Oregon Health & Science University, 707 SW Gaines Rd, Mail Code CDRC-P, Portland, OR, 97239, USA.
Children's National Health System, Washington, DC, USA.
Pediatr Nephrol. 2017 Nov;32(11):2115-2124. doi: 10.1007/s00467-017-3722-4. Epub 2017 Jul 3.
Many causes for neonatal hypertension in premature infants have been described; however in some cases no etiology can be attributed. Our objectives are to describe such cases of unexplained hypertension and to compare hypertensive infants with and without chronic lung disease (CLD).
We reviewed all cases of hypertension in premature infants referred from 18 hospitals over 16 years. Inclusion criteria were hypertension occurring at <6 months of age and birth at <37 weeks gestation; the main exclusion criterion was known secondary hypertension. Continuous variables were compared using analysis of variance. Nominal variables were compared using chi-square tests.
A total of 97 infants met the inclusion criteria, of whom 37 had CLD. Among these infants, hypertension presented at a mean of 11.3 ± 3.2 chronological weeks of age and a postmenstrual age of 39.6 ± 3.6 weeks. Diagnostic testing was notable for plasma renin activity (PRA) being <11 ng/mL/h in 98% of hypertensive infants. Spironolactone was effective monotherapy in 51 of 56 cases of hypertension. Hypertension resolved in all infants, with an average treatment duration of 25 weeks. Significant differences between the two groups of infants were a 0.4 kg lower birthweight and a 2.5 weeks younger gestational age at birth in those with CLD (p < 0.01, p < 0.01, respectively). Hypertension presented in those with CLD 1.8 weeks later, but at the same postmenstrual age as those without CLD (p < 0.01, p = 0.45, respectively).
Premature infants with unexplained hypertension, with and without CLD, presented at a postmenstrual age of 40 weeks with low PRA, transient time course, and a favorable response to spironolactone treatment.
许多早产儿高血压的病因已被描述；然而，在某些情况下，无法归因于任何病因。我们的目的是描述这种不明原因的高血压病例，并比较有和没有慢性肺疾病（CLD）的高血压婴儿。
我们回顾了 16 年来来自 18 家医院的所有早产儿高血压病例。纳入标准为出生 <37 周且 <6 个月龄时发生高血压；主要排除标准为已知继发性高血压。连续变量采用方差分析比较。名义变量采用卡方检验比较。
共有 97 名婴儿符合纳入标准，其中 37 名患有 CLD。在这些婴儿中，高血压平均出现在 11.3±3.2 个校正周龄和 39.6±3.6 个孕周时。诊断性检查的特点是 98%的高血压婴儿的血浆肾素活性（PRA）<11ng/mL/h。螺内酯是 56 例高血压婴儿中 51 例的有效单药治疗。所有婴儿的高血压均得到缓解，平均治疗持续时间为 25 周。两组婴儿之间有显著差异，患有 CLD 的婴儿出生体重低 0.4kg，胎龄小 2.5 周（分别为 p<0.01，p<0.01）。患有 CLD 的婴儿高血压出现时间晚 1.8 周，但与无 CLD 的婴儿相同的孕周（分别为 p<0.01，p=0.45）。
有和没有 CLD 的不明原因高血压早产儿，在胎龄 40 周时出现低 PRA、短暂时间过程，对螺内酯治疗有良好反应。
