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An understanding of the principles of blood pressure measurement with automated oscillometric devices (e.g., Dinamap) allows a user to realize the purpose and level of accuracy for which the equipment is designed. Good technique cells for various actions: (1) using a cuff of proper size (too large a cuff will generally work acceptably, but too small a cuff will yield erroneously high readings); (2) squeezing all of the residual air out of the cuff before applying it to the arm or leg; (3) wrapping the cuff snugly around the arm or leg; (4) instructing the patient to refrain from talking or moving and letting nothing press against the cuff during measurement; (5) keeping the cuff and heart at the same horizontal level. (6) When instrument malfunction is suspected, first checking the status of the patient (not the status of the instrument) to be sure that a clinical emergency is not causing the suspected "malfunction"; (7) repeating a reading several times when it is suspicious and, if necessary, modifying the measurement conditions by using, for example, different limbs or different cuffs until the question is resolved; and (8) remembering that a leak in the cuff, hoses, or connection can cause an unexpected malfunction.

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We have designed and constructed a ruler ("Torrstick") calibrated in millimeters of mercury for the measurement of hydrostatic pressure differences. Marks are placed on a measuring stick every 1.34 cm, to afford the best compromise between a column of 0.9% saline solution and a column of blood. Several uses for this ruler are proposed, including the measurement of central venous pressure.

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The measurement of blood pressure in the premature neonate presents many difficulties. A new device has been developed which allows the noninvasive determination of mean arterial pressure (MAP). The device uses an occluding cuff which may be placed on any of the extremities and chooses as MAP the lowest cuff pressure at which the oscillations in cuff pressure are maximum.The device was tested in a series of 36 studies involving eleven infants whose weights ranged from 3.3 Kg to 800 h. The studies were conducted by comparing the pressure measured using the indirect device, with that pressure measured from an umbilical artery catheter. Where possible, determinations were made on the forearm, bicep, calf, and thigh. Where this was not possible, only the thigh or the bicep was used. The mean error between the two methods was .86 mmHg and the average standard deviation was 2.9 mmHg.Although the measurement of blood pressure in m a l l infants remains more difficult than similar measurements in adults, it was found that with appropriate precautions, accurate results could be achieved over a wide rsnge.of pressures and physiological states. Increased survival of high-risk infants (HRI) born in tertiary care centers has led to the concept that in utero transportation of the HRI is superior to postpartum infant transportation. We evaluated this concept by comparison of 40 infants transported in utero (IUT) with 40 infants transported in the first postpartum day (PPT). Infants were selected by comparing all IUT with the next consecutive admission transported from the same town or an equal distance (+Somi). Infants were then matched for gestational age (+2wk), birth weight (+100gm), and primary neonatal disease. Transport mortalities and other features of the two groups were then carefully analyzed for significance. THE VALUE OF CONTINUOUS POSITIVE AIRWAY PRESSURE IN 1016The IUT were no different from the PPT in number of mothers with >1 risk factor, toxemia, diabetes, or multiple births. More of the PPT were preterm (p<.05) and more IUT suffered premature rupture of membranes (p<.005). No differences were found in Apgars pH, TSP, serum glucose, or primary neonatal disease. Neither group suffered significant hypothermia. 37 infants required ventilation but no differences existed in peak ambient oxygen or end expiratory pressure requirements. Mean age of PPT at admission was 7.7 hours, and mean transport distance was 100 mi. Transport mortality was 12%, 10%. for IUT, PPT, respectively. Survival time for infants expiring in the first month and hospitalization time for neonatal survivors were similar. This study suggests that early PPT may be as valuable as IUT for the high-risk newborn. ACUTE SUDDEN HYPERTENSION IN THE NEWBORN PERIOD. 101s Ekkehard W. Reimold. Univ. of Texas, Southwestern Med. School, Dept. of Pediat., Dallas, Texas. After an initial normotensive period the blood pressure rose in 3 infants at the age of 6 days, 8 days and 4 weeks to 180-230 mmHg. In each case an umbilical artery catheter had been inserted be...