UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Etiology, clinical features, and diagnosis of neonatal hypertension

Author
Joseph T Flynn, MD, MS
Section Editors
Joseph A Garcia-Prats, MD
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

Hypertension can be detected in 1 to 2.5 percent of all neonates (both term and preterm infants) admitted to neonatal intensive care units (NICUs). The clinician needs to be knowledgeable about normative blood pressure (BP) values, the optimal method to measure BP in newborns, the underlying etiologies, and clinical manifestations, in order to identify and treat neonatal hypertension.

The definition, etiology, clinical features, and diagnostic evaluation of neonatal hypertension will be reviewed here. Treatment of hypertension in infants is discussed separately. (See "Management of hypertension in infants".)

DEFINITION

Hypertension — Neonatal hypertension is defined as persistent systolic and/or diastolic blood pressure (BP) that exceeds the 95th percentile for postmenstrual (sometimes referred to as postconceptional) age (figure 1 and table 1). However, it is challenging to define normal neonatal BP as there is a lack of normative BP in this age group. In addition, there are a number of factors that affect normal BP values during the neonatal period (defined as the first 28 days of life). As a result, it has been difficult to develop a standardized definition of hypertension for clinical use in this age group.

Normal BP — Normal BP in newborns varies with gestational age, postmenstrual age, and birth weight. BP values increase following birth, with greater rates of increase seen in preterm infants compared with term infants.

Useful data on BP in newborns were obtained in a study of 608 newborns admitted to 14 neonatal intensive care units (NICUs) in the Philadelphia area (figure 2 and figure 3) [1]. Systolic BP and diastolic BP were measured by oscillometric device every eight hours for 1 to 99 days after delivery. The following findings were noted:

