Neonatal hypertension

1/16/2019
Presentation by- Dr Prince Pareek
Moderator- Dr Pradeep Suryavanshi 1
“Neonatologists diagnose and treat hypotension”
most days of their lives, but rarely diagnose
hypertension in the newborn baby.

Outline
 Physiology of blood pressure
 Introduction to neonatal hypertension
 Incidence & definition
 Causes & presentation
 Evaluation
 Treatment & Prognosis
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Questions to be answered
 What is the proper way of obtaining BP in a neonate?
 Does the device used in getting the BP matters?
 What are the common causes of Hypertension among
the neonates?
8/30/2019 3

 What are the “RED FLAGS” in history and physical
examination that points to neonatal hypertension?
 What initial laboratory studies are important?
 Who should receive treatment ?
 How do we choose a suitable agent?
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 Are there any medications to avoid?
 Long term outcome and prognosis depend on which
factors?
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Blood pressure is the force that blood exerts upon the walls of the blood vessels or
chambers of the heart.
PP= SBP-DBP
MBP= DBP + SBP-DBP/3

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1. Cardiac output CO= HR X SV
BP= CO X TPR
TPR is determined by:
1. Diameter of blood vessel
2. Blood viscosity
2. Elasticity of blood vessels
3. Blood volume

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Short-term mechanism
A. Baroreceptor reflex
B. Chemoreceptor reflex
C. CNS ischemic response
D. Atrial reflexes

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Tissue ischemia - ↓ oxygen, ↑ H⁺ and ↑ carbon dioxide
Stimulates peripheral chemoreceptors (carotid and aortic bodies)
Stimulation of VMC and respiratory center
Rise in blood pressure, heart rate, rate and depth of respiration

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Stimulate VMC
Activation of sympathetic nervous system increases heart rate, cardiac
output, and blood pressure
“Cushing's Reflex”

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Intermediate-term mechanism
A. Capillary fluid shift
B. Stress relaxation and reverse stress relaxation

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Shift of capillary fluid to the extracellular space whenever the blood
pressure rises
Leads to a decrease in blood volume and blood pressure

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accommodating extra blood by
relaxation of arterial wall
arterial contraction due to fall
in blood volume
stress relaxation reverse stress relaxation

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Long-term mechanism:
A. Renin-angiotensin-aldosterone mechanism
B. Antidiuretic hormone

Invasive BP monitoring
 Gold standard
 Advantages-
 allows beat-to-beat pressure measurement
 arterial blood sampling can be performed
 Commonly used vessels- umbilical and radial artery
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column of fluid
Connect arterial system to a pressure transducer
Convert arterial pulse into an electrical signal
processed via a microprocessor
Amplified & displayed as the blood pressure waveform
How it works?

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 Commonest sources of error-
 Improper height adjustment of IBP set
 Small air bubble in the system
 Complications-
 Thrombo-embolism
 Vasospasm
 Thrombosis
 Haemorrhage
 Infection
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 Precautions-
 Haematoma & peripheral nerve injury
 Observe for arterial line patency by monitoring hourly color,
temperature and perfusion of digits and limbs
 Heparinized saline infusion should be changed every 24 hours and
the infusion line every third day
 Blanching, redness, cyanosis and changes in temperature must be
quickly reported
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Non-invasive BP monitoring
 Oscillometric method-
 Most common method
 Principle- blood pulsing through an artery creates
oscillations of the vessel wall. The pulsations are
transmitted to the cuff and sensed by a transducer
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 Meyer et al observed good agreement between the two methods in
preterm neonates assessed on day 1 of life.
 Tacki et al reported good agreement between these two methods of BP
measurements in preterm neonates in their first weeks of life if the
neonates did not have low BP measurements.
8/30/2019
2. Meyer S, Sander J, Gra¨ber S, Gottschling S, Gortner L. Agreement of invasive versus non-invasive blood pressure in
preterm neonates is not dependent on birth weight or gestational age. J Paediatr Child Health 2010; 46: 249–54.
31
1. Takci S, Yigit S, Korkmaz A, Yurdak€ok M. Comparison between oscillometric and invasive blood pressure
measurements in critically ill premature infants. Acta Paediatr 2012;101:132–5.

