Hypotension in children
Author Ольга Кияница
Hypotension is a clinical definition of low blood pressure. In this condition, the homeostasis in the body is disrupted, which leads to deprivation of the brain, heart and other vital organs of oxygen and nutrients.
Arterial pressure, as well as pulse, respiratory rate and body temperature, refers to the basic biological indicators, so it is extremely important to check its value in time.
With various childhood diseases, hypotension can be determined.In some cases it has an extremely important diagnostic value, in others it has no special value. The blood pressure in children is determined most often by a tonometer, which can be put on a finger for very small children and automatically displays the result of the measurement in a minute or two.
Video: Hypotension - what is it, how dangerous and how to recognize it.
Hypotension most often is a symptom of another, basic, disease, and for its mechanism of development, duration and peculiarity of the clinic can be quite heterogeneous. The mechanisms of development of hypotension can be different:
- The minute and shock release of the heart decreases.
- The peripheral resistance of the vessels decreases.
- The volume of circulating blood is reduced.
- Inadequate venous return of blood to the heart.
These changes in hemodynamics can be combined, or arise in isolated form. For a more accurate definition of the main characteristics of hypotension, there is its classification.
- Acute hypotension - occurs due to a sharp decrease in blood pressure.
- Chronic, which happens:
- Primary - is a separate disease, defined as an essential or idiopathic hypotension.
- Secondary - occurs against the background of other diseases, therefore it is considered their symptomatic manifestation.
In chronic hypotension, physiological decrease in blood pressure is separately distinguished, which often does not exceed the lower limits of the norm and the child feels well at the same time. In such cases, doctors speak of a congenital predisposition of the body to reactions associated with low blood pressure.
Orthostatic hypotension is another form of lowered blood pressure, which is characterized by the appearance of signs of disturbance in the transition from horizontal to vertical position. In children, such a disorder is often associated with a change in neurological reactions. In their frustration, the tone of the vessels does not react so quickly to a change in the position of the body, resulting in symptoms that are peculiar to hypotension.
The indicators of the norm of blood pressure in children according to the age, presented by PALS Guidelines, 2015, are provided.
|Age||Systolic pressure||Diastolic pressure||Systolic hypotension|
|Newborns (12 h, <1000 g.)||39-59||16-36||<40-50|
|Newborns (12 h, 3 kg)||60-76||31-45||<50|
|Newborns (96 hours)||67-84||35-53||<60|
|Infants (1-12 months)||72-104||37-56||<70|
|Toddlers (1-2 years)||86-106||42-63||<70 + (age in years x 2)|
|Preschoolers (3-5 years)||89-112||46-72||<70 + (age in years x 2)|
|Schoolchildren (6-9 years)||97-115||57-76||<70 + (age in years x 2)|
|Pre-adrenal age (10-11 years)||102-120||61-80||<90|
|Adolescents (12-15 years)||110-131||64-83||<90|
In adults, hypotension usually proceeds more favorably than in children. In the latter case, blood pressure (BP) may be lowered for various reasons and the least dangerous and reversible is dehydration. Other factors of development represent a clear threat to life, and here, in the first place, is the shock state.
According to the views established in medicine, dehydration (dehydration) occurs when a person consumes an insufficient amount of liquid, which the body begins to react with a decrease in blood pressure with all the ensuing consequences.
Most often, dehydration develops against the background of diarrhea, hyperthermia, increased physical exercise during the hot season or in a stuffy room. The mechanism of development of hypotension due to dehydration is quite simple: With insufficient intake of fluid in the body or increased excretion, the volume of circulating blood decreases, which leads to a decrease in blood pressure.
- Medication administration
Unauthorized reception of medicines is prohibited precisely because a person who is far from medicine does not know the effect of a substance. And some of them affect the vessels in such a way that they can expand or, conversely, narrow. As a result, blood pressure rises or falls.
Hypotension occurs most often when taking medications such as hydralazine (vasodilator), nifedipine (calcium channel blocker), the latter drug blocks the penetration of calcium into vascular and cardiac cells (cardiomyocytes), which leads to an increase in the lumen of the vessels and, as a consequence, hypotension .
In the development of this disease, the main role is played by insufficient amount of iron, because of which the quantity of red blood cells decreases, and with it anemia (anemia) develops. Since anemia can occur in chronic form for many years, it is not always possible to immediately determine the disorder. Among all the symptoms of this disease, orthostatic hypotension is most pronounced. Sometimes anemia develops very quickly, then a sharp decrease in blood pressure is determined.
- Adrenal insufficiency
Normal functioning of the body largely depends on the harmonious functioning of the adrenal glands. This body produces extremely necessary hormonal substances, so if they lack, various pathological conditions develop. In particular, the insufficient intake of aldosterone (mineralocorticoid) in the blood causes a decrease in the concentration of salt in it, which in turn leads to hypotension.
