not be known. Infant hypotension may be caused by heart problems, adrenal gland problems, sepsis (blood infection), and blood loss. Your infant's risk for hypotension increases if he is born too early, or if he weighs very little.
  
  
• Your infant's hypotension may be mild, severe (very bad), or life-threatening. Symptoms include urinating very little and cool, pale (lighter color than normal) skin. Your infant's caregiver will check your infant's BP with a cuff placed on his arm or leg. A catheter (tube) may also be put into your infant's artery (blood vessel) to watch his BP constantly. Your infant may need blood tests and an echocardiogram (test to check his heart and blood flow). Your infant's hypotension may get better without treatment. Your infant may need intravenous (IV) liquids, medicines, or other treatments for his hypotension. Treating your infant's hypotension may resolve his symptoms and correct his BP. Treatment may improve the blood flow to his organs and allow him to grow and develop as he should.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

• Medicines to treat your infant's hypotension may cause high BP or a fast heartbeat. Medicines may cause your infant to have high blood sugar levels, and he may get infections more easily. Certain medicines may slow your infant's growth or cause damage to his stomach, intestines, or brain. IV medicines that leak out of the vein and tube may cause skin and tissue damage. If your infant gets more IV liquid than his body can hold, he may get volume overload. Volume overload may lead to heart or lung problems.
  
  
• Tubes placed in your infant's blood vessels may cause a blood infection or blood clots. Blood clots can cause pain and swelling, and it can stop blood from flowing where it needs to go in your infant's body. The blood clot may break loose and travel to your infant's lungs or brain. A blood clot in your infant's lungs can cause chest pain and trouble breathing. A blood clot in your infant's brain can cause a stroke. These problems can be life-threatening. Even with treatment, your infant's hypotension may not improve, causing poor blood flow to his organs. If your infant's organs cannot work properly, he may die.
  
  
• Without treatment, hypotension can decrease the blood flow to your infant's organs. Poor organ blood flow can cause the organs to stop working. Poor blood flow to your child's brain may cause brain damage. If your infant's hypotension is not treated, he may die. Talk with your infant's caregiver if you have questions or concerns about his condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

IV:

An IV is a tiny tube placed in your infant's vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Arterial line:

An arterial line is a tube placed into an artery, usually in the wrist or groin. The groin is the area where your infant's abdomen (belly) meets his upper leg. The tube may also be placed in your infant's umbilical artery (blood vessel in your infant's umbilical cord). The arterial line is attached to tubing with liquid in it. This liquid helps keep the tubing from getting plugged. The tube may be used for measuring your infant's blood pressure or for drawing blood.

CVP line:

A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your infant's neck, groin, or chest. The CVP line may be used to give medicines, draw blood, or to check your infant's heart. The CVP line can show if your infant has too much or too little fluid in his body.

Oxygen:

Your infant may need oxygen to help him breathe more easily. Your infant may need a nasal cannula (small tubes placed in the nose) or mask. Some infants are placed in an oxygen tent or plastic hood. Do not take off your infant's oxygen without asking his caregiver first.

Endotracheal tube:

Your infant may need an endotracheal (ET) tube to help him breathe. An ET tube is put in your infant's mouth or nose, and goes into the trachea (windpipe). It may be connected to a breathing machine called a ventilator. The ET tube will be taken out when your infant is breathing better.

Treatment options:

• Blood transfusion: During a blood transfusion, your infant will get whole blood, or parts of blood, through an IV. You may be worried that your infant will get AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for HIV, hepatitis, and West Nile Virus.
  
  
• Intravenous liquids: If your infant's hypotension is caused by blood or fluid loss, he may be given liquids in his IV. The liquids may have electrolytes (body salts) and sugar in them to replace what has been lost.
  
  
• Medicines: Ask your infant's caregiver about these or other medicines your infant may need:
  
  
  • Inotropic medicines: Inotropic medicines may be given to increase your infant's blood pressure. Inotropic medicines may also improve the blood flow to your infant's organs.
    
    
  • Steroids: Steroid medicine may be given to help increase your infant's blood pressure. Steroids may also be given to treat adrenal gland problems if that is what caused your infant's hypotension.
    
    
  • Antibiotics: Your infant may be given antibiotic (germ-killing) medicine if his hypotension is caused by a blood infection.

Monitoring:

• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your infant's chest. Each pad has a wire leading to a TV-type screen or to a small portable box (telemetry unit). This screen or box shows a picture of your infant's heartbeat. Caregivers watch this picture to make sure your infant's heart is doing okay.
  
  
• Intake and output: Your infant's caregiver may need to know how much liquid your infant is getting and urinating. Caregivers may also want to know how much your infant eats and if he has a bowel movement (BM). Save your infant's diapers so that a caregiver can weigh them. Do not throw away diapers before asking your infant's caregiver.
  
  
• Neurologic signs: These are also called neuro signs, neuro checks, or neuro status. A caregiver may check your infant's eyes and how easily he wakes up. The strength of your infant's arms, hands, legs, and feet may also be checked. These signs may tell caregivers how your infant's brain is working.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells caregivers how much oxygen is in your infant's blood. A cord with a clip or sticky strip is placed on your infant's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. Tell a caregiver if the sticky strip or clip comes off of your infant. An alarm will sound if the machine cannot read the oxygen level or if your infant needs more oxygen. Tell a caregiver if the machine is alarming. Never turn the pulse oximeter off.
  
  
• Vital signs: This includes taking your infant's temperature, blood pressure, pulse (counting his heartbeat), and respirations (counting his breaths). To take your infant's blood pressure, a cuff is put on his arm or leg and tightened. The cuff is attached to a machine which gives your infant's blood pressure reading. Caregivers may listen to your infant's heart and lungs by using a stethoscope. Your infant's vital signs are taken so caregivers can see how he is doing.

Tests:

The following tests may be needed to learn the cause of your infant's hypotension. These tests may help plan your infant's treatment:

• Blood gases: These tests are also called arterial blood gases (ABGs). Blood is taken from one of your infant's arteries, or from his arterial line. ABGs may be done if your infant has trouble breathing or other problems caused by his illness.
  
  
• Blood tests: Your infant may need blood taken for tests. The blood may be taken from your infant's arm, hand, finger, foot, heel, or IV. Blood tests can give caregivers more information about your infant's health condition. Your infant may need to have blood drawn more than once.
  
  
• Capillary refill time: A caregiver will press an area of your infant's skin, usually a finger or toe, until it becomes white. The caregiver will let go and count how many seconds it takes for the area to turn pink. Testing your infant's capillary refill time can show caregivers how well your infant's blood is moving through his body.
  
  
• Echocardiogram: This test is also called an echo. Sound waves are used to show pictures of the size and shape of your infant's heart. The echo can also show how well the heart is pumping and how well blood flows through it. The echo pictures are shown on a TV-like screen. The whooshing noise that you may hear is the sound of blood flowing through your infant's heart.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Hypotension In Infants (Inpatient Care)