Neonatal hypertension: cases, causes, and clinical approach

Abstract

Neonatal hypertension is increasingly recognized as dramatic improvements in neonatal intensive care, advancements in our understanding of neonatal physiology, and implementation of new therapies have led to improved survival of premature infants. A variety of factors appear to be important in determining blood pressure in neonates, including gestational age, birth weight, and postmenstrual age. Normative data on neonatal blood pressure values remain limited. The cause of hypertension in an affected neonate is often identified with careful diagnostic evaluation, with the most common causes being umbilical catheter-associated thrombosis, renal parenchymal disease, and chronic lung disease. Clinical expertise may need to be relied upon to decide the best approach to treatment in such patients, as data on the use of antihypertensive medications in this age group are extremely limited. Available data suggest that long-term outcomes are usually good, with resolution of hypertension in most infants. In this review, we will take a case-based approach to illustrate these concepts and to point out important evidence gaps that need to be addressed so that management of neonatal hypertension may be improved.

Keywords: Antihypertensive therapy; Chronic lung disease; Kidney disease; Neonate; Prematurity.

Figure 1

Linear regression of systolic (a), diastolic (b), and mean blood pressure (c) according to birth weight (1) and gestational age (2) on day 1 of life, with 95% confidence limits (upper and lower solid lines). Reprinted with permission from Pejovic et al [10].

Figure 2

Effect of infant state on blood pressure (BP) (black bars, systolic BP; grey bars, diastolic BP). Data adapted from Satoh et al [52].