Anemia of Prematurity - Portal Neonatal

FOLLOW-UP Section 8 of 10
Further Inpatient Care:
• Monitor BP regularly until the infant is ready for discharge from the NICU. Infants treated
with ACE inhibitors or diuretics should have their renal function monitored periodically until
discharge.
• Arrangements for home BP monitoring should be part of the discharge plan for any infant
sent home on antihypertensive therapy. The optimal device for home BP measurements in
an infant is a Dinamap or similar oscillometric device. A second choice is a Doppler device
(only measures systolic BP).
Further Outpatient Care: Include BP measurement at all follow-up visits for infants with neonatal
hypertension. In addition, monitor infants with BPD at discharge and those who had complicated
NICU courses for the development of hypertension following discharge.
In/Out Patient Meds: Refer to preceding sections.
Transfer: Occasionally, infants may need to be transferred to specialized centers for advanced
diagnostic or therapeutic procedures, such as angiography or vascular surgery.
Deterrence/Prevention: Although several studies have examined the role of placement of umbilical
artery catheters (ie, low versus high lines), no definitive proof has emerged that changes in catheter
placement can prevent thromboembolism and the subsequent development of hypertension.
Complications: As mentioned above, the long-term sequelae of neonatal hypertension on renal
growth, renal function, and future BP are unknown at this time. Long-term effects related to certain
antihypertensive medications (eg, ACE inhibitors, calcium channel blockers) are also unknown.
These infants may need to be monitored closely even after their hypertension has resolved,
particularly with respect to renal growth and the redevelopment of hypertension in later childhood.
Prognosis:
• The long-term prognosis for most infants with hypertension is quite good. For infants with
hypertension related to an umbilical arterial catheter, the hypertension usually resolves over
time. These infants may require increases in their antihypertensive medications in the first
several months following discharge from the nursery as they undergo rapid growth.
Following this, weaning the patient off antihypertensive therapy is usually possible by
making no further dose increases as the infant continues to grow. Home BP monitoring by
the parents is a crucially important component of this process. Provide proper equipment,
either a Doppler or oscillometric device, for all infants discharged from the NICU on longterm
antihypertensive medications. Such infants may benefit from referral to a
comprehensive pediatric hypertension clinic if their primary care physicians are
inexperienced in managing hypertension.
• Other forms of neonatal hypertension may persist beyond infancy. In particular, PKD and
other forms of renal parenchymal disease may continue to cause hypertension throughout
childhood. Infants with RVT may also remain hypertensive, and some of these children
ultimately benefit from nephrectomy. Persistent or recurrent hypertension may also be
observed in children who have undergone repair of renal arterial stenosis or coarctation of
the aorta. Reappearance of hypertension in these situations should prompt a search for
restenosis using the appropriate imaging studies.