Neonatal hypertension: cases, causes, and clinical approach

Pediatr Nephrol. 2019 May;34(5):787-799. doi: 10.1007/s00467-018-3977-4. Epub 2018 May 28.


Neonatal hypertension is increasingly recognized as dramatic improvements in neonatal intensive care, advancements in our understanding of neonatal physiology, and implementation of new therapies have led to improved survival of premature infants. A variety of factors appear to be important in determining blood pressure in neonates, including gestational age, birth weight, and postmenstrual age. Normative data on neonatal blood pressure values remain limited. The cause of hypertension in an affected neonate is often identified with careful diagnostic evaluation, with the most common causes being umbilical catheter-associated thrombosis, renal parenchymal disease, and chronic lung disease. Clinical expertise may need to be relied upon to decide the best approach to treatment in such patients, as data on the use of antihypertensive medications in this age group are extremely limited. Available data suggest that long-term outcomes are usually good, with resolution of hypertension in most infants. In this review, we will take a case-based approach to illustrate these concepts and to point out important evidence gaps that need to be addressed so that management of neonatal hypertension may be improved.

Keywords: Antihypertensive therapy; Chronic lung disease; Kidney disease; Neonate; Prematurity.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Intravenous
  • Antihypertensive Agents / administration & dosage*
  • Antihypertensive Agents / adverse effects
  • Birth Weight / physiology
  • Blood Pressure / drug effects
  • Blood Pressure / physiology*
  • Blood Pressure Determination / instrumentation
  • Blood Pressure Determination / methods
  • Clinical Decision-Making
  • Gestational Age
  • Humans
  • Hydralazine / administration & dosage
  • Hydralazine / adverse effects
  • Hypertension / diagnosis*
  • Hypertension / epidemiology
  • Hypertension / etiology
  • Hypertension / therapy
  • Incidence
  • Infant, Newborn
  • Infant, Newborn, Diseases / diagnosis*
  • Infant, Newborn, Diseases / epidemiology
  • Infant, Newborn, Diseases / etiology
  • Infant, Newborn, Diseases / therapy
  • Infant, Premature / physiology*
  • Intensive Care Units, Neonatal
  • Kidney / physiopathology
  • Kidney / surgery
  • Labetalol / administration & dosage
  • Labetalol / adverse effects
  • Neuroblastoma / complications
  • Neuroblastoma / surgery
  • Reference Values
  • Renal Artery Obstruction / complications
  • Renal Artery Obstruction / surgery
  • Severity of Illness Index
  • Treatment Outcome


  • Antihypertensive Agents
  • Hydralazine
  • Labetalol