1
|
Gaffar S, Ramanathan R, Easterlin MC. Common Clinical Scenarios of Systemic Hypertension in the NICU. Neoreviews 2024; 25:e36-e49. [PMID: 38161177 DOI: 10.1542/neo.25-1-e36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Hypertension affects ∼1% to 3% of newborns in the NICU. However, the identification and management of hypertension can be challenging because of the lack of data-driven diagnostic criteria and management guidelines. In this review, we summarize the most recent approaches to diagnosis, evaluation, and treatment of hypertension in neonates and infants. We also identify common clinical conditions in neonates in whom hypertension occurs, such as renal vascular and parenchymal disease, bronchopulmonary dysplasia, and cardiac conditions, and address specific considerations for the evaluation and treatment of hypertension in those conditions. Finally, we discuss the importance of ongoing monitoring and long-term follow-up of infants diagnosed with hypertension.
Collapse
Affiliation(s)
- Sheema Gaffar
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Molly Crimmins Easterlin
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
2
|
Goneidy A, Saxena AK. Choice of topical substances in the conservative management of Exomphalos - A systematic review. Acta Paediatr 2023; 112:2293-2299. [PMID: 37674328 DOI: 10.1111/apa.16961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
AIM Exomphalos is a congenital anomaly found in 1/4500 newborns. Choice of non-operative management of exomphalos major unamenable to primary repair is controversial. This study aims at reviewing conservative management modalities and compare outcomes and complications. METHODS A systematic review was performed according to PRISMA guidelines of all English publications in MEDLINE and EMBASE databases. Search words were exomphalos OR omphalocoele AND conservative OR non-operative AND management. Studies were scrutinised for patient demographics, co-morbidities, mode of treatment, time to full feeds, time to full epithelialisation, length of stay, complications and mortality. Studies not specifically describing mode of management and/or describing primary or staged surgical repairs were excluded. RESULTS Initial search resulted in 1243 studies. Forty-two studies were deemed suitable offering 822 patients for analysis after excluding duplicates and non-eligible studies. Management methods varied including painting with Alcohol, Mercurochrome, silver products, Povidone Iodine, honey and other materials. Mortality was mostly due to associated anomalies. There was mixed reporting of alcohol, silver, Povidone Iodine and mercury toxicity as well as infection during the course of treatment. CONCLUSION This report has recognised the variations in topical substances employed for conservative management with no clear consensus. Reports on safety of different methods remain unclear.
Collapse
Affiliation(s)
- Ayman Goneidy
- Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
| | - Amulya K Saxena
- Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
| |
Collapse
|
3
|
Abstract
Neonatal hypertension is uncommon but is becoming increasingly recognized. Normative blood pressure data are limited, as is research regarding the risks, treatment, and long-term outcomes. Therefore, there are no clinical practice guidelines and management is based on clinical judgment and expert opinion. Recognition of neonatal hypertension requires proper blood pressure measurement technique. When hypertension is present there should be a thorough clinical, laboratory, and imaging evaluation to promptly diagnose causes needing medical or surgical management. This review provides a practical overview for the practicing clinician regarding the identification, evaluation, and management of neonatal hypertension.
Collapse
Affiliation(s)
- Rebecca Hjorten
- Department of Pediatrics, Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point Way NE, OC.9.820 - Nephrology, Seattle, WA 98105, USA
| | - Joseph T Flynn
- Department of Pediatrics, Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point Way NE, OC.9.820 - Nephrology, Seattle, WA 98105, USA.
| |
Collapse
|
4
|
Abstract
Hypertension in neonates is increasingly recognized because of improvements in neonatal intensive care that have led to improved survival of premature infants. Although normative data on neonatal blood pressure remain limited, several factors appear to be important in determining blood pressure levels in neonates, especially gestational age, birth weight and maternal factors. Incidence is around 1% in most studies and identification depends on careful blood pressure measurement. Common causes of neonatal hypertension include umbilical catheter associated thrombosis, renal parenchymal disease, and chronic lung disease, and can usually be identified with careful diagnostic evaluation. Given limited data on long-term outcomes and use of antihypertensive medications in these infants, clinical expertise may need to be relied upon to decide the best approach to treatment. This review will discuss these concepts and identify evidence gaps that should be addressed.
Collapse
Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, And Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA.
| |
Collapse
|
5
|
Alexander G, Silva J, Curi B, Yancy J, Bogojevic A, Gaither K. Giant Omphalocele Complicated by 9P Minus Syndrome. J Natl Med Assoc 2020; 113:51-53. [PMID: 32747314 DOI: 10.1016/j.jnma.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Omphalocele is characterized as a ventral wall defect in which there exists a midline herniation of abdominal viscera into the base of the umbilical cord. Fetuses with a diagnosis of this entity are at a significantly increased risk of having an aneuploidy, additional anomalies, or associations with other syndromes such as Beckwith Wiederman. Secondary to these interconnections, there is an elevated risk of fetal loss in affected pregnancies. Detection of concordant abnormalities, appropriate genetic counseling, and involvement of pediatric subspecialties are paramount in affording a prognosis, and providing optimal perinatal management of omphalocele.
