E DIXON REPORT X MANAGEMENT OF HIGH BP IN NEONATES

 Hypertension in  the neonatal period

Causes of neonatal hypertension 

History, Examination in Neonate

Antenatal history -renal anomalies detected by antenatal scan, maternal cocaine use

Perinatal events-  eg HIE

NICU history- umbilical artery catheter, medications   

Physical examination -

Palpable peripheral pulses and BP measurements in the four extremities (coarctation of aorta), 

 examination of the abdomen (renal masses)  genitalia (CAH)

  analysis of the urine (haematuria suggesting renal vein thrombosis).      

Investigations 

Bloods

 electrolytes, urea and creatinine, estimated GFR

 full blood count

 calcium, phosphate

 albumin

 thyroid function

 plasma renin and aldosterone

Urinalysis

 protein, creatinine, microalbumin,

 microscopy for cells, casts and infection

 culture

 urinary catecholamines

. Renal ultrasound - including renal vessel Dopplers (especially if baby had UAC) 

. CXR

. Echocardiogram

 Consider 

 urine VMA, urine HVA

 urine steroid profiles

 17-OH progesterone

 DMSA, MCUG

MANAGEMENT OF HIGH BP IN NEONATE

Consider early discussion with Renal Team GOSH 

Discuss  with Paediatric Pharmacist 

DRUGS USED TO MANAGE HIGH BP IN NEONATES 

NEEDS DISCUSSION  WITH PAEDIATRIC PHARMACIST, BNFC, EVELINA DRUG FORMULARY 

REFERENCES 

1. Dionne, Janis M, Flynn, Joseph T. Management of severe hypertension in the newborn. Arch Dis Child 2017; 102:1176-1179 

2. Committee on Fetus and Newborn, American Academy of Pediatrics. Routine evaluation of blood pressure, haematocrit and glucose in newborns. Pediatrics, 1993; 92:474-6 

3. Seliem, WA, Falk MC, Shadbolt B, et al. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Paediatric Nephrology, 2007;22:2081-7

 4. Blowey DL, Duda PJ, Stokes P, et al. Incidence and treatment of hypertension in the neonatal intensive care unit. Journal Am Soc Hypertens 2011;5:478-83

 5. O’Shea J, Demsey EM. A comparison of Blood Pressure Measurement in Newborns. Amer J Perinatol 2009;26(2):113-116

6. Watkinson M. Hypertension in the newborn baby. Arch Dis Child Fetal Neonatal Ed 2002;86: F78-F81 

7. Northern Neonatal Nursing Initiative. Systolic blood pressure in babies less than 32 weeks’ gestation in the first year of life. Arch Dis Child Fetal Neonatal Ed 1999;80:F38–42 

 8. Tack ED, Perlman JM. Renal failure in sick hypertensive premature infants receiving captopril therapy. J. Pediatrics 1988;112:805-10