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Hypertension in babies following discharge from a neonatal intensive care unit. A 3-year follow-up
1Department of Pediatrics, University of Wisconsin, Clinical Science Center, Madison 53792.
Insights
Neonatal intensive care unit graduates may develop hypertension, sometimes with unknown causes. This condition is treatable with medication, and blood pressure monitoring is crucial for these infants.
Area of Science:
- Pediatrics
- Neonatology
- Cardiology
Background:
- Hypertension following neonatal intensive care unit (NICU) discharge is a concern.
- Identifying causes and risk factors for hypertension in this population is important.
Purpose of the Study:
- To investigate the incidence, causes, and outcomes of hypertension in infants after NICU discharge.
- To assess the efficacy of medical and surgical treatments for post-NICU hypertension.
Main Methods:
- A cohort of 17 infants with hypertension (systolic BP > 113 mm Hg) post-NICU discharge was followed for 6-42 months.
- Identified potential causes including congenital anomalies and procedures.
- Monitored treatment responses to antihypertensive medications and surgical interventions.
Main Results:
- Five infants had identifiable causes (e.g., coarctation of the aorta, ureteropelvic junction obstruction).
- Ten infants had hypertension of unknown etiology.
- Medical treatment (propranolol, with or without chlorothiazide) was effective, with all children discontinuing medication by 24 months.
- Surgical intervention was used in 4 infants.
Conclusions:
- Post-NICU infants require vigilant blood pressure monitoring due to the potential for developing hypertension, including cases with unknown causes.
- Hypertension in this group is responsive to medication, suggesting a favorable prognosis with appropriate management.
- Further research is needed to establish risk, natural history, and optimal treatment strategies for post-NICU hypertension.
Abstract:
Seventeen babies who developed hypertension (systolic BP greater than 113 mm Hg) after discharge from a neonatal intensive care unit were followed for a period ranging from 6 to 42 months. Five of the babies had an apparent cause for hypertension--one each had coarctation of the aorta, neuroblastoma, renal artery thrombosis, and two ureteropelvic junction obstruction. Umbilical artery catheters had been used in two additional babies. Ten of the babies had no obvious etiology for their hypertension. No prenatal, obstetrical or postnatal factor could be determined that predisposed these babies to hypertension. Sixteen of the babies were treated, 4 by surgical techniques and 12 by drugs--propranolol with or without chlorothiazide. All children treated medically were able to discontinue antihypertensives by 24 months of age. We conclude that follow-up of all babies discharged from the neonatal intensive care unit should include careful monitoring of blood pressure; that such infants may develop hypertension of unknown cause and that hypertension in this patient population is responsive to medication. Additional study is required to determine if babies discharged from neonatal intensive care units are at high risk for developing hypertension and to determine the natural history, prognosis and optimum treatment for the babies.