NEONATAL HYPERTENSION LAB STUDIES
Category: Child Health
Abstract : Lab Studies: • Usually only a limited set of laboratory data is needed in
the evaluation of neonatal hypertension. Obtain serum electrolytes, creatinine,
BUN, and a urinalysis in order to look for renal parenchymal disease. Obtain
endocrinologic studies, such as cortisol, aldosterone, or thyroxine, when
pertinent history exists. • Measurement of plasma renin activity
Lab Studies:
• Usually only a limited set of laboratory data is needed in
the evaluation of neonatal hypertension. Obtain serum electrolytes, creatinine,
BUN, and a urinalysis in order to look for renal parenchymal disease. Obtain
endocrinologic studies, such as cortisol, aldosterone, or thyroxine, when
pertinent history exists.
• Measurement of plasma renin activity is
usually recommended as part of the laboratory assessment of hypertensive
newborns, although an elevated peripheral renin may not signify the presence of
underlying pathology because renin values are typically quite high in infancy.
In addition, plasma renin may be elevated falsely by medications that are
commonly used in the NICU, such as aminophylline. Keep these factors in mind
when interpreting renin values.
Imaging Studies:
• Chest radiography
may be helpful in infants with CHF or in those with a murmur on physical
examination.
• Obtain renal ultrasonography in all hypertensive infants.
Accurate renal ultrasonography may help uncover potentially correctable causes
of hypertension (eg, RVT); it may detect aortic thrombi, renal arterial thrombi,
or both; and it can reveal anatomic renal abnormalities or other congenital
renal parenchymal disease.
Ultrasonography is fast, noninvasive, and
relatively inexpensive. Ultrasonography has largely replaced intravenous
pyelography, which has little, if any, use in the routine assessment of neonatal
hypertension.
• For infants with extremely severe BP elevation,
angiography may be necessary. Although some investigators have used aortography
via the umbilical artery catheter, a formal angiography using the traditional
femoral venous approach is much more accurate for diagnosing renal arterial
stenosis, primarily because of the high incidence of intrarenal branch vessel
abnormalities observed in children with FMD.
• Nuclear scanning may
demonstrate abnormalities of renal perfusion caused by thromboembolic
phenomenon, although obtaining good studies in infants is difficult because of
their immature renal function.
• Obtain other studies, including
echocardiography and voiding cystourethrography, as indicated.
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