Hypertension in infancy: diagnosis, management and outcome

Abstract

Advances in the ability to identify, evaluate, and care for infants with hypertension, coupled with advances in the practice of Neonatology, have led to an increased awareness of hypertension in modern neonatal intensive care units. This review will present updated data on blood pressure values in neonates, with a focus on the changes that occur over the first days and weeks of life in both term and preterm infants. Optimal blood pressure measurement techniques as well as the differential diagnosis of hypertension in the neonate and older infants will be discussed. Recommendations for the optimal immediate and long-term evaluation and treatment, including potential treatment parameters, will be presented. We will also review additional information on outcome that has become available over the past decade.

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

“…Despite many methodological reservations and the fact that currently almost exclusively oscillometric measurements are used, the reference values given in the 2 nd Report are practical and easy to apply. Table XVII shows a compilation of previous reference BP values that summarizes the 95 th and 99 th SBP, DBP, and MAP percentiles in 2-week-old neonates, depending on gestational age [129].…”

“…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.…”

Hypertension in Neonates: Need for Future Research

“…The occurrence of NHT in different studies is 1%-2.5% in NICU admitted neonates [5,6]. In pediatric population the prevalence of hypertension is around 3% and is often indicative of an underlying disease process [7].…”

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Drug ClassName of drug and Recommended dose

Fast onset of action

Calcium-channel blockersNicardipine (

95th and 99 th percentile) and mild depending upon the value of BP and end-organ dysfunction and treatment will depend upon the severity of presentation ( Figure 6) [3,5,17,22,23].

When is the surgical Intervention needed for neonatal HT?The indications for surgical treatment of NHT are few and includes renal malformations (renal vessels thrombosis/stenosis, polycystic kidney and renal tumors) and cardiovascular malformations like coarctation of aorta [26][27][28][29][30][31].

How is the prognosis of neonate with HT?The prognosis of NHT depends upon the cause of HT i.e. if cause of iatrogenic than the NHT get resolved once the precipitating factor is removed.

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“…th and 99 th percentile) and mild depending upon the value of BP and end-organ dysfunction and treatment will depend upon the severity of presentation ( Figure 6) [3,5,17,22,23].…”