Nicardipine for the Treatment of Neonatal Hypertension During Extracorporeal Membrane Oxygenation

Liviskie, Caren; DeAvilla, Kathryn M.; Zeller, Brandy; Najaf, Tasnim; McPherson, Christopher

doi:10.1007/s00246-019-02113-3

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…Reports of HTN as a complication of ECMO have been described in more detail in the neonatal population, where a wide incidence of 38-88% is reported. 3,4,6,15 None of these reports however distinguish between VV or VA ECMO support. The most recent pediatric review on the matter analyzed cases from 1995 to 2002 5 using the 1987 NHLBI guidelines 7 to define HTN (SBP reading of >95% for age for ≥1 hour).…”

Section: Discussionmentioning

confidence: 99%

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Systemic Hypertension in Pediatric Veno-Venous Extracorporeal Membrane Oxygenation

Rabinowitz¹,

McGregor²,

O’Connor³

et al. 2020

ASAIO Journal

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Systemic hypertension (HTN) is a recognized complication of veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in children. We sought to determine the prevalence and associated features of HTN in a retrospective cohort of children (>1 year old) supported with VV ECMO from January 2015 to July 2019 at our institution. Patient and ECMO-related characteristics were reviewed, including intensive care unit (ICU) length of stay (LOS), ECMO duration, corticosteroids and nephrotoxic medication exposure, acute kidney injury (AKI), overall fluid balance, and transfusion data. We analyzed 23 children (43% female) with a median age of 8.5 years (interquartile range [IQR] = 4–14.5). Median ICU LOS was 26 days (IQR = 15–47) with a median ECMO duration of 288 hours (IQR = 106–378) and a mortality rate of 35%. HTN was diagnosed in 87% subjects at a median of 25 ECMO hours (IQR = 9–54) of whom 55% were hypertensive >50% of their ECMO duration. AKI and fluid overload were documented in >50% of cohort. All but two subjects received at least one nephrotoxic medication, and nearly all received corticosteroids. Our data demonstrate that HTN is present in a preponderance of children supported with VV ECMO and appears within the first 3 days of cannulation. Underlying etiology is likely multifactorial.

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Section: Discussionmentioning

confidence: 99%

“…2 Systemic hypertension (HTN) has been identified in children requiring VV ECMO with the first published description in 2004. [3][4][5][6] The authors used the 1987 National Heart, Lung, and Blood Institute (NHLBI) guidelines to diagnose HTN. 7 They looked to correlate HTN for ≥1 hour with steroid use, renal insufficiency and degree of fluid overload.…”

mentioning

confidence: 99%

Systemic Hypertension in Pediatric Veno-Venous Extracorporeal Membrane Oxygenation

Rabinowitz¹,

McGregor²,

O’Connor³

et al. 2020

ASAIO Journal

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“…For neonates on extracorporeal membrane oxygenation (ECMO), a nicardipine infusion is recommended due to its rapid onset, titratability, low side effect profile, and low risk of hypotension [ 39 ]. However, the ECMO circuit’s expanded volume of distribution may result in a reduced antihypertensive effect that requires aggressive titration [ 40 ].…”

Section: Treatmentmentioning

confidence: 99%

“…34) For neonates on extracorporeal membrane oxygenation (ECMO), a nicardipine infusion is recommended due to its 34) rapid onset, titratability, low side effect profile, and low risk of hypotension. 39) However, the ECMO circuit's expanded volume of distribution may result in a reduced antihypertensive effect that requires aggressive titration. 40) Nicardipine has also been found to be safe and effective without any significant change in mean heart rate or any adverse effects in children post coartec tomy.…”

Section: Treatmentmentioning

confidence: 99%

Neonatal hypertension: concerns within and beyond the neonatal intensive care unit

