Pediatric emergency medicine trisk 2466 2466
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parenchymal renal disease, and chronic lung disease of prematurity. Additionally,
coarctation of the aorta, hyperthyroidism, congenital adrenal hyperplasia (CAH),
and increased intracranial pressure can cause neonatal hypertension and can be
life threatening if left untreated. Most infants with hypertension are
asymptomatic. When symptoms are present, they are often nonspecific (lethargy,
poor feeding, apnea) and do not necessarily correlate with the degree of
hypertension. Initial evaluation should include blood pressure measurement in all
four extremities, urinalysis, urine culture, blood urea nitrogen, serum creatinine,
electrolytes, and calcium. It is important to note that the absence or presence of
hematuria, proteinuria, or azotemia vary in this age group and cannot be used in
isolation to diagnose renovascular disease. If the history and physical
examination are suggestive of endocrine, neurologic, or intoxication causes of
hypertension, additional testing may be needed. Renal ultrasonography (US) with
Doppler evaluation should also be included to evaluate for renovascular and
parenchymal disease. Echocardiography should be considered to assess left
ventricular function. Determining when to institute pharmacotherapy for
hypertension is based on the underlying etiology, severity of hypertension, and
presence of symptoms. The decision to initiate therapy should be done in
consultation with pediatric nephrologist.
