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Open Access 06-04-2024 | Arterial Hypertension | RESEARCH

Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair

Authors: Clara Engel, Judith Leyens, Bartolomeo Bo, Lennart Hale, Hannah Lagos Kalhoff, Lotte Lemloh, Andreas Mueller, Florian Kipfmueller

Published in: European Journal of Pediatrics

Abstract

Pulmonary hypertension (PH) and cardiac dysfunction are established comorbidities of congenital diaphragmatic hernia (CDH). However, there is very little data focusing on arterial hypertension in CDH. This study aims to investigate the incidence of arterial hypertension in neonates with CDH at hospital discharge. Archived clinical data of 167 CDH infants who received surgical repair of the diaphragmatic defect and survived for > 60 days were retrospectively analyzed. Blood pressure (BP) values were averaged for the last 7 days before discharge and compared to standard BP values for sex, age, and height provided by the AHA in 2004. BP values reaching or extending the 95th percentile were defined as arterial hypertension. The use of antihypertensive medication was analyzed at discharge and during hospitalization. Arterial hypertension at discharge was observed in 19 of 167 infants (11.3%) of which 12 (63%) were not receiving antihypertensive medication. Eighty patients (47.9%) received antihypertensive medication at any point during hospitalization and 28.9% of 152 survivors (n = 44) received antihypertensive medication at discharge, although in 45.5% (n = 20) of patients receiving antihypertensive medication, the indication for antihypertensive medication was myocardial hypertrophy or frequency control. BP was significantly higher in ECMO compared to non-ECMO patients, despite a similar incidence of arterial hypertension in both groups (13.8% vs. 10.1%, p = 0.473). Non-isolated CDH, formula feeding, and minimal creatinine in the first week of life were significantly associated with arterial hypertension on univariate analysis. Following multivariate analysis, only minimal creatinine remained independently associated with arterial hypertension.

Conclusion: This study demonstrates a moderately high incidence of arterial hypertension in CDH infants at discharge and an independent association of creatinine values with arterial hypertension. Physicians should be aware of this risk and include regular BP measurements and test of renal function in CDH care and follow-up.

What is Known: • Due to decreasing mortality, morbidity is increasing in surviving CDH patients. • Pulmonary hypertension and cardiac dysfunction are well-known cardiovascular comorbidities of CDH.
What is New: • There is a moderately high incidence of arterial hypertension in CDH infants at discharge even in a population with frequent treatment with antihypertensive medication. • A more complicated hospital course (ECMO, higher degree of PH, larger defect size) was associated with a higher risk for arterial hypertension.

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Title: Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair
Authors: Clara Engel
Judith Leyens
Bartolomeo Bo
Lennart Hale
Hannah Lagos Kalhoff
Lotte Lemloh
Andreas Mueller
Florian Kipfmueller
Publication date: 06-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Arterial Hypertension
Arterial Hypertension
ECMO
ECMO
Pulmonary Hypertension
Pulmonary Hypertension
Pulmonary Hypertension
Pulmonary Hypertension
Diaphragmatic Hernia
Diaphragmatic Hernia
Acute Kidney Injury
Acute Kidney Injury
Published in: European Journal of Pediatrics
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-024-05509-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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