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Use of enalapril in neonatal hypertension

J L Schilder1, J N Van den Anker

  • 1Department of Pediatrics, Erasmus University, Rotterdam, The Netherlands.

Acta Paediatrica (Oslo, Norway : 1992)
|December 1, 1995
PubMed

Insights

Enalapril, a hypertension medication, caused severe hypotension and renal failure in a preterm infant at a dose of 0.1 mg/kg. A lower starting dose of 0.01 mg/kg is recommended for preterm infants.

Area of Science:

  • Neonatal pharmacology
  • Pediatric nephrology
  • Cardiovascular therapeutics

Background:

  • Hypertension management in preterm infants presents unique challenges due to immature organ systems.
  • Enalapril, a potent angiotensin-converting enzyme (ACE) inhibitor, is increasingly used for pediatric hypertension.
  • Compared to captopril, enalapril offers a longer plasma half-life and potentially fewer side effects.

Observation:

  • A preterm infant received oral enalapril for hypertension treatment.
  • The administered dose was 0.1 mg/kg.
  • The infant subsequently developed severe hypotension and acute renal failure.

Findings:

  • High-dose oral enalapril (0.1 mg/kg) can precipitate serious adverse events in preterm infants.
  • Preterm infants exhibit heightened sensitivity to ACE inhibitors, necessitating careful dose titration.
  • Renal function and hemodynamic stability are critical parameters to monitor during enalapril therapy in neonates.

Implications:

  • The recommended starting oral dose of enalapril for preterm infants should be significantly lower, at 0.01 mg/kg.
  • Intensive monitoring of vital signs and renal function is crucial during the initial administration of enalapril.
  • This case highlights the need for individualized dosing and vigilant surveillance in neonatal pharmacotherapy.

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