                          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Aug 12 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol 1995; 15:470.
  2. Pejovic B, Peco-Antic A, Marinkovic-Eric J. Blood pressure in non-critically ill preterm and full-term neonates. Pediatr Nephrol 2007; 22:249.
  3. Nwankwo MU, Lorenz JM, Gardiner JC. A standard protocol for blood pressure measurement in the newborn. Pediatrics 1997; 99:E10.
  4. Batton B, Li L, Newman NS, et al. Evolving blood pressure dynamics for extremely preterm infants. J Perinatol 2014; 34:301.
  5. Kent AL, Kecskes Z, Shadbolt B, Falk MC. Normative blood pressure data in the early neonatal period. Pediatr Nephrol 2007; 22:1335.
  6. Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol 2012; 27:17.
  7. American Academy of Pediatrics Committee on Fetus and Newborn: Routine evaluation of blood pressure, hematocrit, and glucose in newborns. Pediatrics 1993; 92:474.
  8. Skalina ME, Kliegman RM, Fanaroff AA. Epidemiology and management of severe symptomatic neonatal hypertension. Am J Perinatol 1986; 3:235.
  9. Singh HP, Hurley RM, Myers TF. Neonatal hypertension. Incidence and risk factors. Am J Hypertens 1992; 5:51.
  10. Buchi KF, Siegler RL. Hypertension in the first month of life. J Hypertens 1986; 4:525.
  11. Seliem WA, Falk MC, Shadbolt B, Kent AL. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr Nephrol 2007; 22:2081.
  12. Blowey DL, Duda PJ, Stokes P, Hall M. Incidence and treatment of hypertension in the neonatal intensive care unit. J Am Soc Hypertens 2011; 5:478.
  13. Sahu R, Pannu H, Yu R, et al. Systemic hypertension requiring treatment in the neonatal intensive care unit. J Pediatr 2013; 163:84.
  14. MOSS AJ, DUFFIE ER Jr, EMMANOUILIDES G. BLOOD PRESSURE AND VASOMOTOR REFLEXES IN THE NEWBORN INFANT. Pediatrics 1963; 32:175.
  15. Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY. Does radial artery pressure accurately reflect aortic pressure? Chest 1992; 102:1193.
  16. Gevers M, Hack WW, Ree EF, et al. Arterial blood pressure wave forms in radial and posterior tibial arteries in critically ill newborn infants. J Dev Physiol 1993; 19:179.
  17. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114:555.
  18. Park MK, Lee DH. Normative arm and calf blood pressure values in the newborn. Pediatrics 1989; 83:240.
  19. Goetzman BW, Stadalnik RC, Bogren HG, et al. Thrombotic complications of umbilical artery catheters: A clinical and radiographic study. Pediatrics 1975; 56:374.
  20. Seibert JJ, Taylor BJ, Williamson SL, et al. Sonographic detection of neonatal umbilical-artery thrombosis: clinical correlation. AJR Am J Roentgenol 1987; 148:965.
  21. Boo NY, Wong NC, Zulkifli SS, Lye MS. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health 1999; 35:460.
  22. Neal WA, Reynolds JW, Jarvis CW, Williams HJ. Umbilical artery catheterization: demonstration of arterial thrombosis by aortography. Pediatrics 1972; 50:6.
  23. Adelman RD. Long-term follow-up of neonatal renovascular hypertension. Pediatr Nephrol 1987; 1:35.
  24. Barrington KJ. Umbilical artery catheters in the newborn: effects of position of the catheter tip. Cochrane Database Syst Rev 2000; :CD000505.
  25. Barrington KJ. Umbilical artery catheters in the newborn: effects of heparin. Cochrane Database Syst Rev 2000; :CD000507.
  26. Adelman RD, Morrell RE. Coarctation of the abdominal aorta and renal artery stenosis related to an umbilical artery catheter placement in a neonate. Pediatrics 2000; 106:E36.
  27. Adelman RD. Abdominal aortic aneurysm 18 years after apparent resolution of an umbilical catheter-associated aortic thrombosis. J Pediatr 1998; 132:874.
  28. Connolly JE, Wilson SE, Lawrence PL, Fujitani RM. Middle aortic syndrome: distal thoracic and abdominal coarctation, a disorder with multiple etiologies. J Am Coll Surg 2002; 194:774.
  29. Sethna CB, Kaplan BS, Cahill AM, et al. Idiopathic mid-aortic syndrome in children. Pediatr Nephrol 2008; 23:1135.
  30. Mocan H, Beattie TJ, Murphy AV. Renal venous thrombosis in infancy: long-term follow-up. Pediatr Nephrol 1991; 5:45.
  31. Hegde S, Wright C, Shenoy M, et al. Renovascular hypertension commencing during fetal life. Arch Dis Child Fetal Neonatal Ed 2007; 92:F301.
  32. Estepa R, Gallego N, Orte L, et al. Renovascular hypertension in children. Scand J Urol Nephrol 2001; 35:388.
  33. Esterly JR, Oppenheimer EH. Vascular lesions in infants with congenital rubella. Circulation 1967; 36:544.
  34. Daniels SR, Loggie JM, McEnery PT, Towbin RB. Clinical spectrum of intrinsic renovascular hypertension in children. Pediatrics 1987; 80:698.
  35. Kim ES, Caiati JM, Tu J, et al. Congenital abdominal aortic aneurysm causing renovascular hypertension, cardiomyopathy, and death in a 19-day-old neonate. J Pediatr Surg 2001; 36:1445.
  36. Milner LS, Heitner R, Thomson PD, et al. Hypertension as the major problem of idiopathic arterial calcification of infancy. J Pediatr 1984; 105:934.
