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Copyright (c) 2025 Fahad Saud Mohammad Alsulaiman, Khawlah Ali Hamad Hakami, Hind Mkhoot Alfhigi, Slama Abdallah Aldukhil Allah, Salha Shahi Alanzi, Arwa Ghunaim Aldhaferi, Masiraha Hawaj Noman Aljameeli, Saimah Hassan Ibrahim Habib, Sameer Ali Ibrahim Zakri, Ehdaa Kazim Mohammed Yahya, Esahaq Yacop Aljubili, Al-Hanouf Suleiman Al-Numan, Atallah Ateya Badi Alruwaili
This work is licensed under a Creative Commons Attribution 4.0 International License.
Nursing Management of Neonatal Hypertension in the Neonatal Intensive Care Unit-An Updated Review
Corresponding Author(s) : Fahad Saud Mohammad Alsulaiman
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Neonatal hypertension is increasingly recognized as a clinically significant condition, particularly among premature infants in neonatal intensive care units. Historically, limited normative blood pressure data and variability in measurement methods hindered early diagnosis and management. The condition arises from multifactorial etiologies, including prematurity-related complications, renal pathology, cardiovascular abnormalities, genetic factors, and environmental exposures.
Aim: This review aims to provide an updated, comprehensive overview of the nursing management of neonatal hypertension, emphasizing diagnostic approaches, etiologic considerations, monitoring techniques, and evidence-based treatment strategies.
Methods: A narrative review methodology was employed, synthesizing current literature related to blood pressure measurement techniques, pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, management, prognosis, and interprofessional collaboration in neonatal hypertension.
Results: Accurate diagnosis relies on repeated blood pressure measurements using standardized invasive or noninvasive methods. Prematurity and renal disorders remain the leading causes. Nonrenal factors—such as bronchopulmonary dysplasia, endocrine disorders, and environmental exposures—also contribute. Management centers on addressing underlying causes, optimizing nursing surveillance, and employing pharmacologic or surgical treatments when indicated. Early intervention mitigates risks of end-organ damage, including renal injury, cardiac dysfunction, and neurologic sequelae. Effective care requires interprofessional coordination among neonatologists, nephrologists, nurses, pharmacists, and caregivers.
Conclusion: Neonatal hypertension is a complex, multifactorial condition requiring vigilant nursing assessment, accurate monitoring, and individualized treatment. Early recognition, thorough evaluation, and targeted management substantially improve outcomes, while structured interprofessional collaboration enhances continuity of care and long-term health.
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- Adelman RD. Neonatal hypertension. Pediatr Clin North Am. 1978 Feb;25(1):99-110.
- Seliem WA, Falk MC, Shadbolt B, Kent AL. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr Nephrol. 2007 Dec;22(12):2081-7.
- Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol. 2012 Jan;27(1):17-32.
- Flynn JT. Hypertension in the neonatal period. Curr Opin Pediatr. 2012 Apr;24(2):197-204.
- O'Shea J, Dempsey EM. A comparison of blood pressure measurements in newborns. Am J Perinatol. 2009 Feb;26(2):113-6.
- Dionne JM, Bremner SA, Baygani SK, Batton B, Ergenekon E, Bhatt-Mehta V, Dempsey E, Kluckow M, Pesco Koplowitz L, Apele-Freimane D, Iwami H, Klein A, Turner M, Rabe H., International Neonatal Consortium. Method of Blood Pressure Measurement in Neonates and Infants: A Systematic Review and Analysis. J Pediatr. 2020 Jun;221:23-31.e5.
- Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM., SUBCOMMITTEE ON SCREENING AND MANAGEMENT OF HIGH BLOOD PRESSURE IN CHILDREN. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017 Sep;140(3)
- de Swiet M, Dillon MJ, Littler W, O'Brien E, Padfield PL, Petrie JC. Measurement of blood pressure in children. Recommendations of a working party of the British Hypertension Society. BMJ. 1989 Aug 19;299(6697):497.