 Dannevig et al and Diprose et al found that oscillometric method
overestimated the BP and showed poor agreement between these two
methods of BP measurements
 Lalan S et al observed oscillometric BP measurements are not
equivalent to the intra-arterial BP in ill neonates
8/30/2019
2.Dannevig I, Dale HC, Liestøl K, Lindemann R. Blood pressure in the neonate: three non-invasive oscillometric
pressure monitors compared with invasively measured blood pressure. Acta Paediatr 2005; 94: 191–6.
32
1. Lalan S, Blowey D. Comparison between oscillometric and intra-arterial blood pressure measurements in ill
preterm and full-term neonates. J Am Soc Hypertens. 2014 Jan;8(1):36-44.
3. Diprose GK, Evans DH, Archer LN, Levene MI. Dinamap fails to detect hypotension in very low birthweight
infants. Arch Dis Child 1986;61:771–7.

Introduction of neonatal
hypertension
 Advances in technology and practice of neonatology have led to an increased
awareness of hypertension in neonates
 Blood pressure in neonates depends on various factors, including gestational age,
postnatal age and birth weight
 Hypertension is unusual in otherwise healthy term infants and routine BP
measurement is not advocated
 Hypertension is much more common in infants with BPD, PDA or those with
indwelling UACs
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Incidence
 0.2-3%
8/30/2019
1. Flynn JT. Hypertension in the neonatal period. Curr Opin Pediatr. 2012 Apr;24(2):197-204.
34
2. Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol. 2012
Jan;27(1):17-32.

Incidence
 Enrolled 2162 neonates from 24 centres worldwide
 Hypertension was documented in 1.8%
 3.7% had undiagnosed hypertension
 diastolic and systolic blood pressure recordings >95th percentile for
gestational age.
3. Kraut EJ, Boohaker LJ, Askenazi DJ, Fletcher J, Kent AL; Neonatal Kidney Collaborative (NKC). Incidence of neonatal
hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in
Neonates-AWAKEN]. Pediatr Res. 2018 Aug;84(2):279-289.
8/30/2019 35

Definition
 Systolic and/or diastolic BP ≥95% (> 2 SD above the
mean)
 Stage 1 : BP 95 to <99% + 5 mm Hg
 Stage 2 : BP ≥99% + 5 mm Hg
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1. Watkinson M. Hypertension in the newborn baby. Archives of Disease in Childhood Fetal and Neonatal Edition.
2002;86(2):F78-F81.
.
2. National High Blood Pressure Education Program Working Group on High Blood Pressure in C, Adolescents. The
fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.
Pediatrics. 2004;114(2 Suppl 4th Report):555-76.

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Zubrow AB, Hulman S, Kushner H, Falkner B (1995) Determinants of blood pressure in infants admitted to neonatal intensive
care units: A prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol Off J Calif Perinat
Assoc 15: 470-479.

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Zubrow AB, Hulman S, Kushner H, Falkner B (1995) Determinants of blood pressure in infants admitted to neonatal intensive
care units: A prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol Off J Calif Perinat
Assoc 15: 470-479.

 Zubrow et al studied 695 infant in 14 NICUs
 Observed-
 Day 1, Systolic and Diastolic BP correlate strongly with
BW and GA
 First 5 days after birth
 Systolic increase by 2.2-2.7 mm Hg/day
 Diastolic increase by 1.6-2 mm Hg/day regardless of BW and
GA
 After 5th Day – more gradual increments
 Systolic – 0.24-0.27 mm Hg/day
 Diastolic – 0 – 0.15 mm Hg/day
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Samanta M, Mondal R, Ray S, Sabui T, Hazra A, et al. (2015) Normative blood pressure data for Indian neonates.
Indian Pediatr 52: 669-673.
A prospective observational study was conducted on healthy term and
preterm newborns delivered in a teaching hospital from September 2013 to
April 2014 in Kolkata, India.
Multichannel monitor (Larson and Turbo make; Star 55) was used to
determine systolic BP (SBP), diastolic BP (DBP), and mean arterial
pressure (MAP) by oscillometric method.
From the 2055 neonates screened, 1617 were analysed.

