Department of Pediatrics, Division of Neonatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, P.O. Box 11, Woden, ACT, 2606, Australia.
Pediatr Nephrol. 2019 Jun;34(6):1009-1018. doi: 10.1007/s00467-018-3996-1. Epub 2018 Jul 5.
Hypertension is encountered in up to 3% of neonates and occurs more frequently in neonates requiring hospitalization in the neonatal intensive care unit (NICU) than in neonates in newborn nurseries or outpatient clinics. Former NICU neonates are at higher risk of hypertension secondary to invasive procedures and disease-related comorbidities. Accurate measurement of blood pressure (BP) remains challenging, but new standardized methods result in less measurement error. Multiple factors contribute to the rapidly changing BP of a neonate: gestational age, postmenstrual age (PMA), birth weight, and maternal factors are the most significant contributors. Given the natural evolution of BP as neonates mature, a percentile cutoff of 95% for PMA has been the most common definition used; however, this is not based on outcome data. Common causes of neonatal hypertension are congenital and acquired renal disease, history of umbilical arterial catheter placement, and bronchopulmonary dysplasia. The treatment of neonatal hypertension has mostly been off-label, but as evidence accumulates, the safety of medical management has increased. The prognosis of neonatal hypertension remains largely unknown and thankfully most often resolves unless secondary to renovascular disease, but further research is needed. This review discusses important factors related to neonatal hypertension including BP measurement, determinants of BP, and management of neonatal hypertension.
高血压在多达 3%的新生儿中出现，在需要住院治疗的新生儿重症监护病房（NICU）中比在新生儿病房或门诊中更为常见。前 NICU 新生儿由于侵入性操作和与疾病相关的合并症而更容易发生高血压。准确测量血压（BP）仍然具有挑战性，但新的标准化方法可减少测量误差。多种因素导致新生儿的血压迅速变化：胎龄、孕周（PMA）、出生体重和母体因素是最重要的因素。鉴于 BP 随着新生儿成熟而自然演变，最常用的定义是 PMA 的 95%百分位截断值；然而，这并不是基于结果数据。新生儿高血压的常见原因是先天性和获得性肾脏疾病、脐动脉导管放置史和支气管肺发育不良。新生儿高血压的治疗大多是非标签的，但随着证据的积累，药物治疗的安全性已经提高。新生儿高血压的预后在很大程度上仍然未知，幸运的是，除非继发于肾血管疾病，否则通常会得到解决，但仍需要进一步研究。本文讨论了与新生儿高血压相关的重要因素，包括 BP 测量、BP 的决定因素和新生儿高血压的治疗。