- Nascimento MC, Xavier CC, Goulart EM. Arterial blood pressure of term newborns during the first week of life. Braz J Med Biol Res. 2002 Aug;35(8):905-11.
- Sharma D, Farahbakhsh N, Shastri S, Sharma P. Neonatal hypertension. J Matern Fetal Neonatal Med. 2017 Mar;30(5):540-550.
- Sahu R, Pannu H, Yu R, Shete S, Bricker JT, Gupta-Malhotra M. Systemic hypertension requiring treatment in the neonatal intensive care unit. J Pediatr. 2013 Jul;163(1):84-8.
- Alagappan A, Malloy MH. Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol. 1998 Jan;15(1):3-8.
- Sharma D, Pandita A, Shastri S. Neonatal hypertension: an underdiagnosed condition, a review article. Curr Hypertens Rev. 2014;10(4):205-12.
- Giri P, Roth P. Neonatal Hypertension. Pediatr Rev. 2020 Jun;41(6):307-311.
- Jenkins RD. Phthalates cause a low-renin phenotype commonly found in premature infants with idiopathic neonatal hypertension. Pediatr Nephrol. 2023 Jun;38(6):1717-1724.
- Jenkins R, Farnbach K, Iragorri S. Elimination of Intravenous Di-2-Ethylhexyl Phthalate Exposure Abrogates Most Neonatal Hypertension in Premature Infants with Bronchopulmonary Dysplasia. Toxics. 2021 Apr 02;9(4)
- AlMaazmi A, Hagan J, Fernandes CJ, Gowda SH. Neonatal systemic hypertension across the PHIS database: An update. Int J Cardiol. 2023 Apr 01;376:49-53.
- Kilian K. Hypertension in neonates causes and treatments. J Perinat Neonatal Nurs. 2003 Jan-Mar;17(1):65-74; quiz 75-6.
- Sehgal A, Malikiwi A, Paul E, Tan K, Menahem S. Systemic arterial stiffness in infants with bronchopulmonary dysplasia: potential cause of systemic hypertension. J Perinatol. 2016 Jul;36(7):564-9.
- Skalina ME, Kliegman RM, Fanaroff AA. Epidemiology and management of severe symptomatic neonatal hypertension. Am J Perinatol. 1986 Jul;3(3):235-9.
- Gantenbein MH, Bauersfeld U, Baenziger O, Frey B, Neuhaus T, Sennhauser F, Bernet V. Side effects of angiotensin converting enzyme inhibitor (captopril) in newborns and young infants. J Perinat Med. 2008;36(5):448-52.
- Stanley JC, Zelenock GB, Messina LM, Wakefield TW. Pediatric renovascular hypertension: a thirty-year experience of operative treatment. J Vasc Surg. 1995 Feb;21(2):212-26; discussion 226-7.
- Xiao N, Starr M, Stolfi A, Hamdani G, Hashmat S, Kiessling SG, Sethna C, Kallash M, Matloff R, Woroniecki R, Sanderson K, Yamaguchi I, Cha SD, Semanik MG, Chanchlani R, Flynn JT, Mitsnefes M. Blood Pressure Outcomes in NICU-Admitted Infants with Neonatal Hypertension: A Pediatric Nephrology Research Consortium Study. J Pediatr. 2024 Jan;264:113765.
References
Adelman RD. Neonatal hypertension. Pediatr Clin North Am. 1978 Feb;25(1):99-110.
Seliem WA, Falk MC, Shadbolt B, Kent AL. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr Nephrol. 2007 Dec;22(12):2081-7.
Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol. 2012 Jan;27(1):17-32.
Flynn JT. Hypertension in the neonatal period. Curr Opin Pediatr. 2012 Apr;24(2):197-204.
O'Shea J, Dempsey EM. A comparison of blood pressure measurements in newborns. Am J Perinatol. 2009 Feb;26(2):113-6.
