Renal failure in sick hypertensive premature infants receiving captopril therapy

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A retrospective study of nine sick premature infants with chronic lung disease who received captopril for control of systemic hypertension (systolic blood pressure (BP) >113 mm Hg) was carried out to determine efficacy of therapy and associated complications. All nine infants had markedly elevated peripheral renin values, 134.3 ± 128.1 ng/mL/hr (mean ± SD). Five Infants had abnormal renal sonographic and perfusion scans with evidence of renal artery thrombosis, parenchymal disease, or both. Captopril therapy (0.3 mg/kg) was instituted at a postnatal age of 123 ± 108 days. After the initial dose, the systolic BP decreased significantly in all infants, the decrease ranging from 21% to 58% of the pretreatment value. Dosage was subsequently halved in all infants. Seventeen episodes of unpredictable decreases in BP more than 40% from baseline occurred during the reduced maintenance therapy. Four infants had a total of seven episodes during which the BP decreased by 57 ± 10% from baseline; this decrease persisted for 17 ± 6 hours and was unresponsive to volume reexpansion and inotropic therapy. All seven episodes were accompanied by oliguria (urine output ±1 mL/kg/hr) that persisted for 18 ± 12 hours. These episodes were accompanied by neurologic signs (subtle seizures, lethargy, and/or apnea) within 18 ± 6 hours after the onset of oliguria. The remaining five infants had a total of 13 episodes of decreased BP of 50 ± 8% of baseline, which were of significantly shorter duration and responded to volume reexpanders, inotropic therapy, or both and were unaccompanied by oliguria. These data suggest the need for close observation of BP in infants receiving maintenance captopril therapy.

References (40)

  • E Bifano et al.

    Treatment of neonatal hypertension with captopril

    J PEDIATR

    (1982)
  • D Weismann et al.

    Captopril treatment

    Am J Dis Child

    (1983)
  • AR Sinaiko et al.

    Antihypertensive drug therapy with captopril in children and adolescents

    Clin Exp Hypertens [A]

    (1986)
  • LC Hymes et al.

    Long-term treatment of hypertension in a preterm infant and in older children

    Am J Dis Child

    (1983)
  • Perlman JM. Neonatal hypertension. In: Robson L, ed. Pediatric hypertension. New York: Blackwell Scientific...
  • JM Hicks et al.
  • LA Cabal et al.

    Neonatal clinical cardiopulmonary monitoring

  • SLB Ploos van Amstel et al.

    Long-term treatment of severe hypertension with captopril [abstract]

    Int J Pediatr Nephrol

    (1982)
  • K Miller

    Accelerated hypertension occurring while on captopril therapy [abstract]

    Int J Pediatr Nephrol

    (1982)
  • W Rosendahl et al.

    Successful acute and long-term treatment of renin-induced hypertension in two infants on captopril

    Eur J Pediatr

    (1980)
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