Epidemiology and Management of Severe Symptomatic Neonatal Hypertension

Abstract

Symptomatic neonatal hypertension, defined as a mean arterial blood pressure (MAP) greater than 70 mm Hg for 3 separate determinations, was observed in 2% of all admissions (20 of 988) to the intensive and intermediate care nurseries. Evidence of renal dysfunction occurred in 85% of these infants, including increased plasma renin, abnormal renal scintiscans, and pathologic evidence of renal vascular embolism or thrombus in 13 of 20. Cardiac complications were present in 55% of affected patients, and features of hypertensive retinopathy were noted in 53% of those examined. Medical management during the neonatal period successfully controlled hypertension in all infants. Higher than usual doses of three or more antihypertensive medications were necessary in 15 of 18 treated patients. The infants requiring these high doses did not develop adverse side effects. In light of the fact that 80% of our affected patients had indwelling umbilical arterial catheters whose tips were in the thoracic aorta, the possible role of catheter management, position, or placement in the pathogenesis of this disorder is suggested.

Neonatal arterial hypertension in nephro-urological malformations in a tertiary care hospital

“…This series selection is to our knowledge unique in the literature. Skalina et al, 11 Buchi and Siegler 12 and Singh et al 13 had already pointed out in their series that laboratory findings of renal disease were risk factors for the diagnosis of neonatal hypertension. At the time of SAH diagnosis, 2/15 patients (13%) were in dialytic chronic renal failure and 2/15 (13%) patients presented initial and discharge serum creatinine levels above reference range values for gestational and chronological age, 14 which shows early nephron loss.…”

“…Neonatal malformations VV Lanzarini et al utilization of this equipment in pediatric intensive care units and the scant but important neonatal hypertension literature that was based on this kind of noninvasive BP measurement, 3,11,13,[21][22][23][24] oscillometric normative levels should be developed with the more recently available equipment after validation for use in the neonatal period.…”

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

“…The incidence of AH in neonates is approximately 0.2-0.3% [125,126], but it is much higher (0.81-9%) in premature infants and in the presence of additional risk factors (umbilical vessel catheterization, patent ductus arteriosus, intraventricular haemorrhage) and associated diseases (40% in neonates with chronic bronchopulmonary disease). Neonatal hypertension is a secondary nature and is related mainly to renal pathology, most commonly renovascular diseases, but iatrogenic factors are also of major importance [127].…”

“…Indications for BP measurement and investigations for hypertension concern preterm neonates born with concomitant congenital malformations and diseases associated with hypertension and newborns requiring hospitalization. It is recommended to perform BP measurements in appropriate www.ah.viamedica.pl [126] conditions and using the technique described in Table XVIII [129][130][131][132][133][134][135]. In neonates, infants and young children, auscultatory measurement is not recommended due to technical difficulties and a high prevalence of the white coat effect compared to automatic measurement.…”

Neonatal hypertension – a long-term pilot follow-up study

“…Among infants admitted to an NICU, the incidence ranges 0.7%-3%. [5][6][7][8] In one retrospective Australian study of 2572 newborn infants, including patients admitted to the NICU, the incidence of HTN was 1.3%. 8 Most cases of neonatal HTN are of renal origin, which includes mainly renovascular and renal parenchymal diseases.…”