Dionne JM, Bremner SA, Baygani SK, Batton B, Ergenekon E, Bhatt-Mehta V, Dempsey E, Kluckow M, Pesco Koplowitz L, Apele-Freimane D, Iwami H, Klein A, Turner M, Rabe H., International Neonatal Consortium. Method of Blood Pressure Measurement in Neonates and Infants: A Systematic Review and Analysis. J Pediatr. 2020 Jun;221:23-31.e5.
Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM., SUBCOMMITTEE ON SCREENING AND MANAGEMENT OF HIGH BLOOD PRESSURE IN CHILDREN. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017 Sep;140(3)
de Swiet M, Dillon MJ, Littler W, O'Brien E, Padfield PL, Petrie JC. Measurement of blood pressure in children. Recommendations of a working party of the British Hypertension Society. BMJ. 1989 Aug 19;299(6697):497.
Nascimento MC, Xavier CC, Goulart EM. Arterial blood pressure of term newborns during the first week of life. Braz J Med Biol Res. 2002 Aug;35(8):905-11.
Sharma D, Farahbakhsh N, Shastri S, Sharma P. Neonatal hypertension. J Matern Fetal Neonatal Med. 2017 Mar;30(5):540-550.
Sahu R, Pannu H, Yu R, Shete S, Bricker JT, Gupta-Malhotra M. Systemic hypertension requiring treatment in the neonatal intensive care unit. J Pediatr. 2013 Jul;163(1):84-8.
Alagappan A, Malloy MH. Systemic hypertension in very low-birth weight infants with bronchopulmonary dysplasia: incidence and risk factors. Am J Perinatol. 1998 Jan;15(1):3-8.
Sharma D, Pandita A, Shastri S. Neonatal hypertension: an underdiagnosed condition, a review article. Curr Hypertens Rev. 2014;10(4):205-12.
Giri P, Roth P. Neonatal Hypertension. Pediatr Rev. 2020 Jun;41(6):307-311.
Jenkins RD. Phthalates cause a low-renin phenotype commonly found in premature infants with idiopathic neonatal hypertension. Pediatr Nephrol. 2023 Jun;38(6):1717-1724.
Jenkins R, Farnbach K, Iragorri S. Elimination of Intravenous Di-2-Ethylhexyl Phthalate Exposure Abrogates Most Neonatal Hypertension in Premature Infants with Bronchopulmonary Dysplasia. Toxics. 2021 Apr 02;9(4)
AlMaazmi A, Hagan J, Fernandes CJ, Gowda SH. Neonatal systemic hypertension across the PHIS database: An update. Int J Cardiol. 2023 Apr 01;376:49-53.
Kilian K. Hypertension in neonates causes and treatments. J Perinat Neonatal Nurs. 2003 Jan-Mar;17(1):65-74; quiz 75-6.
Sehgal A, Malikiwi A, Paul E, Tan K, Menahem S. Systemic arterial stiffness in infants with bronchopulmonary dysplasia: potential cause of systemic hypertension. J Perinatol. 2016 Jul;36(7):564-9.
Skalina ME, Kliegman RM, Fanaroff AA. Epidemiology and management of severe symptomatic neonatal hypertension. Am J Perinatol. 1986 Jul;3(3):235-9.
Gantenbein MH, Bauersfeld U, Baenziger O, Frey B, Neuhaus T, Sennhauser F, Bernet V. Side effects of angiotensin converting enzyme inhibitor (captopril) in newborns and young infants. J Perinat Med. 2008;36(5):448-52.
Stanley JC, Zelenock GB, Messina LM, Wakefield TW. Pediatric renovascular hypertension: a thirty-year experience of operative treatment. J Vasc Surg. 1995 Feb;21(2):212-26; discussion 226-7.
Xiao N, Starr M, Stolfi A, Hamdani G, Hashmat S, Kiessling SG, Sethna C, Kallash M, Matloff R, Woroniecki R, Sanderson K, Yamaguchi I, Cha SD, Semanik MG, Chanchlani R, Flynn JT, Mitsnefes M. Blood Pressure Outcomes in NICU-Admitted Infants with Neonatal Hypertension: A Pediatric Nephrology Research Consortium Study. J Pediatr. 2024 Jan;264:113765.