Neonatal hypertension /0
Dysmorphic features, heart murmur, cyanosis, dyspnea/tachypnea,
Medical procedures (e.g. umbilical artery catheterization)
Serum: CBC, BUN, creatinine, electrolytes, calcium
Serum: PRA, cortisol, thyroid studies, aldosterone
Imaging: chest X-ray, echocardiogram renal sonogram and Doppler study
Imaging: abdominal/pelvic sonogram, voiding cystourethrography, CT angiogram, nuclear scan (DTPA/Mag-3/DMSA)
Renovascular 1 Cardio-pulmonary 2 Endocrine Neurologic 4 Miscellaneous Congenital Thromboembolism Coarctation of aorta Congenital adrenal Glucocorticoids Wilms’ tumor PKD (AD, AR) Renal artery stenosis hyperplasia Theophylline Elevated intracranial Mesoblastic Hypercalcemia Mid-aortic coarctation Hyperthyroidism Caffeine pressure (intracranial nephroma Postclosure of Obstructive uropathy Gordon syndrome Vitamin D intoxication hemorrhage, Neuroblastoma abdominal wall defect Acquired Congenital rubella syndrome Maternal drug abuse hydrocephalus, etc.) Acute tubular necrosis (cocaine, heroin) Seizures Cortical necrosis
– BP is low at birth. It increases with age, by
1 mm Hg per day within the period of 3–8 days. It rises
by about 1 mm Hg per week between ages 5 and 6
Brewer ED: Evaluation of hypertension in childhood
weeks. At a later age, systolic BP is around 95 ± 10 mm
diseases; in Avner ED, Harmon WE, Niaudet P (eds):
Hg. Hypertension is a rare condition in the neonate.
Pediatric Nephrology, ed 5. Philadelphia, Lippincott
Neonates with hypertension are at a high risk of devel-
Williams & Wilkins, 2004, pp 1179–1198.
oping cardiorespiratory failure and cerebral distress.
Cordero L, Timan CJ, Waters HH, Sachs LA: Mean
In a neonate or infant, the BP is considered to be
arterial pressures during the fi rst 24 hours of life in
elevated if it is above the 95th percentile for infants of
< or = 600-gram birth weight infants. J Perinatol
similar gestational or postconceptual age and size.
For older infants (1–12 months), hypertension could be
Flynn JT: Neonatal hypertension: diagnosis and
defi ned as blood pressure elevation above the 95th
management. Pediatr Nephrol 2000;14:332–341.
percentile for infants of similar age, size and gender. Friedman AL, Hustead VA: Hypertension in babies
following discharge from a neonatal intensive care
– The actual incidence of hypertension in
unit. Pediatr. Nephrol 1987;1:30–34.
neonates is between 0.2 and 3%. As opposed to older
Lee J, Rajadurai VS, Tan KW: Blood pressure
children in whom hypertension is most commonly
standards for very low birth weight infants during
caused by renal or endocrine disorders, in neonates
the fi rst day of life. Arch Dis Child Fetal Neonatal Ed
the common causes of hypertension are renovascular
disease, cardiac malformations, as well as broncho-
Zubrow AB, Hulman S, Kushmer H, Falkner B: Determinants of blood pressure in infants admitted
to neonatal intensive care units: a prospective
– Umbilical artery catheter is the most com-
multicenter study. J Perinatol 1995;15:470–479.
mon cause of hypertension in neonates. The catheter may lead to thrombus formation. The thrombi may embolize to the kidneys, causing areas of infarction and increased release of renin, which, in turn, elevates blood pressure. RVT is a relatively common cause of hypertension in asphyxiated or hypovolemic infants,
Table. Commonly used drugs for the treatment of neonatal hypertension
infants with coagulopathies, as well as in infants of
– Coarctation of the aorta is the most common
unpredictable, use with caution, may cause
heart malformation that leads to hypertension in neo-
nates. The hypertension in this condition is found in
The etiology of hypertension in BPD is probably
multifactorial and includes prolonged glucocorticoid
– Various drugs may cause hypertension in
must administer q 4 h when given i.v. bolus
neonates, either by direct administration to the sick
neonate (glucocorticoids, theophylline), or due to
maternal drug abuse that leads to hypertension in their infant child (e.g. heroin, cocaine).
heart failure, BPD relative contraindications
– A common cause of hypertension in prema-
ture infants is intracranial hemorrhage.
prolonged (>72 h) use or in renal failure
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No Estudo de Proteção do Coração - Heart Protection Study (HPS), sinvastatina os efeitos do tratamento com sinvastatina durante um período de acompanhamento de 5,3 anos, em média, foram avaliados em Medicamento genérico 20.536 pacientes com ou sem hiperlipidemia e alto risco de even- Lei nº 9.787, de 1999 tos coronarianos, em decorrência de diabetes, antecedentes de acide