Incidence and treatment of hypertension in the neonatal intensive care unit

The incidence and risk factors for hypertension in the neonatal intensive care unit (NICU) is inadequately defined, and the current utilization of antihypertensive medications in this specialized environment is not known. We evaluated the incidence of hypertension, associated risk factors, and utilization of antihypertensive drugs in the NICU using a large, geographically diverse pediatric database. A total of 123,847 NICU encounters were identified in the database. After exclusion of the 44,861 neonates with congenital cardiac disorders, 764 (1%) were coded with the diagnosis of hypertension. On multivariate analysis, the risk for hypertension was greatest in those neonates with a high All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness assessment (OR = 35.8), extracorporeal membrane oxygenation (OR = 3.8), coexisting renal disorder (OR = 4.7), and renal failure (OR = 2.4). Of the 441 (57.7%) infants receiving antihypertensive medication, the median duration of exposure was 10 days, and 45% were exposed to more than one antihypertensive medication. Vasodilators were used in 64.2% of hypertensive neonates, followed by angiotensin-converting enzyme inhibitors (50.8%), calcium channel blockers (24%), and alpha- and beta-blockers (18.4%). Although hypertension occurs infrequently in the NICU, certain neonates are at increased risk for this condition. Hypertensive infants are frequently exposed to antihypertensive medications, often to several different agents during their NICU course of treatment.