Blood Pressure Outcomes in NICU-Admitted Infants with Neonatal Hypertension: A Pediatric Nephrology Research Consortium Study

Overview

Journal J Pediatr

Specialty Pediatrics

Date 2023 Oct 1

PMID 37778410

Authors

Nianzhou Xiao

Michelle Starr

Adrienne Stolfi

Gilad Hamdani

Shireen Hashmat

Stefan G Kiessling

Christina Sethna

Mahmoud Kallash

Robyn Matloff

Robert Woroniecki

Keia Sanderson

Ikuyo Yamaguchi

Stephen D Cha

Michael G Semanik

Rahul Chanchlani

Joseph T Flynn

Mark Mitsnefes

Affiliations

Soon will be listed here.

Abstract

Objective: To describe the blood pressure outcomes of infants admitted to the neonatal intensive care unit (NICU) with idiopathic (nonsecondary) hypertension (HTN) who were discharged on antihypertensive therapy.

Study Design: Retrospective, multicenter study of 14 centers within the Pediatric Nephrology Research Consortium. We included all infants with a diagnosis of idiopathic HTN discharged from the NICU on antihypertensive treatment. The primary outcome was time to discontinuation of antihypertensive therapy, grouped into (≤6 months, >6 months to 1 year, and >1 year). Comparisons between groups were made with χ tests, Fisher's exact tests, and ANOVA.

Results: Data from 118 infants (66% male) were included. Calcium channel blockers were the most prescribed class of antihypertensives (56%) in the cohort. The percentages remaining on antihypertensives after NICU discharge were 60% at 6 months, 26% at 1 year, and 7% at 2 years. Antenatal steroid treatment was associated with decreased likelihood of antihypertensive therapy >1 year after discharge.

Conclusions: This multicenter study reports that most infants admitted to the NICU diagnosed with idiopathic HTN will discontinue antihypertensive treatment by 2 years after NICU discharge. These data provide important insights into the outcome of neonatal HTN, but should be confirmed prospectively.

Citing Articles

Critical Insights Into Neonatal Hypertension: A Comprehensive Review of Current Understanding and Management Strategies.

Taksande A, Khandelwal R, Javvaji C Cureus. 2024; 16(6):e62421.

PMID: 39011229 PMC: 11248457. DOI: 10.7759/cureus.62421.

References

Kraut E, Boohaker L, Askenazi D, Fletcher J, Kent A . Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]. Pediatr Res. 2018; 84(2):279-289. DOI: 10.1038/s41390-018-0018-8. View

Adelman R . Long-term follow-up of neonatal renovascular hypertension. Pediatr Nephrol. 1987; 1(1):35-41. DOI: 10.1007/BF00866882. View

Sacco A, Cornish E, Marlow N, David A, Giussani D . The effect of antenatal corticosteroid use on offspring cardiovascular function: A systematic review. BJOG. 2022; 130(4):325-333. PMC: 10092187. DOI: 10.1111/1471-0528.17316. View

Perl A, Schuh M, Kopan R . Regulation of nephron progenitor cell lifespan and nephron endowment. Nat Rev Nephrol. 2022; 18(11):683-695. PMC: 11078284. DOI: 10.1038/s41581-022-00620-w. View

Callaway D, McGill-Vargas L, Quinn A, Jordan J, Winter L, Anzueto D . Prematurity disrupts glomeruli development, whereas prematurity and hyperglycemia lead to altered nephron maturation and increased oxidative stress in newborn baboons. Pediatr Res. 2017; 83(3):702-711. PMC: 5902650. DOI: 10.1038/pr.2017.290. View

Sutherland M, Gubhaju L, Yoder B, Stahlman M, Black M . The effects of postnatal retinoic acid administration on nephron endowment in the preterm baboon kidney. Pediatr Res. 2008; 65(4):397-402. PMC: 3633555. DOI: 10.1203/PDR.0b013e3181975f52. View

Clayton P, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A . Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metab. 2007; 92(3):804-10. DOI: 10.1210/jc.2006-2017. View

Gubhaju L, Sutherland M, Yoder B, Zulli A, Bertram J, Black M . Is nephrogenesis affected by preterm birth? Studies in a non-human primate model. Am J Physiol Renal Physiol. 2009; 297(6):F1668-77. PMC: 2801336. DOI: 10.1152/ajprenal.00163.2009. View

Almaazmi A, Hagan J, Fernandes C, Gowda S . Neonatal systemic hypertension across the PHIS database: An update. Int J Cardiol. 2023; 376:49-53. DOI: 10.1016/j.ijcard.2023.01.060. View

10.

Starr M, Flynn J . Neonatal hypertension: cases, causes, and clinical approach. Pediatr Nephrol. 2018; 34(5):787-799. PMC: 6261698. DOI: 10.1007/s00467-018-3977-4. View

11.

Jenkins R, Aziz J, Gievers L, Mooers H, Fino N, Rozansky D . Characteristics of hypertension in premature infants with and without chronic lung disease: a long-term multi-center study. Pediatr Nephrol. 2017; 32(11):2115-2124. DOI: 10.1007/s00467-017-3722-4. View

12.

Sutherland M, Yoder B, McCurnin D, Seidner S, Gubhaju L, Clyman R . Effects of ibuprofen treatment on the developing preterm baboon kidney. Am J Physiol Renal Physiol. 2012; 302(10):F1286-92. PMC: 3362063. DOI: 10.1152/ajprenal.00216.2011. View

13.

Fenton T, Kim J . A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013; 13:59. PMC: 3637477. DOI: 10.1186/1471-2431-13-59. View

14.

Starr M, Hingorani S . Prematurity and future kidney health: the growing risk of chronic kidney disease. Curr Opin Pediatr. 2018; 30(2):228-235. PMC: 6085891. DOI: 10.1097/MOP.0000000000000607. View

15.

Blowey D, Duda P, Stokes P, Hall M . Incidence and treatment of hypertension in the neonatal intensive care unit. J Am Soc Hypertens. 2011; 5(6):478-83. DOI: 10.1016/j.jash.2011.08.001. View

16.

Seliem W, Falk M, Shadbolt B, Kent A . Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr Nephrol. 2007; 22(12):2081-7. DOI: 10.1007/s00467-007-0603-2. View

17.

Friedman A, Hustead V . Hypertension in babies following discharge from a neonatal intensive care unit. A 3-year follow-up. Pediatr Nephrol. 1987; 1(1):30-4. DOI: 10.1007/BF00866881. View

18.

Dionne J, Abitbol C, Flynn J . Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol. 2011; 27(1):17-32. DOI: 10.1007/s00467-010-1755-z. View