Singh HP, Hurley RM, Myers TF. Neonatal hypertension. Incidence and risk factors. Am J Hypertens. 1992 Feb. 5(2):51-5. [QxMD MEDLINE Link].
Friedman AL, Hustead VA. Hypertension in babies following discharge from a neonatal intensive care unit. A 3-year follow-up. Pediatr Nephrol. 1987 Jan. 1(1):30-4. [QxMD MEDLINE Link].
Blowey DL, Duda PJ, Stokes P, Hall M. Incidence and treatment of hypertension in the neonatal intensive care unit. J Am Soc Hypertens. 2011 Nov-Dec. 5(6):478-83. [QxMD MEDLINE Link].
Neal WA, Reynolds JW, Jarvis CW, Williams HJ. Umbilical artery catheterization: demonstration of arterial thrombosis by aortography. Pediatrics. 1972 Jul. 50(1):6-13. [QxMD MEDLINE Link].
Hassan R, Verma RP. Neonatal hypertension. StatPearls [Internet]. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Abman SH, Warady BA, Lum GM, Koops BL. Systemic hypertension in infants with bronchopulmonary dysplasia. J Pediatr. 1984 Jun. 104(6):928-31. [QxMD MEDLINE Link].
Alagappan A, Malloy MH. Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol. 1998 Jan. 15(1):3-8. [QxMD MEDLINE Link].
Nickavar A, Assadi F. Managing hypertension in the newborn infants. Int J Prev Med. 2014 Mar. 5(Suppl 1):S39-43. [QxMD MEDLINE Link]. [Full Text].
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 Jul. 163(1):84-8. [QxMD MEDLINE Link].
Seliem WA, Falk MC, Shadbolt B, Kent AL. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr Nephrol. 2007 Dec. 22(12):2081-7. [QxMD MEDLINE Link].
Cho MH. Hypertension in adulthood is programmed during the perinatal period. Clin Exp Pediatr. 2022 Oct. 65(10):494-5. [QxMD MEDLINE Link]. [Full Text].
Altemose K, Dionne JM. Neonatal hypertension: concerns within and beyond the neonatal intensive care unit. Clin Exp Pediatr. 2022 Aug. 65(8):367-76. [QxMD MEDLINE Link]. [Full Text].
Shah AB, Hashmi SS, Sahulee R, Pannu H, Gupta-Malhotra M. Characteristics of systemic hypertension in preterm children. J Clin Hypertens (Greenwich). 2015 May. 17(5):364-70. [QxMD MEDLINE Link]. [Full Text].
Sharma D, Farahbakhsh N, Shastri S, Sharma P. Neonatal hypertension. J Matern Fetal Neonatal Med. 2017 Mar. 30(5):540-50. [QxMD MEDLINE Link].
Xiao N, Tandon A, Goldstein S, Lorts A. Cardiogenic shock as the initial presentation of neonatal systemic hypertension. J Neonatal Perinatal Med. 2013. 6(3):267-72. [QxMD MEDLINE Link].
Starr MC, Flynn JT. Neonatal hypertension: cases, causes, and clinical approach. Pediatr Nephrol. 2019 May. 34(5):787-99. [QxMD MEDLINE Link]. [Full Text].
Harer MW, Kent AL. Neonatal hypertension: an educational review. Pediatr Nephrol. 2019 Jun. 34(6):1009-18. [QxMD MEDLINE Link].
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 Nov-Dec. 15(6):470-9. [QxMD MEDLINE Link].
Pejovic B, Peco-Antic A, Marinkovic-Eric J. Blood pressure in non-critically ill preterm and full-term neonates. Pediatr Nephrol. 2007 Feb. 22(2):249-57. [QxMD MEDLINE Link].
Kent AL, Kecskes Z, Shadbolt B, Falk MC. Normative blood pressure data in the early neonatal period. Pediatr Nephrol. 2007 Sep. 22(9):1335-41. [QxMD MEDLINE Link].
Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol. 2012 Jan. 27(1):17-32. [QxMD MEDLINE Link].
Dionne JM, Abitbol CL, Flynn JT. Erratum to: Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol. 2012 Jan. 27(1):159-60. [QxMD MEDLINE Link].
Task Force on Blood Pressure Control in Children. Report of the Second Task Force on Blood Pressure Control in Children--1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics. 1987 Jan. 79(1):1-25. [QxMD MEDLINE Link].
Crossland DS, Furness JC, Abu-Harb M, et al. Variability of four limb blood pressure in normal neonates. Arch Dis Child Fetal Neonatal Ed. 2004 Jul. 89(4):F325-7. [QxMD MEDLINE Link].
Batisky DL. Neonatal hypertension. Clin Perinatol. 2014 Sep. 41(3):529-42. [QxMD MEDLINE Link].
Brierley J, Marks SD. Treating the causes of paediatric hypertension using non-invasive physiological parameters. Med Hypotheses. 2010 Nov. 75(5):439-41. [QxMD MEDLINE Link].
Costa HTML, Costa TX, Martins RR, Oliveira AG. Use of off-label and unlicensed medicines in neonatal intensive care. PLoS One. 2018. 13(9):e0204427. [QxMD MEDLINE Link]. [Full Text].
Pillai A, Sharma D, Kadam P. Hypertension in the neonatal period: an update. Curr Hypertens Rev. 2016. 12(3):186-95. [QxMD MEDLINE Link].