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Parameter Status Mean (SD) 5th 10th 25th 50th 75th 90th 95th 99th
Day 4-SBP Term 74 (7) 62 64 68 74 78 82 84 88
Preterm 62 (7) 46 54 58 62 66 72 74 78
DBP Term 54 (7) 42 43 50 54 60 62 62 66
Preterm 43 (6) 32 34 40 42 47 50 52 56
MAP Term 61 (6) 48 50 56 60 66 68 70 73
Preterm 49 (6) 38 41 46 48 53 56 58 62
Day 7-SBP Term 78 (6) 66 70 74 78 82 84 87 90
Preterm 66 (7) 54 58 62 66 70 74 77 82
DBP Term 58 (6) 50 50 55 60 62 64 66 72
Preterm 47 (6) 38 40 42 48 50 55 56 62
MAP Term 64 (5) 54 56 61 66 68 70 72 75
Preterm 53 (5) 44 46 50 54 57 60 63 66
Day 14-SBP Term 81 (5) 72 74 78 82 84 88 90 90
Preterm 70 (7) 60 61 66 70 75 78 80 85
DBP Term 61 (6) 52 54 60 60 64 68 70 74
Preterm 51 (6) 40 42 50 50 55 60 60 62
MAP Term 68 (5) 58 61 66 68 71 74 75 79
Preterm 58 (6) 47 49 56 57 61 66 66 68
SBP = Systolic blood pressure; DBP = Diastolic blood pressure; MAP = Mean arterial pressure.
Oscillometric Neonatal Blood Pressure (mmHg) Stratified by Gestational Status (N=1617)

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Week BP Day-4 Day-7 Day-14
Percentile SBP DBP MAP SBP DBP MAP SBP DBP MAP
32 10 50 32 41 55 40 45 60 40 48
50 58 40 46 62 42 50 68 50 56
90 68 50 54 72 52 59 75 55 61
95 77 50 56 74 55 59 75 56 62
99 78 56 58 74 56 61 76 58 64
33 10 54 35 43 61 40 48 62 42 49
50 64 42 48 68 45 52 68 50 56
90 74 51 56 74 52 59 78 58 64
95 77 52 56 78 55 60 78 58 64
99 82 58 66 80 60 66 82 58 66
34 10 55 30 41 60 40 48 62 44 50
50 62 42 48 65 48 53 68 50 56
90 70 48 53 72 52 58 76 55 62
95 78 50 56 74 54 59 78 58 64
99 78 55 61 78 58 64 82 60 67
Oscillometric Neonatal Blood Pressure Recordings Stratified by Gestational Age (Weeks) at Birth

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35 10 59 38 45 62 42 50 68 48 55
50 64 44 50 68 50 56 73 52 59
90 69 51 56 74 54 60 78 58 64
95 72 52 56 76 55 61 78 60 66
99 74 58 62 78 62 66 78 62 67
36 10 55 40 46 62 42 50 65 50 56
50 66 44 51 68 50 57 74 55 60
90 75 52 59 78 56 63 80 62 66
95 76 55 61 78 58 64 82 62 68
99 77 55 62 82 62 66 86 65 68
37 10 62 42 49 68 50 56 74 52 60
50 72 52 58 76 56 62 78 60 66
90 80 60 66 82 62 68 88 62 69
95 82 62 66 85 62 68 88 68 73
99 84 64 70 87 68 74 90 72 77

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38 10 64 47 53 70 52 58 74 54 61
50 73 53 60 78 58 65 80 60 67
90 79 62 66 84 62 69 86 66 72
95 82 62 67 84 64 70 88 68 74
99 84 66 72 88 68 74 90 72 76
39 10 66 44 51 70 50 58 74 55 61
50 76 54 61 78 60 66 82 60 68
90 82 62 67 84 62 69 88 68 73
95 84 62 68 86 66 72 90 70 75
99 88 66 72 90 72 74 92 75 80
40 10 68 50 56 72 53 60 78 58 64
50 77 58 64 82 60 68 84 64 70
90 84 62 70 87 66 72 90 70 75
95 87 64 70 88 68 74 90 70 76
99 88 68 74 90 72 77 90 76 81

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Dionne JM, Abitbol CL, Flynn JT (2012) Hypertension in infancy: Diagnosis, management and outcome. Pediatr
Nephrol Berl Ger 27: 17-32.
Estimated BP values after 2 weeks of age in infants from 26 to 44 weeks
postconceptional age

