Does prematurity prompt blood pressure evaluations at primary care visits?

Background: Prematurity (gestational age (GA) < 37 weeks) is a risk factor for hypertension that should prompt blood pressure (BP) screening at primary care visits of children ages 0-33 months. No studies have described provider adherence to this recommendation or outcomes of these BP screenings. Objectives: To understand the patterns of care related to BP screening of children born prematurely and determine the frequency and outcome of these screenings. Design/Methods: 46 pediatric practices were invited to complete a site review assessing readiness to measure infant BP. A retrospective medical record review was conducted to identify these practices’ patients born prematurely over an 18 month period and who would have been at least 36 months of age at the time of the review. Data reviewed included demographics, birth weight and GA. Visits at ages 0-33 months were reviewed for height, weight, BP, BP interpretation, BP-related diagnoses and comorbidities. BP readings were interpreted by investigators using standard references. Elevated BP was defined as any measurement >90th %ile for age/sex/height. Chi-square test evaluated frequency of BP screening by GA groups and comorbidity status. Results: 26 practices (57%) provided information on BP management at the practice. 5 practices (19%) did not have an infant BP cuff available. Only one practice had a protocol to measure BP in patients born prematurely. We identified 119 children with history of prematurity from 16 participating practices. Children were 56% male, 52% private insurance and most (60%) were born at 32<37 weeks (21% 28<32 weeks; 19% <28 weeks). 27% of children had at least one BP documented before age 33 months.There was no difference in BP screening by child GA group (p=0.922). Among the 32 children with documented BP, 34% had at least one reading elevated; 10/15 elevations were >95th %ile. 4 of 6 children with a kidney-related diagnosis had BP screening performed versus 25% screened among the 113 without such diagnosis (p=0.044). There were 19 children with known history of umbilical catheter use; having this risk factor did not significantly alter screening (p=0.531). Conclusions: Most pediatric providers do not routinely check BP prior to age 3 in patients born prematurely despite having proper equipment available. BP was often elevated when it was measured. New systems are needed to identify and prompt BP screening at primary care visits of children with a history of prematurity.