Table 1. Neonatal Blood Pressures and Potential Treatment Parameters. Adapted from Dionne et al.*

Postconceptual Age	50th Percentile	95th Percentile	99th Percentile
44 weeks
SBP	88	105	110
DBP	50	68	73
MAP	63	80	85
42 weeks
SBP	85	98	102
DBP	50	65	70
MAP	62	76	81
40 weeks
SBP	80	95	100
DBP	50	65	70
MAP	60	75	80
38 weeks
SBP	77	92	97
DBP	50	65	70
MAP	59	74	79
36 weeks
SBP	72	87	92
DBP	50	65	70
MAP	57	72	77
34 weeks
SBP	70	85	90
DBP	40	55	60
MAP	50	65	70
32 weeks
SBP	68	83	88
DBP	40	55	60
MAP	49	64	69
30 weeks
SBP	65	80	85
DBP	40	55	60
MAP	48	63	68
28 weeks
SBP	60	75	80
DBP	38	50	54
MAP	45	58	63
26 weeks
SBP	55	72	77
DBP	30	50	56
MAP	38	57	63

Table 2. Intravenous Drugs for Severe Hypertension in Neonates ^[21]

Drug	Class	Intravenous (IV) Dosage	Comments
Esmolol	Beta blocker	100-300 mcg/kg/min IV infusion	Very short acting; constant IV infusion necessary
Hydralazine	Vasodilator (arteriolar)	0.15-0.6 mg/kg/dose IV bolus or 0.75-5mcg/kg/min IV constant infusion	Tachycardia is frequent adverse effect; must administer every 4 hours when administered as IV bolus
Labetalol	Alpha blocker and beta blocker	0.2-1 mg/kg/dose IV bolus or 0.25-3 mg/kg/h IV constant infusion	Heart failure, bronchopulmonary dysplasia (BPD), relative contraindications
Nicardipine	Calcium channel blocker	1-5 mcg/kg/min IV constant infusion	May cause reflex tachycardia
Sodium nitroprusside	Vasodilator (arteriolar and venous)	0.5-10 mcg/kg/min IV constant infusion	Thiocyanate toxicity can occur with prolonged use (>72 h) or in renal failure; usual maintenance dose is below 2 mcg/kg/min; may use 10 mcg/kg/min for short duration (ie, < 10-15 min)

Table 3. Oral Antihypertensive Agents Useful for Treatment of Neonatal Hypertension ^[21]

Drug	Class	Oral Dosage	Comments
Captopril	Angiotensin-converting enzyme (ACE) inhibitor	Under age 3 months: 0.01-0.5 mg/kg/dose 3 times daily; not to exceed 2 mg/kg/day At or above age 3 months: 0.15-0.3 mg/kg/dose 3 times daily; not to exceed 6 mg/kg/day	Monitor serum creatinine and potassium levels
Clonidine	Central agonist	0.05-0.1 mg/dose 2-3 times daily	Adverse effects include dry mouth and sedation; rebound hypertension with abrupt discontinuation
Enalapril	ACE inhibitor	0.08-0.6 mg/kg/day, given once or twice daily	Monitor serum creatinine and potassium levels
Hydralazine	Vasodilator (arteriolar)	0.25-1 mg/kg/dose 3-4 times daily; not to exceed 7.5 mg/kg/day	Suspension stable up to 1 wk; tachycardia and fluid retention are common adverse effects; lupuslike syndrome may develop in slow acetylators
Isradipine	Calcium channel blocker	0.05-0.15 mg/kg/dose 4 times daily; not to exceed 0.8 mg/kg/d or 20 mg/day	Suspension may be compounded; useful for both acute and chronic hypertension
Amlodipine	Calcium channel blocker	0.1-0.3 mg/kg/dose twice daily; not to exceed 0.6 mg/kg/d or 20 mg/d	Less likely to cause sudden hypotension than isradipine
Minoxidil	Vasodilator (arteriolar)	0.1-0.2 mg/kg/dose 2-3 times daily	Most potent oral vasodilator; excellent for refractory hypertension
Propranolol	Beta-blocker	0.5-1 mg/kg/dose 3 times daily	Maximal dose depends on heart rate; may administer as much as 8-10 mg/kg/d if no bradycardia; avoid in infants with BPD
Labetalol	Alpha and beta blocker	1 mg/kg/dose 2-3 times daily, up to 12 mg/kg/d	Monitor heart rate; avoid in infants with BPD
Spironolactone	Aldosterone antagonist	0.5-1.5 mg/kg/dose twice daily	Potassium-sparing diuretic; monitor electrolytes; several days necessary to observe maximum effectiveness
Hydrochlorothiazide	Thiazide diuretic	2-3 mg/kg/d orally every day or divided twice daily	Monitor electrolytes
Chlorothiazide	Thiazide diuretic	5-15 mg/kg/dose twice daily	Monitor electrolytes

Back to List

Author

Joseph Flynn, MD, MS Chief, Division of Nephrology, Seattle Children's Hospital; Professor, Department of Pediatrics, University of Washington School of Medicine

Joseph Flynn, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, National Kidney Foundation, Phi Beta Kappa

Disclosure: Received consulting fee from Pfizer, Inc for review panel membership; Received royalty from UpToDate, Inc. for author; Received royalty from Spronger, Inc for authoring.

Chief Editor

Dharmendra J Nimavat, MD, FAAP Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine; Staff Neonatologist, Clinical Director, NICU Regional Perinatal Center, HSHS St John's Children's Hospital

Dharmendra J Nimavat, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Additional Contributors

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

Arun K Pramanik, MD, MBBS Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center

Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.