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Post
conceptional age
50th percentile 95th percentile 99th percentile
44 weeks
SBP 88 105 110
DBP 50 68 73
MBP 63 80 42
42 weeks
SBP 85 98 102
DBP 50 65 70
MBP 62 76 81
40 weeks
SBP 80 95 100
DBP 50 65 70
MBP 60 75 80
38 weeks
SBP 77 92 97
DBP 50 65 70
MBP 59 74 79

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Post
conceptional age
36 weeks
SBP 72 87 92
DBP 50 65 70
MBP 57 72 71
34 weeks
SBP 70 85 90
DBP 40 55 60
MBP 50 65 70
32 weeks
SBP 68 83 88
DBP 40 55 60
MBP 48 62 69
30 weeks
SBP 65 80 85
DBP 40 55 60
MBP 48 65 68

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Post
conceptional age
28 weeks
SBP 60 75 80
DBP 38 50 54
MBP 45 58 63
26 weeks
SBP 55 72 77
DBP 30 50 56
MBP 38 57 63

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Age-specific percentiles for blood pressure in boys (a) and girls (b) from birth to 12
months of age. From the Task Force on Blood Pressure Control in Children

Standard protocol for BP measurement in
neonates
 BP measured by oscillometric device
 BP measurement preferentially preformed 1.5 hours
after a feed or medical intervention
 Infant lying in a prone or supine position
 Use of an appropriate sized BP cuff
8/30/2019 51
Nwankwo MU, Lorenz JM, Gardiner JC. A standard protocol for blood pressure measurement in the newborn.
Pediatrics. 1997 Jun;99(6):E10.

Standard protocol for BP measurement in
neonates
 BP measurement performed in the right upper arm
 After cuff placement , blood pressure should be
measured several minutes after the infant has settled
into a calm state
 BP measurement performed while the infant is asleep
or in a quiet awake state
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Causes of Neonatal Hypertension
1. Renal
•Renal artery thrombosis (particularly if a UAC has been in place)
•Renal vein thrombosis
•Renal artery stenosis or compression (e.g. from tumour, post tight abdominal
wall closure)
•Parenchymal renal disease – congenital or acquired
•Renal hypoplasia
•Severely obstructed urinary tract
•Idiopathic arterial calcification
•Haemolytic uraemic syndrome
•VLBW babies – low renal mass / impaired nephrogenesis / nephrocalcinosis

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2. Cardiovascular
•Coarctation of the aorta
•Interrupted aortic arch
•Distal aortic thrombosis (particularly if a UAC has been in place)
•Fluid overload
3. Endocrine
•Congenital Adrenal Hyperplasia
•Hyperaldosteronism
•Hyperthyroidism
•Adrenal haemorrhage
•Hypercalcaemia

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4. Chronic Lung Disease
•May manifest late after discharge from NICU
5. Medications
•Dexamethasone
•Adrenergic agents
•Bronchodilators
•Caffeine
•Neonatal TPN through salt and water overload or hypercalcaemia

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6. Neurological
•Pain
•Seizures
•Intracranial hypertension
•Drug Withdrawal
•HIE
7. Miscellaneous / multifactorial
•ECMO

Clinical features
 Apnea
 Tachypnea
 Hypertonia
 Tachycardia
 Cyanosis
 Mottling
 Lethargy
 Vomiting
 Excessive irritability
 Seizures
 Recurrent feed intolerance
 Abdominal distension
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 Hematuria
 Failure to thrive
 Congestive cardiac failure
 Cerebral hemorrhage
 Cardiogenic shock
 Hypertensive retinopathy
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Clinical features

Evaluation
 History-
 Prenatal history- drug abuse by mother, maternal
diabetes, fetal anomalies on antenatal USG
 Perinatal history- History of delayed cry or passage of
meconium
 Postnatal history- umbilical catheter, medicine,
neurological status of infant during BP measurement,
post-natal course and morbidities in the nursery
8/30/2019 60

Evaluation
 Physical examination-
 BP in lower extremities/non-palpable femoral pulses –
Coarctation of aorta
 Dysmorphic features – CAH/Turner Syndrome
 Flank mass – PUJ obstruction, renal vein thrombosis
 Epigastric bruit – renal artery stenosis
8/30/2019 61

Evaluation
 Physical examination-
 Abdominal distention – obstructive uropathy, PKD,
tumors
 Peripheral thrombi – UAC related HTN
 Tachycardia/flushing/LBW- hyperthyroidism
 Ambiguous genitalia - CAH
8/30/2019 62