Collapse
Affiliation(s)
| | - Jessica Silva
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | - Berenice Curi
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | - Jana Yancy
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY
| | | | - Kecia Gaither
- NYC Health+Hospital/Lincoln, Department of Ob/Gyn, Bronx, NY.
| |
Collapse
|
6
|
Starr MC, Flynn JT. Neonatal hypertension: cases, causes, and clinical approach. Pediatr Nephrol 2019; 34:787-799. [PMID: 29808264 PMCID: PMC6261698 DOI: 10.1007/s00467-018-3977-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/12/2018] [Accepted: 05/01/2018] [Indexed: 12/24/2022]
Abstract
Neonatal hypertension is increasingly recognized as dramatic improvements in neonatal intensive care, advancements in our understanding of neonatal physiology, and implementation of new therapies have led to improved survival of premature infants. A variety of factors appear to be important in determining blood pressure in neonates, including gestational age, birth weight, and postmenstrual age. Normative data on neonatal blood pressure values remain limited. The cause of hypertension in an affected neonate is often identified with careful diagnostic evaluation, with the most common causes being umbilical catheter-associated thrombosis, renal parenchymal disease, and chronic lung disease. Clinical expertise may need to be relied upon to decide the best approach to treatment in such patients, as data on the use of antihypertensive medications in this age group are extremely limited. Available data suggest that long-term outcomes are usually good, with resolution of hypertension in most infants. In this review, we will take a case-based approach to illustrate these concepts and to point out important evidence gaps that need to be addressed so that management of neonatal hypertension may be improved.
Collapse
Affiliation(s)
- Michelle C. Starr
- Division of Nephrology, Department of Pediatrics, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Joseph T. Flynn
- Division of Nephrology, Department of Pediatrics, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
7
|
Roux N, Jakubowicz D, Salomon L, Grangé G, Giuseppi A, Rousseau V, Khen-Dunlop N, Beaudoin S. Early surgical management for giant omphalocele: Results and prognostic factors. J Pediatr Surg 2018; 53:1908-1913. [PMID: 29803304 DOI: 10.1016/j.jpedsurg.2018.04.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Giant omphalocele often represents a major surgical challenge and is reported with high mortality and morbidity rates. The aim of this study was to assess the outcome of neonates with giant omphalocele managed with early operative surgical treatment, and subsequently to identify possible factors that could alter the prognosis. METHODS We reviewed the medical records of 29 consecutive newborns with prenatally diagnosed giant omphalocele. In these cases one of two procedures had been performed: either staged closure after silo, or immediate closure with a synthetic patch. The cases were separated into 2 groups: Isolated giant omphalocele (IO group) and giant omphalocele associated with malformation (NIO group). RESULTS Infants in the IO group had a lower size of the omphalocele (p<0,001), a shorter hospital stay (95 days [45-915] vs. 41.5 days [10-110] p= 0, 02), and a shorter median ventilation length (10 days [1-33] vs. 27, 5 [6-65] p = 0, 05). In the NIO group, 5 cases displayed a significantly more difficult course than the others. They were compared to the remaining cases for prenatal and anatomic features. Four factors associated with greater morbidity were identified: CONCLUSIONS: Isolated omphalocele, even containing the whole liver, has a very good prognosis with early surgical treatment. Without associated anomalies, 95% of giant omphaloceles can be discharged with a median of 41.5 days in hospital. However, associated anomalies (especially cardiopathies) may burden the prognosis and should be both carefully assessed during pregnancy and taken into account in parental information. TYPE OF STUDY Retrospective Study LEVEL OF EVIDENCE: Level I.
Collapse
Affiliation(s)
- Nathalie Roux
- Department of Obstetrics, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Déborah Jakubowicz
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Laurent Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Gilles Grangé
- Department of Obstetrics, Maternité Port Royal, APHP, Paris, France
| | - Agnès Giuseppi
- Department of Neonatal Medecine, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Véronique Rousseau
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Naziha Khen-Dunlop
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Sylvie Beaudoin
- Department of Paediatric Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France.
| |
Collapse
|
8
|
Santana S, Salci T, Andriato P, Bonfim-Mendonça P, Caparroz-Assef S, Negri M, Svidzinski T. Diagnosis and management of a fatal case of sepsis caused by Candida parapsilosis sensu stricto in a neonate with omphalocele. Med Mycol Case Rep 2018; 20:10-14. [PMID: 29348997 PMCID: PMC5768148 DOI: 10.1016/j.mmcr.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/20/2017] [Accepted: 01/09/2018] [Indexed: 11/02/2022] Open
Abstract
We present a fatal case of persistent neonatal candidemia by Candida parapsilosis following omphalocele, without other anomalies. Despite an encouraging initial prognosis, after surgical correction and closure of the abdominal wall the case became difficult to treat, as in addition to the exposure of the patient to multiple risk factors for candidemia, antifungal therapy apparently was not adequate.
