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Pediatr Nephrol (2012) 27:1732 DOI 10.1007/s00467-010-1755-z
REVIEW
Hypertension in infancy: diagnosis, management and outcome
Janis M. Dionne & Carolyn L. Abitbol & Joseph T. Flynn
Received: 1 November 2010 /Revised: 16 December 2010 /Accepted: 20 December 2010 /Published online: 22 January 2011 # IPNA 2011
Abstract Advances in the ability to identify, evaluate, and care for infants with hypertension, coupled with advances in the practice of Neonatology, have led to an increased awareness of hypertension in modern neonatal intensive care units. This review will present updated data on blood pressure values in neonates, with a focus on the changes that occur over the first days and weeks of life in both term and preterm infants. Optimal blood pressure measurement techniques as well as the differential diagnosis of hyper-tension in the neonate and older infants will be discussed. Recommendations for the optimal immediate and long-term evaluation and treatment, including potential treatment parameters, will be presented. We will also review additional information on outcome that has become available over the past decade.
Keywords Blood pressure . Neonate . Infant . Prematurity.
ACE inhibitor . Calcium channel blocker. Hypertension . Kidney disease
Introduction
Recent advances in the ability to identify, evaluate, and care for infants with hypertension, coupled with advances in the practice of Neonatology, have led to an increased awareness of hypertension in infants since its first description in the 1970s [13]. While information on normal blood pressure (BP) in both premature and term infants has increased, defining hypertension and determining treatment criteria in infancy remain controversial. This paper will review available information on normative values and present suggested cut-points for diagnosis and treatment. We will also address the differential diagnosis of hypertension in the neonate, the pathophysiology and heritable aspects of the disease as well as the optimal immediate and long-term evaluation and treatment. Finally, the additional information on outcome that has become available over the past decade will be summarized.
Incidence
Most reports indicate that the incidence of hypertension in neonates is quite low, ranging from 0.2 to 3% [1, 2, 46]. It is so unusual in otherwise healthy term infants that routine BP determination is not advocated for this group [7]. For preterm and otherwise high-risk newborns admitted to modern neonate intensive care units...