Laboratory investigations
 1st line investigations-
 Complete blood count and platelet count
(Thrombocytopenia in renal vein thrombosis)
 Urine complete analysis and culture (Hematuria/renal
cast/infection)
 Urine protein: creatinine ratio & Urine albumin: creatinine
ratio
 S. electrolytes (Hypokalemia/hyperkalemia/hypercalcemia)
8/30/2019 63

 Serum creatinine
 Blood urea nitrogen
 Arterial blood gas analysis
 Coagulation profile (Renal artery/vein thrombosis)
 D-dimer assay (Renal artery/vein thrombosis)
 Chest x-ray (Cardiomegaly)
8/30/2019 64

 Renal Doppler and ultrasound (Renal artery/vein-
thrombosis/obstruction/stenosis)
 Echocardiogram (Structural/functional anomalies)
 Cardiac enzymes (Cardiac injury)
 Head ultrasound (Intraventricular/ cerebral hemorrhage)
8/30/2019
Sharma D, Pandita A, Shastri S (2014) Neonatal hypertension: An underdiagnosed condition, a review
article. Curr Hypertens Rev 10: 205-212.
65

 2nd line investigations-
 Thyroid Hormone (Hyperthyroidism)
 Urine VMA/HVA (Vanillylmandelic acid/homovanillic
acid) (pheochromocytoma and neuroblastoma)
 Plasma renin activity (Renal artery stenosis/thrombosis)
 S. Aldosterone & S. cortisol (Cushing syndrome
/congenital adrenal hyperplasia)
8/30/2019 66

 Urinary 17-hydroxysteroid, 17-ketosteroid (Cushing
syndrome/congenital adrenal hyperplasia)
 Abdominal/pelvic ultrasound (Mass or malformations)
 Urine for toxicology screening (Suspicion of mother
drug addict)
 Voiding cystoureterogram (VCUG) (Hydronephrosis)
 Aortography
8/30/2019 67

 Renal angiography (Renal artery stenosis/thrombosis)
 Nuclear scan DTPA /MAG-3/DMSA (Renal infarct
/assessment of renal function)
 MRI abdomen (Abdominal mass)
 I131 MIBG (Pheochromocytoma)
8/30/2019 68
Sharma D, Pandita A, Shastri S (2014) Neonatal hypertension: An underdiagnosed condition, a review
article. Curr Hypertens Rev 10: 205-212.

Treatment
 First, do no harm!
 Optimum management remains uncertain due to lack
of evidence regarding long term outcome
 Clinical trials evaluating the safety & efficacy of
antihypertensive agents in neonates still lacking
8/30/2019 70

Treatment
 Asymptomatic/Mild Hypertension (Systolic 95th to <99th%)
 observation
 resolves in time
 Moderate to Severe (Systolic ≥99th %)
 antihypertensive therapy
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Treatment
 Address the correctable causes-
 Treat pain
 Correct volume overload
 Wean inotropic infusion
 Remove umbilical catheters
 Wean or stop drugs causing hypertension
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Treatment
 Choice of agent- depends on the clinical situation
 Hypertensive emergencies-
 Cardiopulmonary failure
 Acute neurological dysfunction
 Acute kidney injury
 Drug of choice- Continuous IV infusion- nicardipine
8/30/2019
Fanaroff and martin’s- neonatal perinatal medicine 10th edition
73

Treatment
 Benefits of continuous infusion-
 Intermittent agent cause fluctuation in BP
 Increase risk of cerebral ischemia & hemorrhage in
preterms with sudden drop in BP
 Rate of infusion can be controlled
 Other agents for IV infusion- labetalol, esmolol,
nitroprusside
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Treatment
 Goal of therapy-
 Gradual decrease in BP to minimize injury to the brain,
heart & kidneys
 BP should not be lowered below 95th percentile for at
least 24-48 hrs to avoid the possibility cerebral and optic
disc ischemia
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Treatment
 Less severe hypertension not ready for oral
 Intermittent IV agents
 Hydralazine
 Labetalol
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Treatment
 Infant ready to be weaned from iv/ready for oral
 Oral antihypertensive agents
 Calcium channel blockers
 ACE inhibitors
 Diuretic
 β Blocker
8/30/2019 77

