Conditions Associated with Hypertension in a High-risk Premature Infant

Abstract

Hypertension is an uncommon but significant problem in high-risk neonates and infants, and the spectrum of potential causes is broad. Here, we describe an extremely premature infant (birth weight, 728 g; gestational age, 27 weeks) with multiple complications and hypertension. During admission, umbilical artery catheters were used for a period of time, and he suffered from respiratory distress syndrome, intraventricular hemorrhage, pulmonary hemorrhage, patent ductus arteriosus, pericardial effusion, heart failure, repeated sepsis, anemia, thrombocytopenia, chronic lung disease, and progressive liver damage. He was treated with multiple medications, including erythropoietin, indomethacin, epinephrine, dopamine, aminophylline, multiple antibiotics, amphotericin B, and total parenteral nutrition. Hypertension was first noted when he was 41 days old, with spontaneous remission. It then recurred, reaching higher than 100 mmHg when he was almost 4 months old. After stopping erythropoietin, hypertension subsided for a short period of time and went up again. Multiple factor-related hypertension in this premature infant was considered. Related literature on hypertension in premature infants is reviewed. In conclusion, multiple factors can influence blood pressure and may induce hypertension in high-risk premature infants. Thus, blood pressure should be closely monitored in high-risk premature infants. Judicious use of all medications and interventions are crucial to decrease the incidence of hypertension in high-risk premature infants.

Systemic Hypertension Requiring Treatment in the Neonatal Intensive Care Unit

“…The etiology of hypertension in infants varies widely and besides traditional risk factors, which are similar to older children and adults (ie, kidney disease, heart disease) 10 , includes some unique perinatal risk factors 11 seen in the NICU such as: renal artery thrombosis (secondary to thromboembolism from umbilical catheters 6 ), 12 medication-related (steroid 13 , indomethacin 6 ), parenteral nutrition (volume, calcium and salt excess) 14, 15 extra-corporeal membrane oxygenation(ECMO), 16, 17 bronchopulmonary dysplasia 6, 18 , patent ductus arteriosus 6 among many others 15 . Interestingly, the prevalence of idiopathic hypertension among infants, where no cause can be detected, is reported to range from 5–57% 6, 9, 10 .…”

Erythropoietin for neonatal brain injury: opportunity and challenge

“…Although there have been some reports of EPO‐related hypertension in adult uremia cases (Aher and Ohlsson, 2006b; Klipp et al, 2007; Ohls et al, 2001), EPO‐associated neonatal hypertension is rare. In a case report study, an extremely premature infant developed hypertension after the EPO treatment for a period of time, but then hypertension seemed to be improved after EPO was stopped (Chen et al, 2008).…”

The Protective Role of Erythropoietin in the Developing Brain

“…In a case report, an extremely premature infant developed hypertension after Epo treatment for a period of time, but then hypertension seemed to have improved after Epo was discontinued (Chen et al, 2008).…”