Collapse
Affiliation(s)
- Simone Santana
- Medical Mycology Division, State University of Maringá, Av. Colombo, 5790, CEP 87020-900 Maringá, Paraná, Brazil
| | - Tania Salci
- Department of Pharmacology, State University of Maringá, Av. Colombo, 5790, CEP 87020-900 Maringá, Paraná, Brazil
| | - Patricia Andriato
- Department of Pharmacology, State University of Maringá, Av. Colombo, 5790, CEP 87020-900 Maringá, Paraná, Brazil
| | - Patricia Bonfim-Mendonça
- Medical Mycology Division, State University of Maringá, Av. Colombo, 5790, CEP 87020-900 Maringá, Paraná, Brazil
| | - Silvana Caparroz-Assef
- Department of Pharmacology, State University of Maringá, Av. Colombo, 5790, CEP 87020-900 Maringá, Paraná, Brazil
| | - Melyssa Negri
- Medical Mycology Division, State University of Maringá, Av. Colombo, 5790, CEP 87020-900 Maringá, Paraná, Brazil
| | - Terezinha Svidzinski
- Medical Mycology Division, State University of Maringá, Av. Colombo, 5790, CEP 87020-900 Maringá, Paraná, Brazil
| |
Collapse
|
9
|
Hutson S, Baerg J, Deming D, St Peter SD, Hopper A, Goff DA. High Prevalence of Pulmonary Hypertension Complicates the Care of Infants with Omphalocele. Neonatology 2017; 112:281-286. [PMID: 28704835 DOI: 10.1159/000477535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Omphalocele is one of the most common abdominal wall defects. Many newborn infants born with omphalocele present with significant respiratory distress at birth, requiring mechanical ventilatory support, and have clinical evidence of pulmonary hypertension. Little information exists on the prevalence of and risk factors associated with pulmonary hypertension in this cohort of infants. OBJECTIVES To describe the prevalence of and risk factors associated with pulmonary hypertension among infants with omphalocele. METHODS This is a multicenter retrospective chart review of demographic data and clinical characteristics of infants with omphalocele admitted to the neonatal intensive care units of Loma Linda University Children's Hospital and Children's Mercy Hospital between 1994 and 2011. Echocardiogram images were reviewed for pulmonary hypertension, and statistical analyses were performed to identify risk factors associated with the presence of pulmonary hypertension. RESULTS Pulmonary hypertension was diagnosed in 32/56 (57%) infants with omphalocele. Compared to infants without pulmonary hypertension, infants with pulmonary hypertension were more likely to have a liver-containing defect (16/32 [50%] vs. 5/24 [21%], p = 0.03), require intubation at birth (18/32 [56%] vs. 6/24 [17%], p = 0.03), and die during initial hospitalization (12/32 [38%] vs. 2/24 [8%], p = 0.01). CONCLUSION The majority of infants with omphalocele have evidence of pulmonary hypertension which is associated with increased mortality. Echocardiograms to screen for pulmonary hypertension should be obtained at ≥2 days of life in infants with omphalocele, especially in those with liver within the omphalocele sac and/or in those infants who require intubation at birth to screen for pulmonary hypertension.
Collapse
Affiliation(s)
- Shandee Hutson
- Department of Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | | | | | | | | | | |
Collapse
|
10
|
Lamquami S, Mamouni N, Errarhay S, Bouchikhi C, Banani A. Antenatal diagnosis of isolated omphalocele. Pan Afr Med J 2015; 21:233. [PMID: 26523175 PMCID: PMC4607970 DOI: 10.11604/pamj.2015.21.233.7151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 07/19/2015] [Indexed: 11/23/2022] Open
Abstract
The concern of obstetric and surgical teams is when diagnosis of omphalocele, the care of the newborn and the prognosis of the malformation, mainly linked to the existence of associated malformations or chromosomal abnormalities. In our case of isolated omphalocele, the overall prognosis was good.
Collapse
Affiliation(s)
- Safae Lamquami
- Gynaecology and Obstetrics Department I, University Hospital Hassan II, Fez, Morocco
| | - Nisrine Mamouni
- Gynaecology and Obstetrics Department I, University Hospital Hassan II, Fez, Morocco
| | - Sanae Errarhay
- Gynaecology and Obstetrics Department I, University Hospital Hassan II, Fez, Morocco
| | - Chahrazzad Bouchikhi
- Gynaecology and Obstetrics Department I, University Hospital Hassan II, Fez, Morocco
| | - Abdelaziz Banani
- Gynaecology and Obstetrics Department I, University Hospital Hassan II, Fez, Morocco
| |
Collapse
|