Journal of the American Society of Hypertension
Research ArticleIncidence and treatment of hypertension in the neonatal intensive care unit
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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2022, Clinics in PerinatologyCitation 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