Neonatal arterial hypertension in nephro-urological malformations in a tertiary care hospital

Enalapril and Acute Kidney Injury in a Hypertensive Premature Newborn - Should It Be Used or Not?

Extremely low birth weight infants (birth weight ≤1000 g) have a significantly lower nephron number. The glomerular filtration rate (GFR) is usually sufficient under normal conditions but is unable to meet the needs during stress, which results in acute kidney injury (AKI). We describe the case of an extremely low birth weight infant (970 g) with a gestational age of 27 weeks (immature preterm) who was mechanically ventilated because of hyaline membrane disease. AKI with anuria and a rise in serum creatinine to 3.4 mg/dL developed in the second week. Diuresis was restored after diuretics and dopamine were administered intravenously and kidney function recovered in the next two weeks. However, he slowly became hypertensive, so intravenous enalapril was introduced in the 6^th week. After the third dose, he suffered another AKI. After cessation of enalapril, kidney function recovered over the next few days. Although angiotensin-converting enzyme inhibitors (ACEi) may cause kidney injury, it can be used with great caution in the treatment of hypertension or heart failure in preterm infants. There remains a real dilemma of whether enalapril should be used in extremely low birth weight immature infants.

Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors

The present article intends to provide an update of the article "Focus on prevention, diagnosis and treatment of hypertension in children and adolescents" published in 2013 (Spagnolo et al., Ital J Pediatr 39:20, 2013) in this journal. This revision is justified by the fact that during the last years there have been several new scientific contributions to the problem of hypertension in pediatric age and during adolescence. Nevertheless, for what regards some aspects of the previous article, the newly acquired information did not require substantial changes to what was already published, both from a cultural and from a clinical point of view. We felt, however, the necessity to rewrite and/or to extend other parts in the light of the most recent scientific publications. More specifically, we updated and extended the chapters on the diagnosis and management of hypertension in newborns and unweaned babies, on the use and interpretation of ambulatory blood pressure monitoring, and on the usefulness of and indications for physical activity. Furthermore, we added an entirely new section on the role that simple carbohydrates (fructose in particular) and uric acid may play in the pathogenesis of hypertension in pediatric age.

Minoxidil-associated anorexia in an infant with refractory hypertension

Minoxidil is a potent antihypertensive used as an adjunctive agent in refractory hypertension. It exerts an antihypertensive effect through two mechanisms: selective arterial vasodilation by activation of potassium channels in the vascular smooth muscle and stimulation of carotid and aortic baroreceptors, leading to downstream release of renin and norepinephrine. Although frequently cited in reviews of antihypertensive agents, limited data about the use of minoxidil in neonates are available. We describe an infant girl, born at 35 weeks of gestation, who was diagnosed with idiopathic hypertension after extensive diagnostic evaluation. Adequate blood pressure control was not achieved with captopril, amlodipine, and clonidine. Oliguria secondary to captopril and rapid-onset congestive heart failure due to persistent hypertension led to the introduction of intravenous agents labetalol and nitroprusside. Although adequate blood pressure control was achieved, attempts to transition back to oral agents were unsuccessful, prompting the use of minoxidil as an alternative agent. Although good blood pressure control was achieved, the infant's oral intake plummeted from 210 to 63 ml/kg/day. The anorexia quickly resolved after stopping minoxidil, and she was discharged home at 5 months of age receiving propranolol, amlodipine, and doxazosin. Use of the Naranjo adverse drug reaction probability scale indicated a definite relationship (score of 10) between the patient's development of anorexia and minoxidil therapy. To our knowledge, there have been no previous reports of minoxidil-associated anorexia in preterm or term infants. Clinicians should be aware that anorexia is a possible adverse effect of minoxidil in this patient population when initiating the drug in similar patients.

Hypertension in the neonatal period

PURPOSE OF REVIEW

Continued interest in neonatal hypertension has led to generation of new data on normal blood pressure (BP) values in neonates, identification of new causes of hypertension in the neonatal period, and improved insights into therapy.

RECENT FINDINGS

Normal BP in neonates depends on a variety of factors, including gestational age, postnatal age, and birth weight, and may be influenced by other antenatal conditions. The incidence of neonatal hypertension is low, and it is most often seen in infants with concurrent conditions such as chronic lung disease (CLD) or renal disease, or in those that have undergone umbilical arterial catheterization. Although few data exist on efficacy and safety of antihypertensive medications in neonates, a wide variety of medications have been utilized in those who do require treatment. Hypertension resolves over time in most infants, although robust long-term outcome data are lacking.

SUMMARY

Our understanding of neonatal hypertension continues to evolve. Although better data are available on normal BP and the incidence of hypertension, we still need studies focused on appropriate treatment and long-term prognosis.

Early urinary aldosterone excretion in very low birth weight infants

HYPOTHESIS/ INTRODUCTION: In the neonatal period, many factors may interfere with aldosterone production but data currently available are few and controversial. In this study we aim to assess the early urinary aldosterone excretion (UAE) in very low birth weight (VLBW) infants and to identify some possible clinical and biochemical variables that may influence this excretion.

MATERIALS AND METHODS

We conducted a prospective study in 30 VLBW infants. Aldosterone was measured in the first 72 hours of life in the urine and plasma and urinary electrolytes were determined. Demographic and clinical data were also recorded.

RESULTS

The exploratory analysis showed that a significant positive correlation exists between UAE and gestational age and birth weight and that infants with respiratory distress syndrome have higher urinary aldosterone levels than infants without respiratory distress, but only plasma sodium resulted a significant independent factor that negatively influenced UAE at linear regression analysis (coefficient -0.02, 95% confidence interval [-0.03; -0.004]; adjusted R(2) 0.33).

CONCLUSIONS

The renin-angiotensin-aldosterone system of VLBW infants seems to be able, even immediately after birth, to respond to variations of plasma sodium concentrations; measurement of UAE constitutes an interesting method to determine aldosterone production, avoiding blood sampling in neonates so small and frail as VLBW infants.

Hypertension in infancy: diagnosis, management and outcome

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 hypertension 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.