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• W2056039029 abstract "In a systematic review, Susannah Fleming and colleagues (March 19, p 1011)1Fleming S Thompson M Stevens R et al.Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies.Lancet. 2011; 377: 1011-1018Summary Full Text Full Text PDF PubMed Scopus (661) Google Scholar derived evidence-based centile charts for heart rate and respiratory rate in children, compared these with reference ranges published in existing paediatric resuscitation guidelines, and found striking disagreement. Their study provides robust data for updating resuscitation guidelines. Nevertheless it would have been even more useful if blood pressure had been included in their investigation.Fleming and colleagues' summary of included studies (webappendix pp 8–11) shows that blood pressure measurements were reported in at least 15 papers. With appropriate search strategies, further studies could have been identified, and similar methods could have created centile charts for blood pressure. Surprisingly, blood pressure was mentioned neither in Fleming and colleagues' discussion of reference ranges nor in the accompanying Comment by Rosalind Smyth.2Smyth RL Lessons from normal heart and respiratory rates in children.Lancet. 2011; 377: 974-975Summary Full Text Full Text PDF Scopus (6) Google ScholarIn a cross-sectional study of more than 1000 healthy Chinese children aged 1–12 years in a community setting, we derived centile curves for blood pressure, heart rate, and respiratory rate and compared these with the Advanced Paediatric Life Support (APLS) reference ranges.3Chan SS Cattermole GN Mak PS Leung MP Graham CA Rainer TH Validation of the APLS age-based vital signs reference ranges in a Chinese population.Resuscitation. 2011; 82: 891-895Summary Full Text Full Text PDF Scopus (5) Google Scholar We found that, for children aged 2–12 years, the mean value for blood pressure was significantly higher than APLS mean values, whereas the mean values for heart rate and respiratory rate were significantly lower. Under published APLS ranges, 55·9%, 34·1%, and 55·7% of our study participants' blood pressure, heart rate, and respiratory rate, respectively, would be wrongly classified as abnormal.More detailed studies are urgently needed to establish reliable blood pressure reference ranges applicable to resuscitation in children.We declare that we have no conflicts of interest. In a systematic review, Susannah Fleming and colleagues (March 19, p 1011)1Fleming S Thompson M Stevens R et al.Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies.Lancet. 2011; 377: 1011-1018Summary Full Text Full Text PDF PubMed Scopus (661) Google Scholar derived evidence-based centile charts for heart rate and respiratory rate in children, compared these with reference ranges published in existing paediatric resuscitation guidelines, and found striking disagreement. Their study provides robust data for updating resuscitation guidelines. Nevertheless it would have been even more useful if blood pressure had been included in their investigation. Fleming and colleagues' summary of included studies (webappendix pp 8–11) shows that blood pressure measurements were reported in at least 15 papers. With appropriate search strategies, further studies could have been identified, and similar methods could have created centile charts for blood pressure. Surprisingly, blood pressure was mentioned neither in Fleming and colleagues' discussion of reference ranges nor in the accompanying Comment by Rosalind Smyth.2Smyth RL Lessons from normal heart and respiratory rates in children.Lancet. 2011; 377: 974-975Summary Full Text Full Text PDF Scopus (6) Google Scholar In a cross-sectional study of more than 1000 healthy Chinese children aged 1–12 years in a community setting, we derived centile curves for blood pressure, heart rate, and respiratory rate and compared these with the Advanced Paediatric Life Support (APLS) reference ranges.3Chan SS Cattermole GN Mak PS Leung MP Graham CA Rainer TH Validation of the APLS age-based vital signs reference ranges in a Chinese population.Resuscitation. 2011; 82: 891-895Summary Full Text Full Text PDF Scopus (5) Google Scholar We found that, for children aged 2–12 years, the mean value for blood pressure was significantly higher than APLS mean values, whereas the mean values for heart rate and respiratory rate were significantly lower. Under published APLS ranges, 55·9%, 34·1%, and 55·7% of our study participants' blood pressure, heart rate, and respiratory rate, respectively, would be wrongly classified as abnormal. More detailed studies are urgently needed to establish reliable blood pressure reference ranges applicable to resuscitation in children. We declare that we have no conflicts of interest. Normal ranges of blood pressure in paediatric resuscitation guidelines – Authors' replyStewart Chan and colleagues suggest that it would have been useful to have included data on blood pressure in our systematic review of heart rate and breathing rate in children. Our search strategy was not designed to identify studies of blood pressure in children, although we did identify some incidentally since in some cases an automated blood pressure monitor had been used to measure heart rate.1 Full-Text PDF" @default.
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• W2056039029 title "Normal ranges of blood pressure in paediatric resuscitation guidelines" @default.
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• W2056039029 doi "https://doi.org/10.1016/s0140-6736(11)61288-9" @default.
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