eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology
Neonatal Hypertension: Differential Diagnoses & Workup
Updated: Dec 4, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Renovascular conditions
Thromboembolism
Renal artery stenosis
Midabdominal aortic coarctation
Renal venous thrombosis
Compression of renal artery
Idiopathic arterial calcification
Congenital rubella syndrome
Renal parenchymal disease
Polycystic kidney disease
Multicystic-dysplastic kidney disease
Tuberous sclerosis
Ureteropelvic junction obstruction
Acute tubular necrosis
Cortical necrosis
Interstitial nephritis
Hemolytic-uremic syndrome
Pulmonary conditions
Bronchopulmonary dysplasia (BPD)
Pneumothorax
Cardiac conditions
Thoracic aortic coarctation
Endocrine conditions
Congenital adrenal hyperplasia
Hyperaldosteronism
Hyperthyroidism
Pseudohypoaldosteronism type II
Medications/Intoxications
Dexamethasone
Adrenergic agents
Vitamin D intoxication
Theophylline
Caffeine
Pancuronium
Phenylephrine
Maternal cocaine or heroin use
Tumors
Neoplasia
Wilms tumor
Mesoblastic nephroma
Neuroblastoma
Pheochromocytoma
Neurologic conditions
Pain
Intracranial hypertension
Seizures
Familial dysautonomia
Subdural hematoma
Miscellaneous conditions
Closure of abdominal wall defect
Adrenal hemorrhage
Hypercalcemia
Traction
Extracorporeal membrane oxygenation (ECMO)
Birth asphyxia
Urological neoplasms
Workup
Laboratory Studies
- Usually only a limited set of laboratory data are needed in the evaluation of neonatal hypertension. Obtain serum electrolyte, creatinine, and BUN levels as well as urinalysis in order to look for renal parenchymal disease. Obtain endocrinologic studies, such as cortisol, aldosterone, or thyroxine, when pertinent history is noted.
- Measurement of plasma renin activity (PRA) is usually recommended as part of the laboratory assessment in newborns with hypertension, although elevated peripheral renin levels may not signify the presence of underlying pathology because renin values are typically high in infancy. In addition, plasma renin levels may be falsely elevated by medications that are commonly used in the neonatal ICU (NICU), such as aminophylline. Furthermore, many laboratories have switched from measurement of PRA to the direct renin assay, which is easier to perform. However, normative values for the direct renin assay in neonates are not widely available. Keep these factors in mind when interpreting renin values.
- Alternatively, suppressed PRA in an infant with hypertension is a significant finding, possibly indicating the presence of a genetic form of hypertension associated with volume overload, such as glucocorticoid-remediable aldosteronism or Liddle Syndrome.
Imaging Studies
- Chest radiography may be helpful in infants with congestive heart failure (CHF) or in those with a murmur upon physical examination.
- Perform renal ultrasonography with Doppler of the renal vessels in all hypertensive infants. Accurate renal ultrasonography may help uncover potentially correctable causes of hypertension (eg, renal venous thrombosis [RVT]); it may detect aortic thrombi, renal arterial thrombi, or both; and it can reveal anatomic renal abnormalities or other congenital renal parenchymal disease. Ultrasonography is fast, noninvasive, and relatively inexpensive. Ultrasonography has largely replaced intravenous pyelography, which has little, if any, use in the routine assessment of neonatal hypertension.
- For infants with extremely severe blood pressure (BP) elevation, angiography may be necessary. Although some investigators have used aortography via the umbilical artery catheter, formal renal arteriography using the traditional femoral vascular approach is much more accurate for diagnosing renal arterial stenosis, primarily because of the high incidence of intrarenal branch vessel abnormalities observed in children with fibromuscular dysplasia (FMD). Depending on the expertise available, this may need to be deferred until the infant is larger. MR and CT angiography are of little value in infants as they do not provide sufficient resolution to identify branch vessel stenoses.
- Nuclear scanning may demonstrate abnormalities of renal perfusion caused by thromboembolic phenomenon, although obtaining good studies in infants is difficult because of their immature renal function.
- Obtain other studies, including echocardiography and voiding cystourethrography, as indicated.
More on Neonatal Hypertension |
| Overview: Neonatal Hypertension |
 Differential Diagnoses & Workup: Neonatal Hypertension |
| Treatment & Medication: Neonatal Hypertension |
| Follow-up: Neonatal Hypertension |
| References |
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References
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Further Reading
Keywords
neonatal hypertension, high blood pressure, high BP, premature infants, bronchopulmonary dysplasia, BPD, steroids, maternal hypertension, umbilical arterial catheter, postnatal acute renal failure, patent ductus arteriosus, chronic lung disease, congestive heart failure, cardiogenic shock, congenital adrenal hyperplasia, CAH, umbilical artery catheter–associated thromboembolism, renal venous thrombosis, RVT, renal artery stenosis, fibromuscular dysplasia, FMD, rubella, polycystic kidney disease, PKD, hydronephrotic kidney, nephromegaly, multicystic dysplastic kidney, congenital ureteropelvic junction obstruction, ureteral obstruction, hyperaldosteronism, hyperthyroidism, hypercalcemia, neuroblastoma, Wilms tumor, mesoblastic nephroma
