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
Neurologic 4
Coarctation of aorta
Congenital adrenal
Wilms’ tumor
Renal artery stenosis
Elevated intracranial
Mid-aortic coarctation
pressure (intracranial
Postclosure of
Gordon syndrome
Vitamin D intoxication
abdominal wall defect
Congenital rubella syndrome
Maternal drug abuse
hydrocephalus, etc.)
Acute tubular necrosis
(cocaine, heroin)
– BP is low at birth. It increases with age, by Selected reading
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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