- Shock condition
The concept of "shock" is often associated with those conditions when, for one reason or another, there is a sharp narrowing of the vessels and, as a consequence, oxygen and nutrients cease to flow to the organs and tissues. If the shock is associated with a bacterial infection, then they talk about sepsis. Prolonged and severely leaking diarrhea can lead to a decrease in blood volume so that hypovolemic shock will occur. In children, according to doctors Wendy Pomerants and Mark Robak, the reduction in blood pressure to ⅓ is compensated by the efforts of the body, so in such cases the child feels satisfactory. If the fall in blood pressure continues, then the patient's condition deteriorates sharply and a shock develops. Therefore, it is extremely important to prevent the development of the disease before this stage.
It is necessary to know that shock, anemia, dehydration can occur due to bleeding, which is internal and external. In such cases, it is often said about acute hypotension. The more blood the patient loses, the more pronounced the clinic and the heavier his condition.
Other causes of hypotension in children:
- Hereditary predisposition.
- Congenital hypoplasia of the aorta (aortic narrowing).
- Reducing the viscosity of the blood.
- Lack of vitamins E, C, B5
- Sharp climate change, etc.
Video: What could be the cause of low blood pressure and decline of strength? - Doctor Komarovsky
The manifestations of orthostatic hypotension and physiological hypotension are similar. These include:
- Unclear vision
- Confusion in the mind
- Weakness in the whole body
- Feeling tired
Orthostatic hypotension can occur within a few seconds or after the baby is sitting or lying. If, at the onset of symptoms, the patient remains for some time in a calm state, then manifestations tend to pass.
Severe hypotension associated with shock
Early signs and symptoms of reduced blood flow to the brain include weakness, drowsiness and confusion.
Over time, when the condition worsens, the patient will not be able to sit still. If the pathology continues to develop, often a loss of consciousness occurs. Shock is often fatal if medical assistance is not provided on time.
Other signs and symptoms of shock depend on the causes of its occurrence. When a shock is determined against a background of low blood volume (for example, due to acute blood loss) or poor pumping function of the heart (for example, due to a congenital malformation), then the following symptoms appear:
- The skin becomes cold and damp to the touch. Often looks blue or pale. If you click, the color will return to normal more slowly than usual. Under the skin appears a bluish network of lines.
- The pulse becomes weak and fast.
- The baby starts to breathe very quickly.
- When the extreme expansion of blood vessels causes a shock (for example, with vasodilatation shock), the patient feels at first warm and reddened. Later the skin becomes cold and sweaty, the patient has drowsiness.
Shock is an emergency, and when it occurs, you need to contact immediately for an emergency
Hypotension is diagnosed on the basis of medical history, physical examination and the results of various tests and instrumental research methods.
Hypotension against a background of shock is a life-threatening condition requiring urgent care. For other types of hypotension, the doctor can recommend diagnostic methods to find out the cause of the illness and make a clinical conclusion.
- Blood tests
For the study, a small amount of blood from the finger or vein of the hand is taken using a scarifier or needle. The procedure is carried out quickly, but children, especially small children, often have to be held in order not to move sharply. A blood test can show if there is anemia or low blood sugar.
This is a simple method of diagnosis, which allows you to record the electrical activity of the heart. As a result, data on the heart's work are obtained, whether there is an unstable or irregular rhythm, etc. The ECG also shows the strength of the electrical signals with which they pass through the myocardium.
- Holter monitoring
With the help of special medical devices that record the electrical activity of the heart, heartbeat is determined throughout the day. Further the same analysis of the obtained data is carried out, as in the case of the standard ECG.
In this study, sound waves are used to create a moving image of the heart. There are several types of echocardiography, including echocardiography. This method of diagnosis is part of the stress test, which is usually done to find out if the child has cardiac circulatory disorders.
Measuring blood pressure in children
During the measurement of blood pressure in the child, parents or caregivers should ensure that the doctor follows the following algorithm of actions:
- Cuff Size
Since a cuff of the wrong size can contribute to getting inaccurate data, you need to make sure that the doctor has chosen the correct size. As a rule, it depends on the size of the arm and the length of the cuff itself, under which, while tightening, there is space for the head of the stethoscope.
Recent physical activity may distort the results of the study, so you need to wait until the child is relatively calm for at least 5 minutes before starting the measurement. During the procedure, children should sit quietly, preferably in a relaxed state. A parent with a child can make a couple of deep breaths, which will help to eliminate the disturbing state.
During the visit, at least two measurements with a small interval should be carried out.
If the automatic device first detects a change in blood pressure, it is recommended to use the Gold Standard - a stethoscope and a normal tonometer - for the second time, instead of making a repeated determination of the BP by a digital device.
