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High blood pressure - infants

Hypertension - infants

 

High blood pressure (hypertension) is an increase in the force of blood against the arteries in the body. This article focuses on high blood pressure in infants.

Causes

 

Blood pressure measures how hard the heart is working, and how healthy the arteries are. There are 2 numbers in each blood pressure measurement:

  • The first (top) number is the systolic blood pressure, which measures the force of blood released when the heart beats.
  • The second (bottom) number is the diastolic pressure, which measures the pressure in the arteries when the heart is at rest.

Blood pressure measurements are written this way: 120/80. One or both of these numbers can be too high.

Several factors affect blood pressure, including:

  • Hormones
  • The health of the heart and blood vessels
  • The health of the kidneys

High blood pressure in infants may be due to kidney or heart disease that is present at birth (congenital). Common examples include:

  • Coarctation of the aorta  (narrowing of the large blood vessel of the heart called the aorta)
  • Patent ductus arteriosus (blood vessel between the aorta and pulmonary artery that should close after birth, but remains open)
  • Bronchopulmonary dysplasia (lung condition that affects newborn babies who were either put on a breathing machine after birth or were born very early)
  • Kidney disease involving the kidney tissue
  • Renal artery stenosis (narrowing of the major blood vessel of the kidney)

In newborn babies, high blood pressure is often caused by a blood clot in a kidney blood vessel, a complication of having an umbilical artery catheter .

Other causes of high blood pressure in infants may include:

  • Certain medicines
  • Exposure to illegal drugs such as cocaine
  • Certain tumors
  • Inherited conditions (problems that run in families)
  • Thyroid problems

Blood pressure rises as the baby grows. The average blood pressure in a newborn is 64/41. The average blood pressure in a child 1 month through 2 years old is 95/58. It is normal for these numbers to vary.

 

Symptoms

 

Most babies with high blood pressure will not have symptoms. Instead, symptoms may be related to the condition causing the high blood pressure. These symptoms may include:

  • Bluish skin
  • Failure to grow and gain weight
  • Frequent urinary tract infections
  • Pale skin (pallor)
  • Rapid breathing

Symptoms that may appear if the baby has very high blood pressure include:

  • Irritability
  • Seizures
  • Trouble breathing
  • Vomiting

 

Exams and Tests

 

In most cases, the only sign of high blood pressure is the blood pressure measurement itself.

Signs of very high blood pressure include:

  • Heart failure
  • Kidney failure
  • Rapid pulse

Blood pressure in infants is measured with an automatic device.

If coarctation of the aorta is the cause, there may be decreased pulses or blood pressure in the legs. A click may be heard if a bicuspid aortic valve occurs with the coarctation.

Other tests in infants with high blood pressure will try to find the cause of the problem. Such tests may include:

  • A special type of x-ray that uses a dye to look at blood vessels (angiography)
  • Laboratory tests, including blood and urine tests
  • X-rays of the chest or abdomen
  • Ultrasounds, including an ultrasound of the working heart (echocardiogram) and of the kidneys
  • MRI of the blood vessels

 

Treatment

 

The treatment depends on the cause of high blood pressure in the infant. Treatment can include:

  • Dialysis to treat kidney failure
  • Medicines to lower blood pressure or help the heart pump better
  • Surgery (including transplantation surgery or repair of the coarctation)

 

Outlook (Prognosis)

 

How well the baby does depends on the cause of high blood pressure and other factors such as:

  • Other health problems in the baby
  • Whether damage (such as kidney damage) has occurred as a result of the high blood pressure

 

Possible Complications

 

Untreated, high blood pressure may lead to:

  • Heart or kidney failure
  • Organ damage
  • Seizures

 

When to Contact a Medical Professional

 

Call your health care provider if your baby:

  • Fails to grow and gain weight
  • Has bluish skin
  • Has frequent urinary tract infections
  • Seems irritable
  • Tires easily

Take your baby to the emergency department if your baby:

  • Has seizures
  • Is not responding
  • Is vomiting constantly

 

Prevention

 

Some causes of high blood pressure run in families. Talk to your provider before you get pregnant if you have a family history of:

  • Congenital heart disease
  • High blood pressure
  • Kidney disease

Also talk to your provider before becoming pregnant if you take medicine for a health problem. Exposure to certain drugs in the womb may increase your baby's risk of developing problems that can lead to high blood pressure.

 

 

Open References

References

Beard L, Neonatology. In: Engorn B, Flerlage J, eds. The Harriet Lane Handbook: A Manual for Pediatric House Officers . 20th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 18.

Lande MB. Systemic hypertension. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 445.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics . 2004;114 (2 Suppl 4th Report):555-576. PMID: 15286277 www.ncbi.nlm.nih.gov/pubmed/15286277 .

 
  • Umbilical catheter

    Umbilical catheter - illustration

    An umbilical catheter is a long, soft plastic tube (usually made of silicone) that is placed in the umbilical cord either through the umbilical artery or umbilical vein to allow IV fluids and medications to be given over an extended period of time.

    Umbilical catheter

    illustration

  • Coarctation of the aorta

    Coarctation of the aorta - illustration

    Coarctation of the aorta is a birth defect in which the aorta, the major artery from the heart, is narrowed. The narrowing results in high blood pressure before the point of coarctation and low blood pressure beyond the point of coarctation. Most commonly, coarctation is located so that there is high blood pressure in the upper body and arms and low blood pressure in the lower body and legs. Symptoms can include localized hypertension, cold feet or legs, decreased exercise performance, and heart failure.

    Coarctation of the aorta

    illustration

    • Umbilical catheter

      Umbilical catheter - illustration

      An umbilical catheter is a long, soft plastic tube (usually made of silicone) that is placed in the umbilical cord either through the umbilical artery or umbilical vein to allow IV fluids and medications to be given over an extended period of time.

      Umbilical catheter

      illustration

    • Coarctation of the aorta

      Coarctation of the aorta - illustration

      Coarctation of the aorta is a birth defect in which the aorta, the major artery from the heart, is narrowed. The narrowing results in high blood pressure before the point of coarctation and low blood pressure beyond the point of coarctation. Most commonly, coarctation is located so that there is high blood pressure in the upper body and arms and low blood pressure in the lower body and legs. Symptoms can include localized hypertension, cold feet or legs, decreased exercise performance, and heart failure.

      Coarctation of the aorta

      illustration

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

      Tests for High blood pressure - infants

       
       

      Review Date: 5/6/2016

      Reviewed By: Scott I Aydin, MD, Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Division of Pediatric Cardiology and Critical Care Medicine, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

       
       
       

       

       

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