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Antihypertensive drug exposure in premature infants from 1997 to 2013

Published online by Cambridge University Press:  17 October 2016

Srikanth Ravisankar ,
Devon Kuehn ,
Reese H. Clark ,
Rachel G. Greenberg ,
P. Brian Smith  and
Christoph P. Hornik
Srikanth Ravisankar
Affiliation:
Department of Pediatrics, East Carolina University, Greenville, North Carolina, United States of America
Devon Kuehn
Affiliation:
Department of Pediatrics, East Carolina University, Greenville, North Carolina, United States of America
Reese H. Clark
Affiliation:
Pediatrix Medical Group, Greenville, Sunrise, Florida, United States of America
Rachel G. Greenberg
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina, United States of America
P. Brian Smith
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina, United States of America
Christoph P. Hornik*
Affiliation:
Duke Clinical Research Institute, Durham, North Carolina, United States of America
*
Correspondence to: C. P. Hornik, MD, Assistant Professor of Pediatrics, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27715, United States of America. Tel: +1 919 668 8935; Fax: +1 919 668 7032; E-mail: christoph.hornik@duke.edu
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Abstract

Background

Systemic hypertension is increasingly recognised in premature infants. There is limited evidence regarding treatment, and most published treatment recommendations are based solely on expert opinions.

Methods

We identified all infants born ⩽32 weeks of gestation and ⩽1500 g birth weight discharged from one of 348 neonatal ICUs managed by the Pediatrix Medical Group between 1997 and 2013. We defined antihypertensive drugs as vasodilators, angiotensin-converting enzyme inhibitors, β receptor blockers, calcium channel blockers, and central α2 receptor agonists. We compared characteristics between infants who were treated with at least one antihypertensive drug during their initial hospitalisation and infants who were not prescribed antihypertensive drugs using Wilcoxon’s ranked sum test or Pearson’s χ2-test.

Results

We identified 2504/119,360 (2.1%) infants who required at least one antihypertensive drug. The median postnatal age of first exposure was 48 days (25th, 75th percentile 15, 86), and the median length of therapy was 6 days (1, 16). Hydralazine was the most commonly prescribed antihypertensive with 1280/2504 (51.1%) treated infants exposed to the drug. More than two antihypertensive drugs were administered in 582/2504 (23.2%) infants, and 199/2097 (9.5%) of the treated infants were discharged home on antihypertensive therapy. Infants who received antihypertensive drugs were of lower gestational age (p<0.001) and birth weight (p<0.001) compared with infants not prescribed antihypertensive drugs.

Conclusions

Our study is the largest to describe current antihypertensive drug exposure in a cohort of exclusively premature infants born ⩽32 weeks of gestation. We found wide variations in practice for treating hypertension in premature infants.

Keywords

Pharmacotherapyhypertensionneonateprematurityvery low birth weight
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 5 , July 2017 , pp. 905 - 911
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Copyright
© Cambridge University Press 2016 

