Clinical Outcomes of Neonates Receiving Antihypertensive Treatment

Neonatal hypertension is uncommon but clinically significant due to its systemic complications. Data on the clinical course, etiologies, and outcomes of neonates receiving antihypertensive therapy in the neonatal intensive care unit are limited. This study aimed to describe the clinical characteristics, underlying etiologies, management strategies, and outcomes of neonates receiving antihypertensive therapy in a tertiary level 4 NICU.

We conducted a retrospective review of medical records of neonates admitted to the NICU between January 2024 and June 2025 who received antihypertensive treatment. Etiologies were classified as renal, vascular, or miscellaneous. Follow-up data were analyzed to identify persistence of hypertension after discharge.

Of 17 neonates, 9 (52%) were preterm and 8 (47%) were term. Renal etiologies predominated (47%), including acute kidney injury, congenital anomalies of the kidney and urinary tract, and polycystic kidney disease. Vascular causes accounted for 5.8%, and miscellaneous etiologies, such as intracranial lesions and sepsis, for 47%. Monotherapy with amlodipine, enalapril, or captopril was used in most cases, while combination therapy was required in two neonates with renal etiologies. Four neonates (23.5%) were discharged on ongoing antihypertensive therapy, all with structural or genetic renal or vascular abnormalities.

Neonatal hypertension is heterogeneous, with renal disorders being the most frequent cause. Persistent hypertension occurs mainly in neonates with structural renal or vascular abnormalities, while those with other causes often discontinue therapy before discharge. These findings highlight the importance of identifying neonates at risk for long-term complications.