Incidence and treatment of hypertension in the neonatal intensive care unit

doi:10.1016/j.jash.2011.08.001

Journal of the American Society of Hypertension

Volume 5, Issue 6, November–December 2011, Pages 478-483

https://doi.org/10.1016/j.jash.2011.08.001 Get rights and content

Abstract

The incidence and risk factors for hypertension in the neonatal intensive care unit (NICU) is inadequately defined, and the current utilization of antihypertensive medications in this specialized environment is not known. We evaluated the incidence of hypertension, associated risk factors, and utilization of antihypertensive drugs in the NICU using a large, geographically diverse pediatric database. A total of 123,847 NICU encounters were identified in the database. After exclusion of the 44,861 neonates with congenital cardiac disorders, 764 (1%) were coded with the diagnosis of hypertension. On multivariate analysis, the risk for hypertension was greatest in those neonates with a high All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness assessment (OR = 35.8), extracorporeal membrane oxygenation (OR = 3.8), coexisting renal disorder (OR = 4.7), and renal failure (OR = 2.4). Of the 441 (57.7%) infants receiving antihypertensive medication, the median duration of exposure was 10 days, and 45% were exposed to more than one antihypertensive medication. Vasodilators were used in 64.2% of hypertensive neonates, followed by angiotensin-converting enzyme inhibitors (50.8%), calcium channel blockers (24%), and alpha- and beta-blockers (18.4%). Although hypertension occurs infrequently in the NICU, certain neonates are at increased risk for this condition. Hypertensive infants are frequently exposed to antihypertensive medications, often to several different agents during their NICU course of treatment.

Introduction

Hypertension (HTN) in a healthy newborn infant is such an uncommon finding, occurring in only 0.2% of babies, that the American Academy of Pediatrics does not recommend routine blood pressure screening.¹ For neonates requiring admission to a neonatal intensive care unit (NICU), the reported incidence of HTN is slightly higher, approximating 0.81–1.3%.2, 3 Previous reports suggest that the incidence of HTN among neonates is increased in very-low birth weight infants,3, 4 infants with bronchopulmonary dysplasia (BPD),5, 6 patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), umbilical artery catheters (UACs),³ dexamethasone therapy,⁷ renal failure,³ and exposure to extracorporeal membrane oxygenation (ECMO).⁸

When pharmacologic therapy is deemed necessary to treat HTN in a neonate, there is little information available on drug disposition, efficacy, and the adverse effect profile in this subpopulation to guide rational drug treatment decisions. As a result, there are no evidence-based guidelines for the treatment of neonatal HTN and the choice of antihypertensive therapy is usually based on the prescriber’s experience or recommendations based on expert opinion.⁹

The goals of the study reported herein were to assess the incidence of HTN in the modern-day NICU, to investigate risk factors associated with HTN, and to describe the use of antihypertensive drugs in a large population of neonates admitted to the NICU.

Section snippets

Database

Data for this retrospective cohort study were obtained from the Pediatric Health Information System (PHIS), a national administrative database containing resource utilization data from 41 freestanding, tertiary care children’s hospitals affiliated with the Child Health Corporation of America (Shawnee Mission, KS). PHIS-participating hospitals account for 20% of all tertiary care general children’s hospitals. Data quality and reliability are assured through a joint effort between the Child

Results

There were 123,847 NICU encounters identified in the PHIS database discharged between January 1, 2005, and December 31, 2009. Of these encounters, 2,057 (1.7%) were coded with the diagnosis of HTN. After the encounters with congenital cardiac disorders were omitted, there were 78,986 remaining encounters across 36 hospitals. Of these, 764 (1.0%) were coded with the diagnosis of HTN.

The demographic information for the 78,986 encounters with and without the diagnosis of HTN is presented in Table 1

Discussion

In this study, a large database with more than 120,000 NICU encounters was used to investigate the incidence of HTN and the utilization of antihypertensive drugs in the NICU. HTN was diagnosed in 1.7% of neonates when the complete population was considered and 1% when neonates with congenital cardiovascular disease were excluded. The 1% incidence of HTN identified in this study is specific to neonates hospitalized at tertiary care centers and may not be representative of the incidence of HTN

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Citation Excerpt :
Generally, the incidence of hypertension in the neonatal period has focused primarily on those in the neonatal intensive care unit (NICU) within small single-center populations using different thresholds for defining hypertension. Such studies have reported incidences of 0.8% to 2%.1–5 The largest study used the Pediatric Health Information System to look for diagnosis of hypertension within 123,847 NICU encounters finding an incidence of 1%.2

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Research ArticleIncidence and treatment of hypertension in the neonatal intensive care unit

Abstract

Introduction

Section snippets

Database

Results

Discussion

J Pediatr

J Pediatr

J Pediatr

J Pediatr

J Pediatr

Neonatal hypertension. Incidence and risk factors

Am J Hypertens

Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up

Pediatr Nephrol

Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors

Am J Perinatol

Hypertension in babies following discharge from a neonatal intensive care unit

Pediatr Nephrol

Dexamethasone associated systemic hypertension in low birth weight babies with chronic lung disease

Eur J Pediatr

Hypertension during extracorporeal membrane oxygenation: cause, effect, and management

Surgery

Hypertension in infancy: diagnosis, management and outcome

Pediatr Nephrol.

Achieving data quality. How data from a pediatric health information system earns the trust of its users

J AHIMA

Corticosteroids and mortality in children with bacterial meningitis

JAMA

Research Article
Incidence and treatment of hypertension in the neonatal intensive care unit