Treatment of children of patients for hypotension is most often handled by a children's cardiologist. Additionally, physicians of such specialization as surgeons, nephrologists, neurologists can be consulted.
Treatment depends on the type of hypotension and the severity of the symptoms. The goal of the treatment is to restore normal blood pressure to alleviate the symptoms. Another task is to influence the existing risk factor that causes hypotension.
In a clinically healthy person, low blood pressure without any signs is usually not dangerous, so no specific treatment is required.
If there are signs of hypotension, then you need to place the baby in a sitting or lying position. You can also put your feet above the level of the heart. If these actions do not quickly disappear, medical attention should be sought.
Many therapeutic methods are available for the treatment of orthostatic hypotension. First of all the doctor can advise to make changes in a way of life, for example:
- Drink plenty of fluids, such as water or non-carbonated beverages, containing trace elements such as sodium and potassium.
- Slowly get up from a lying or sitting position.
- Sitting should not cross legs.
- It is necessary to slowly increase the amount of time that is spent sitting, especially if you have to not move for a long time because of your health.
- Nutrition is best done in small portions, from low-carbohydrate, vitamin-rich foods.
For newborns and infants, the doctor can prescribe special vitamin complexes at the appropriate age-appropriate dose.
If a medical product causes a decrease in blood pressure, the doctor may change the medicine or adjust the dose that the child takes.
Only a few drugs are used to treat orthostatic hypotension. The most commonly used is fludrocortisone and midodrin, and only after a medical consultation.
Specific treatment of this form of hypotension is most often not carried out, while children of this condition often overgrow. In addition, you can use the following recommendations:
- Avoid situations in which symptoms occur, such as prolonged exposure to sunlight or in a stuffy environment.Unpleasant, frustrating or scary situations can also cause symptoms of a lowered blood pressure.
- You need to drink enough fluids, while children are more suitable vitaminized drinks.
- It is necessary to increase salt intake (after preliminary consultation with the attending physician).
With minor hypotension it is useful to learn to recognize the symptoms that occur before fainting and take measures to increase blood pressure. For example, putting your head between your knees or lying down, you can help raise blood pressure.
Severe hypotension associated with shock
The shock represents a danger to life due to the development of an emergency. As a rule, patients in a state of shock require immediate intervention of medical personnel.
The goals of the treatment of shock are as follows:
- Restore blood circulation throughout the body as quickly as possible to prevent damage to organs
- Find and reverse the cause of the impact
- Blood or special fluids are injected into the bloodstream to restore normal blood circulation.
- Medications can help raise blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments, such as antibiotics or surgery, may be required.
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Life with hypotension
Doctors can successfully cure hypotension. Many people after such therapy, lead a normal, healthy life.
If the child is diagnosed with hypotension, then measures can be taken to prevent or limit symptoms such as dizziness and fainting.
If orthostatic hypotension is diagnosed, you should slowly get up after sitting / lying down or moving your legs before changing your position. Other lifestyle changes can also help control hypotension.
During and after restoration of blood circulation, various degrees of organ damage can remain and, if possible, they should be identified and involved in medical supervision. For example, acute tubular necrosis may be a consequence of uncompensated shock.
The liver and intestines are damaged during shock, which leads to bleeding and increased risk of necrotizing enterocolitis, especially in premature infants.
The degree of irreversible damage to the brain is probably most alarmingly controlled after a shock, because the brain is so sensitive to hypoxic-ischemic damage that compensatory methods are often unsuccessful against this background.
The most unfavorable in its development is hypotension associated with shock. This condition remains the main cause of neonatal morbidity and mortality. The prognosis after neonatal shock is associated with the underlying cause (eg, sepsis, heart disease) and injuries sustained during inadequate perfusion.
Early detection and treatment of neonatal shock is necessary to maximize the results of therapy. Morbidity due to trauma of the end organs and their dysfunction is similar. Frequent complications include pulmonary, renal, endocrine, gastrointestinal and neurological dysfunction. The delay in diagnosis and treatment can lead to permanent neurological consequences, such as cerebral palsy, epilepsy and mental retardation
With physiological and orthostatic hypotension, the prognosis is usually favorable, since these conditions do not lead to significant violations of the child's quality of life.
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During pregnancy, both high blood pressure and low blood pressure can be observed. In the latter case, the greatest clinical value is the combination of hypotension with other anxiety symptoms such as dizziness or even fainting. Then immediately begin medical treatment.
Among the various indicators of the physiological state of a person, a special place is occupied by arterial pressure. This indicator, as well as the pulse, has a direct connection with the cardiovascular system and in its magnitude it is possible to determine in general whether the person is in a normal state or is presumably suffering from any kind of disease.