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References

1. Seliem, WA, Falk, MC, Shadbolt, B, Kent, AL. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr Nephrol 2007; 22: 2081–2087.CrossRefGoogle ScholarPubMed
2. Alagappan, A, Malloy, MH. Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol 1998; 15: 3–8.CrossRefGoogle ScholarPubMed
3. Dionne, JM, Abitbol, CL, Flynn, JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol 2012; 27: 17–32.CrossRefGoogle ScholarPubMed
4. Blowey, DL, Duda, PJ, Stokes, P, Hall, M. Incidence and treatment of hypertension in the neonatal intensive care unit. J Am Soc Hypertens 2011; 5: 478–483.CrossRefGoogle ScholarPubMed
5. Sahu, R, Pannu, H, Yu, R, Shete, S, Bricker, JT, Gupta-Malhotra, M. Systemic hypertension requiring treatment in the neonatal intensive care unit. J Pediatr 2013; 163: 84–88.CrossRefGoogle ScholarPubMed
6. Hsieh, EM, Hornik, CP, Clark, RH, et al. Medication use in the neonatal intensive care unit. Am J Perinatol 2014; 31: 811–822.CrossRefGoogle ScholarPubMed
7. Singh, HP, Hurley, RM, Myers, TF. Neonatal hypertension. Incidence and risk factors. Am J Hypertens 1992; 5: 51–55.CrossRefGoogle ScholarPubMed
8. Buchi, KF, Siegler, RL. Hypertension in the first month of life. J Hypertens 1986; 4: 525–528.CrossRefGoogle ScholarPubMed
9. Skalina, ME, Kliegman, RM, Fanaroff, AA. Epidemiology and management of severe symptomatic neonatal hypertension. Am J Perinatol 1986; 3: 235–239.CrossRefGoogle ScholarPubMed
10. American Academy of Pediatrics Committee on Fetus and Newborn: routine evaluation of blood pressure, hematocrit, and glucose in newborns. Pediatrics 1993; 92: 474–476.CrossRefGoogle Scholar
11. de Swiet, M, Fayers, P, Shinebourne, EA. Systolic blood pressure in a population of infants in the first year of life: the Brompton study. Pediatrics 1980; 65: 1028–1035.CrossRefGoogle Scholar
12. Pejovic, B, Peco-Antic, A, Marinkovic-Eric, J. Blood pressure in non-critically ill preterm and full-term neonates. Pediatr Nephrol 2006; 22: 249–257.CrossRefGoogle ScholarPubMed
13. Kent, AL, Meskell, S, Falk, MC, Shadbolt, B. Normative blood pressure data in non-ventilated premature neonates from 28–36 weeks gestation. Pediatr Nephrol 2008; 24: 141–146.CrossRefGoogle ScholarPubMed
14. Lurbe, E, Garcia-Vicent, C, Torro, I, et al. First-year blood pressure increase steepest in low birthweight newborns. J Hypertens 2006; 25: 81–86.CrossRefGoogle Scholar
15. Zubrow, AB, Hulman, S, Kushner, H, Falkner, B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol 1995; 15: 470–479.Google ScholarPubMed
16. Friedman, AL, Hustead, VA. Hypertension in babies following discharge from a neonatal intensive care unit. A 3-year follow-up. Pediatr Nephrol 1987; 1: 30–34.CrossRefGoogle ScholarPubMed
17. O’Dea, RF, Mirkin, BL, Alward, CT, Sinaiko, AR. Treatment of neonatal hypertension with captopril. J Pediatr 1988; 113: 403–406.CrossRefGoogle ScholarPubMed
18. Guron, G, Friberg, P. An intact renin-angiotensin system is a prerequisite for normal renal development. J Hypertens 2000; 18: 123–137.CrossRefGoogle ScholarPubMed
19. Wells, TG, Bunchman, TE, Kearns, GL. Treatment of neonatal hypertension with enalaprilat. J Pediatr 1990; 117: 664–667.CrossRefGoogle ScholarPubMed
20. Mason, T, Polak, MJ, Pyles, L, Mullett, M, Swanke, C. Treatment of neonatal renovascular hypertension with intravenous enalapril. Am J Perinatol 1992; 9: 254–257.CrossRefGoogle ScholarPubMed
21. Flynn, JT. Neonatal hypertension: diagnosis and management. Pediatr Nephrol 2000; 14: 332–341.CrossRefGoogle ScholarPubMed
22. Sheftel, DN, Hustead, V, Friedman, A. Hypertension screening in the follow-up of premature infants. Pediatrics 1983; 71: 763–766.CrossRefGoogle ScholarPubMed
23. Arar, MY, Hogg, RJ, Arant, BS, Seikaly, MG. Etiology of sustained hypertension in children in the southwestern United States. Pediatr Nephrol 1994; 8: 186–189.CrossRefGoogle ScholarPubMed
24. Shah, AB, Hashmi, S, Sahulee, R, Pannu, H, Gupta-Malhotra, M. Characteristics of systemic hypertension in preterm children. J Clin Hypertens (Greenwich) 2015; 17: 364–370.CrossRefGoogle ScholarPubMed
25. Chu, PY, Hill, KD, Clark, RH, Smith, PB, Hornik, CP. Treatment of supraventricular tachycardia in infants: analysis of a large multicenter database. Early Hum Dev 2015; 91: 345–350.CrossRefGoogle ScholarPubMed
26. Hsu, DT, Zak, V, Mahony, L, et al. Enalapril in infants with single ventricle: results of a multicenter randomized trial. Circulation 2010; 122: 333–340.CrossRefGoogle ScholarPubMed