Faculty Collaboration Database

Characteristics of hypertension in premature infants with and without chronic lung disease: a long-term multi-center study. Pediatr Nephrol 2017 Nov;32(11):2115-2124

Date

07/05/2017

Pubmed ID

28674750

DOI

10.1007/s00467-017-3722-4

Scopus ID

2-s2.0-85021811681 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: Many causes for neonatal hypertension in premature infants have been described; however in some cases no etiology can be attributed. Our objectives are to describe such cases of unexplained hypertension and to compare hypertensive infants with and without chronic lung disease (CLD).

METHODS: We reviewed all cases of hypertension in premature infants referred from 18 hospitals over 16 years. Inclusion criteria were hypertension occurring at <6 months of age and birth at <37 weeks gestation; the main exclusion criterion was known secondary hypertension. Continuous variables were compared using analysis of variance. Nominal variables were compared using chi-square tests.

RESULTS: A total of 97 infants met the inclusion criteria, of whom 37 had CLD. Among these infants, hypertension presented at a mean of 11.3 ± 3.2 chronological weeks of age and a postmenstrual age of 39.6 ± 3.6 weeks. Diagnostic testing was notable for plasma renin activity (PRA) being <11 ng/mL/h in 98% of hypertensive infants. Spironolactone was effective monotherapy in 51 of 56 cases of hypertension. Hypertension resolved in all infants, with an average treatment duration of 25 weeks. Significant differences between the two groups of infants were a 0.4 kg lower birthweight and a 2.5 weeks younger gestational age at birth in those with CLD (p < 0.01, p < 0.01, respectively). Hypertension presented in those with CLD 1.8 weeks later, but at the same postmenstrual age as those without CLD (p < 0.01, p = 0.45, respectively).

CONCLUSION: Premature infants with unexplained hypertension, with and without CLD, presented at a postmenstrual age of 40 weeks with low PRA, transient time course, and a favorable response to spironolactone treatment.

Author List

Jenkins RD, Aziz JK, Gievers LL, Mooers HM, Fino N, Rozansky DJ

Author

Harrison Mooers MD Staff Physician in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aldosterone
Antihypertensive Agents
Chronic Disease
Female
Humans
Hypertension
Infant
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases
Lung Diseases
Male
Renin
Retrospective Studies