NEONATAL HYPERTENSION FOLLOW UP
Category: Child Health
Abstract : Further Inpatient Care: • Monitor BP regularly until the infant is ready for discharge from the NICU. Infants treated with ACE inhibitors or diuretics should have their renal function monitored periodically until discharge. • Arrangements for home BP monitoring should be part of the discharge plan for any infant sent home on antihypertensive therapy. The optimal device for ho
Further Inpatient Care:
• Monitor BP regularly until the infant is ready for discharge from the NICU. Infants treated with ACE inhibitors or diuretics should have their renal function monitored periodically until discharge.
• Arrangements for home BP monitoring should be part of the discharge plan for any infant sent home on antihypertensive therapy.
The optimal device for home BP measurements in an infant is a Dinamap or similar oscillometric device. A second choice is a Doppler device (only measures systolic BP).
Further Outpatient Care:
Include BP measurement at all follow-up visits for infants with neonatal hypertension. In addition, monitor infants with BPD at discharge and those who had complicated NICU courses for the development of hypertension following discharge.
In/Out Patient Meds:
Refer to preceding sections.
Transfer:
Occasionally, infants may need to be transferred to specialized centers for advanced diagnostic or therapeutic procedures, such as angiography or vascular surgery.
Deterrence/Prevention:
Although several studies have examined the role of placement of umbilical artery catheters (ie, low versus high lines), no definitive proof has emerged that changes in catheter placement can prevent thromboembolism and the subsequent development of hypertension.
Complications:
As mentioned above, the long-term sequelae of neonatal hypertension on renal growth, renal function, and future BP are unknown at this time. Long-term effects related to certain antihypertensive medications (eg, ACE inhibitors, calcium channel blockers) are also unknown. These infants may need to be monitored closely even after their hypertension has resolved, particularly with respect to renal growth and the redevelopment of hypertension in later childhood.
Prognosis:
• The long-term prognosis for most infants with hypertension is quite good. For infants with hypertension related to an umbilical arterial catheter, the hypertension usually resolves over time. These infants may require increases in their antihypertensive medications in the first several months following discharge from the nursery as they undergo rapid growth. Following this, weaning the patient off antihypertensive therapy is usually possible by making no further dose increases as the infant continues to grow. Home BP monitoring by the parents is a crucially important component of this process. Provide proper equipment, either a Doppler or oscillometric device, for all infants discharged from the NICU on long-term antihypertensive medications. Such infants may benefit from referral to a comprehensive pediatric hypertension clinic if their primary care physicians are inexperienced in managing hypertension.
• Other forms of neonatal hypertension may persist beyond infancy. In particular, PKD and other forms of renal parenchymal disease may continue to cause hypertension throughout childhood. Infants with RVT may also remain hypertensive, and some of these children ultimately benefit from nephrectomy. Persistent or recurrent hypertension may also be observed in children who have undergone repair of renal arterial stenosis or coarctation of the aorta. Reappearance of hypertension in these situations should prompt a search for restenosis using the appropriate imaging studies.
• BP in newborns depends on a variety of factors, including gestational age, postnatal age, and birth weight. Hypertension can be observed in a variety of situations in the modern NICU and is especially common in infants who have undergone umbilical arterial catheterization. A careful diagnostic evaluation should lead to determination of the underlying cause of hypertension in most infants. Tailor treatment decisions, which may include intravenous therapy, oral therapy, or both, to the severity of the hypertension. Hypertension resolves in most infants over time, although a small number of infants may have persistent BP elevation throughout childhood.
Patient Education: Educate the parents of infants who develop hypertension requiring drug therapy about the expected effects and side effects of their infant's antihypertensive medications. In addition, arrange home BP monitoring equipment and educate the parents in its use prior to the infant's discharge from the NICU. Parents must monitor the BP of all infants discharged on antihypertensive medications on a regular basis (ie, usually daily); parents should call the physician if the infant's BP exceeds or falls below the target range.
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