Altemose

Dionne

2022

Clin Exp Pediatr

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Neonatal hypertension occurs in 1%–2% of neonates in the neonatal intensive care unit (NICU) although may be underdiagnosed. Blood pressure values in premature neonates change rapidly in the first days and weeks of life which may make it more difficult to recognize abnormal blood pressure values. In addition, the proper blood pressure measurement technique must be used to ensure the accuracy of the measured values as most blood pressure devices are not manufactured specifically for this population. In premature neonates, the cause of the hypertension is most commonly related to prematurity-associated complications or management while in term neonates is more likely to be due to an underlying condition. Both oral and intravenous antihypertensive medications can be used in neonates to treat high blood pressure although none are approved for use in this population by regulatory agencies. The natural history of most neonatal hypertension is that it resolves over the first year or two of life. Of concern are the various neonatal risk factors for later cardiovascular and kidney disease that are present in most NICU graduates. Prematurity increases the risk of adulthood hypertension while intrauterine growth restriction may even lead to hypertension during childhood. From neonates through to adulthood NICU graduates, this review will cover each of these topics in more detail and highlight the aspects of blood pressure management that are established while also highlighting where knowledge gaps exist.

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“…However, the risk of inducing myocardial dysfunction and dysrhythmia is theoretically lower in peripherally acting calcium channel blockers such as nicardipine. Several studies have explored the side effect profile and efficacy of nicardipine in infants but contemporary, direct comparisons between nicardipine and nitroprusside for infants after cardiac surgery are limited (6)(7)(8)(9)(10). In a 2020 systematic review of five randomized controlled trials in adult cardiac surgical patients, nicardipine and nitroprusside had similar abilities in reducing afterload (11).…”

mentioning

confidence: 99%

Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020*

Wong,

Mruk,

Grimaldi

et al. 2024

Pediatric Critical Care Medicine

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Objectives: Postoperative hypertension frequently occurs after surgery for congenital heart disease. Given safety concerns when using calcium channel blockers in infants along with the cost and side-effect profile of nitroprusside, we retrospectively assessed our experience of using nicardipine and nitroprusside for postoperative blood pressure control in infants who underwent surgery for congenital heart disease. We also investigated the cost difference between the medications. Design: This study was a single-center retrospective, pre-post chart review of patients who had surgery for congenital heart disease between 2016 and 2020. The primary aim was a noninferiority comparison of achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agent. Secondary comparisons included achievement of blood pressure goal at 2 hours after medication initiation, Vasoactive-Inotropic Score (VIS), and blood transfusion, crystalloid volume, and calcium needs. Setting: Academic quaternary-care center. Patients: Infants under 1 year old who required treatment for hypertension with nitroprusside (n = 71) or nicardipine (n = 52) within 24 hours of surgery for congenital heart disease. Interventions: None. Measurements and Main Results: We failed to identify any difference in proportion of patients that achieved blood pressure control at 1-hour after medication initiation (nitroprusside 52% vs. nicardipine 54%; p = 0.86), with nicardipine noninferior to nitroprusside within a 15% margin. Of patients who did not achieve control at 1-hour post-medication initiation, receiving nicardipine was associated with blood pressure control at 2 hours post-medication initiation (79% vs. 38%; p = 0.003). We also failed to identify an association between antihypertensive types and mean VIS scores, blood transfusion volumes, crystalloid volumes, and quantities of calcium administered. Index cost of using nitroprusside was 16 times higher than using nicardipine, primarily due to difference in wholesale cost. Conclusions: In our experience of achieving blood pressure control in infants after surgery for congenital heart disease (2016–2020), antihypertensive treatment with nicardipine was noninferior to nitroprusside. Furthermore, nicardipine use was significantly less expensive than nitroprusside. Our contemporary practice is therefore to use nicardipine in preference to nitroprusside.

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Nicardipine for the Treatment of Neonatal Hypertension During Extracorporeal Membrane Oxygenation

Cited by 7 publications

References 25 publications

Systemic Hypertension in Pediatric Veno-Venous Extracorporeal Membrane Oxygenation

Systemic Hypertension in Pediatric Veno-Venous Extracorporeal Membrane Oxygenation

Neonatal hypertension: concerns within and beyond the neonatal intensive care unit

Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020*

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