Stanford Amy H, Reyes Melanie, Rios Danielle R, Giesinger Regan E, Jetton Jennifer G, Bischoff Adrianne R, McNamara Patrick J
Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Division of Pediatric Nephrology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
J Clin Med. 2021 Sep 29;10(19):4519. doi: 10.3390/jcm10194519.
Neonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case series, enalapril, an angiotensin-converting enzyme (ACE) inhibitor, was started in neonates with systemic hypertension and echocardiography signs of LV diastolic dysfunction. A total of 11 patients were included with birth weight of 785 ± 239 grams and gestational age of 25.3 (24, 26.1) weeks. Blood pressure improvement was noticed within 2 weeks of treatment. Improvement in LV diastolic function indices were observed with a reduction in Isovolumic Relaxation Time (IVRT) from 63.1 ± 7.2 to 50.9 ± 7.4 msec and improvement in the left atrium size indexed to aorta (LA:Ao) from1.73 (1.43, 1.88) to 1.23 (1.07, 1.29). Neonatal systemic hypertension is often underappreciated in ex-preterm infants and may be associated with important maladaptive cardiac changes with long term implications. It is biologically plausible that identifying and treating LV diastolic dysfunction in neonates with systemic hypertension may have a positive modulator effect on cardiovascular health in childhood and beyond.
支气管肺发育不良（BPD）的早产儿中，新生儿高血压越来越受到关注；值得注意的是，这些婴儿中的一部分可能存在左心室（LV）舒张功能受损，需要及时治疗以尽量减少长期影响。在这个病例系列中，对患有系统性高血压且有左心室舒张功能障碍超声心动图表现的新生儿开始使用血管紧张素转换酶（ACE）抑制剂依那普利进行治疗。共纳入11例患者，出生体重为785±239克，胎龄为25.3（24，26.1）周。治疗2周内血压有所改善。观察到左心室舒张功能指标有所改善，等容舒张时间（IVRT）从63.1±7.2毫秒降至50.9±7.4毫秒，左心房与主动脉直径比值（LA:Ao）从1.73（1.43，1.88）改善至1.23（1.07，1.29）。新生儿系统性高血压在早产出院婴儿中常常未得到充分认识，可能与重要的心脏适应性改变有关，并具有长期影响。从生物学角度来看，识别并治疗患有系统性高血压的新生儿的左心室舒张功能障碍，可能对儿童期及以后的心血管健康产生积极的调节作用。