Treatment
 Calcium channel blockers (isradipine, amlodipine)
 1st choice agents
 Mechanism of action- inhibit calcium mediated slow
channel component of action potential in smooth/
cardiac muscle
 Vasodilatation
 Negative chronotropic, inotropic & dromotropic action on heart
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Mechanism of action on calcium channel blockers
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Treatment
 Adverse effects-
 Tachycardia
 Hypotension
 Flushing
 Gastro-esophageal reflux
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Treatment
 Nicardipine-
 Class- dihydropyridine
 Highly vaso-selective
 Short half life : 10-15 minutes
 IV infusion 0.5 mcg/kg/min if normal BP not achieved
in 15 minutes increase infusion to max of 3 mcg/kg/min
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Treatment
 Amlodipine-
 Oral agent, slow absorption
 Peak levels- 6-9 hrs
 Large volume of distribution and long half life
 Less side effects
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Treatment
 ACE inhibitors- captopril, enalapril
 Mechanism of action- inhibit conversion of angiotensin
I to angiotensin II
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Mechanism of action of ACE inhibitors
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Treatment
 Captopril-
 Good oral absorption
 Half life- 2hrs
 Duration of action- 6-12 hrs
 Excretion- renal
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Treatment
 Captopril-
 Adverse effects-
 Hypotension, hyperkalemia, rashes, AKI in patients with B/L
renal artery stenosis
 Not recommended in infants <44 weeks postconceptional age
as it can impair renal maturation
 Urine output, S. creatinine and potassium monitoring is
required
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Treatment
 Diuretics-
 Act by reducing extracellular and plasma volume
 used in infants with chronic lung disease
 E.g., furosemide, chlorothiazide
8/30/2019 87

Treatment
 β blockers
 Labetalol-
 both α + β blocker
 Has rapid onset of action
 Reduces total peripheral resistance
 Effective in hypertensive emergencies
 β blockers should be avoided in patients with BPD
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Treatment
 β blockers
 Esmolol-
 Ultra short acting
 β1 selective
 Half life- 10 min
 Rapid onset of action
 Used in hypertensive emergencies
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Drug Dose Interval Action
Esmolol 100-500mcg/kg/min Continuous
infusion
Beta blocker
Hydralazine 0.15-0.6 mg/kg/dose Every 4-6 hrs Vasodilator
Labetalol 0.2-1.0 mg/kg/dose
0.25-3.0 mg/kg/hr
Every 4-6 hrs
Continuous
infusion
Alpha & beta
blocker
Nicardipine 1-4 mcg/kg/min Continuous
infusion
Calcium channel
blocker
Sodium
nitroprusside
0.5-10.0 mcg/kg/min Continuous
infusion
vasodilator
IV Antihypertensive medications

8/30/2019 92
Drug Dose Interval Class
Amlodipine 0.05-0.3
mg/kg/dose
OD to BD CCB
Captopril 0.01-0.5
mg/kg/dose
TDS ACE inhibitors
Chlorothiazide 5-15 mg/kg/dose BD Thiazides
Clonidine 5-10 mcg/kg/day TDS Alpha agonist
Enalapril 0.04-0.3
mg/kg/dose
OD to BD ACE inhibitors
Oral Antihypertensive medications

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Oral Antihypertensive medications
Drug Dose Interval Class
Furosemide 1-2 mg/kg/dose OD to TDS Loop diuretic
Isradipine 0.05-0.15 mg/kg/dose QID CCB
Labetalol 0.05-1.0 mg/kg/dose BD to TDS Alpha & beta
blockers
Propranolol 0.5-1.0 mg/kg/dose TDS Beta blockers

Prognosis
 Most neonates with hypertension caused by UAC or
BPD resolves with time & infants do not require
antihypertensive medications beyond 12 months of age
 Infants with elevated BP related to PCKD, RVT or CKD
will most likely to have hypertension that persists into
childhood
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Prognosis
 Seliem WA et al observed in their study that 41% of
neonates discharged on antihypertensive medications
and only 15% of them receiving at 3-6 months of age
 Long term monitoring of children with a history of
neonatal hypertension is necessary, as they may be at
risk for development of late onset hypertension and
chronic kidney disease
8/30/2019
Seliem WA, Falk MC, Shadbolt B, et al. Antenatal & postnatal risk factors for neonatal hypertension & infant follow
up. Pediatr Nephrol. 2007;22:2081-2087.
95

Neonatal hypertension

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