  37. Guay-Woodford LM, Desmond RA. Autosomal recessive polycystic kidney disease: the clinical experience in North America. Pediatrics 2003; 111:1072.
  38. Sukthankar S, Watson AR. Unilateral multicystic dysplastic kidney disease: defining the natural history. Anglia Paediatric Nephrourology Group. Acta Paediatr 2000; 89:811.
  39. Webb NJ, Lewis MA, Bruce J, et al. Unilateral multicystic dysplastic kidney: the case for nephrectomy. Arch Dis Child 1997; 76:31.
  40. Munoz AI, Baralt JF, Melendez MT. Arterial hypertension in infants with hydronephrosis. Report of six cases. Am J Dis Child 1977; 131:38.
  41. Braren V, West JC Jr, Boerth RC, Harmon CM. Management of children with hypertension from reflux or obstructive nephropathy. Urology 1988; 32:228.
  42. Gilboa N, Urizar RE. Severe hypertension in newborn after pyeloplasty of hydronephrotic kidney. Urology 1983; 22:179.
  43. Schell-Feith EA, Kist-van Holthe JE, van Zwieten PH, et al. Preterm neonates with nephrocalcinosis: natural course and renal function. Pediatr Nephrol 2003; 18:1102.
  44. Abman SH, Warady BA, Lum GM, Koops BL. Systemic hypertension in infants with bronchopulmonary dysplasia. J Pediatr 1984; 104:928.
  45. Anderson AH, Warady BA, Daily DK, et al. Systemic hypertension in infants with severe bronchopulmonary dysplasia: associated clinical factors. Am J Perinatol 1993; 10:190.
  46. Alagappan A, Malloy MH. Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol 1998; 15:3.
  47. Abman SH. Monitoring cardiovascular function in infants with chronic lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed 2002; 87:F15.
  48. Dagle JM, Fisher TJ, Haynes SE, et al. Cytochrome P450 (CYP2D6) genotype is associated with elevated systolic blood pressure in preterm infants after discharge from the neonatal intensive care unit. J Pediatr 2011; 159:104.
  49. Smets K, Vanhaesebrouck P. Dexamethasone associated systemic hypertension in low birth weight babies with chronic lung disease. Eur J Pediatr 1996; 155:573.
  50. Vermont Oxford Network Steroid Study Group. Early postnatal dexamethasone therapy for the prevention of chronic lung disease. Pediatrics 2001; 108:741.
  51. Greenough A, Emery EF, Gamsu HR. Dexamethasone and hypertension in preterm infants. Eur J Pediatr 1992; 151:134.
  52. Merritt JC, Kraybill EN. Effect of mydriatics on blood pressure in premature infants. J Pediatr Ophthalmol Strabismus 1981; 18:42.
  53. Pijnenburg MW, Zweens MJ, Bink MT, et al. Hypertensive encephalopathy in a patient with neonatal thyrotoxicosis. Eur J Pediatr 1999; 158:789.
  54. Veenhoven RH, Vande Walle JG, Donckerwolcke RA, et al. A neonate with idiopathic hyperaldosteronism. Pediatr Nephrol 1991; 5:680.
  55. Miller OF, Kolon TF. Hyperreninemia and congenital mesoblastic nephroma: case report and review of the literature. Urology 2000; 55:775.
  56. Lindner W, Behnisch W, Kunz U, et al. Congenital neuroblastoma mimicking early onset sepsis. Eur J Pediatr 2001; 160:436.
  57. Glick RD, Hicks MJ, Nuchtern JG, et al. Renal tumors in infants less than 6 months of age. J Pediatr Surg 2004; 39:522.
  58. Boedy RF, Goldberg AK, Howell CG Jr, et al. Incidence of hypertension in infants on extracorporeal membrane oxygenation. J Pediatr Surg 1990; 25:258.
  59. Becker JA, Short BL, Martin GR. Cardiovascular complications adversely affect survival during extracorporeal membrane oxygenation. Crit Care Med 1998; 26:1582.
  60. Adelman RD, Sherman MP. Hypertension in the neonate following closure of abdominal wall defects. J Pediatr 1980; 97:642.
  61. Cachat F, Van Melle G, McGahren ED, et al. Arterial hypertension after surgical closure of omphalocele and gastroschisis. Pediatr Nephrol 2006; 21:225.
  62. Marshall TA, Deeder R, Pai S, et al. Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med 1984; 12:501.
  63. Burgess GH, Oh W, Brann BS 4th, et al. Effects of phenobarbital on cerebral blood flow velocity after endotracheal suctioning in premature neonates. Arch Pediatr Adolesc Med 2001; 155:723.
  64. Durand M, Sangha B, Cabal LA, et al. Cardiopulmonary and intracranial pressure changes related to endotracheal suctioning in preterm infants. Crit Care Med 1989; 17:506.
  65. Horn PT. Persistent hypertension after prenatal cocaine exposure. J Pediatr 1992; 121:288.
  66. Flynn JT. Neonatal hypertension: diagnosis and management. Pediatr Nephrol 2000; 14:332.
  67. Xiao N, Tandon A, Goldstein S, Lorts A. Cardiogenic shock as the initial presentation of neonatal systemic hypertension. J Neonatal Perinatal Med 2013; 6:267.
  68. Skalina ME, Annable WL, Kliegman RM, Fanaroff AA. Hypertensive retinopathy in the newborn infant. J Pediatr 1983; 103:781.
  69. Cachat F, Bogaru A, Micheli JL, et al. Severe hypertension and massive proteinuria in a newborn with renal artery stenosis. Pediatr Nephrol 2004; 19:544.
  70. Bendel-Stenzel M, Najarian JS, Sinaiko AR. Renal artery stenosis in infants: long-term medical treatment before surgery. Pediatr Nephrol 1996; 10:147.