Antihypertensive drug exposure in premature infants from 1997 to 2013.
BACKGROUND
Systemic hypertension is increasingly recognised in premature infants. There is limited evidence regarding treatment, and most published treatment recommendations are based solely on expert opinions.


METHODS
We identified all infants born ⩽32 weeks of gestation and ⩽1500 g birth weight discharged from one of 348 neonatal ICUs managed by the Pediatrix Medical Group between 1997 and 2013. We defined antihypertensive drugs as vasodilators, angiotensin-converting enzyme inhibitors, β receptor blockers, calcium channel blockers, and central α2 receptor agonists. We compared characteristics between infants who were treated with at least one antihypertensive drug during their initial hospitalisation and infants who were not prescribed antihypertensive drugs using Wilcoxon's ranked sum test or Pearson's χ2-test.


RESULTS
We identified 2504/119,360 (2.1%) infants who required at least one antihypertensive drug. The median postnatal age of first exposure was 48 days (25th, 75th percentile 15, 86), and the median length of therapy was 6 days (1, 16). Hydralazine was the most commonly prescribed antihypertensive with 1280/2504 (51.1%) treated infants exposed to the drug. More than two antihypertensive drugs were administered in 582/2504 (23.2%) infants, and 199/2097 (9.5%) of the treated infants were discharged home on antihypertensive therapy. Infants who received antihypertensive drugs were of lower gestational age (p<0.001) and birth weight (p<0.001) compared with infants not prescribed antihypertensive drugs.


CONCLUSIONS
Our study is the largest to describe current antihypertensive drug exposure in a cohort of exclusively premature infants born ⩽32 weeks of gestation. We found wide variations in practice for treating hypertension in premature infants.
['Ravisankar|Srikanth|S|', 'Kuehn|Devon|D|', 'Clark|Reese H|RH|', 'Greenberg|Rachel G|RG|', 'Smith|P Brian|PB|', 'Hornik|Christoph P|CP|']
D000319:Adrenergic beta-Antagonists D000806:Angiotensin-Converting Enzyme Inhibitors D000959:Antihypertensive Agents D001794:Blood Pressure D002121:Calcium Channel Blockers D015331:Cohort Studies D016208:Databases, Factual D011307:Drug Prescriptions D005260:Female D005865:Gestational Age D006801:Humans D006973:Hypertension D007231:Infant, Newborn D007234:Infant, Premature D019102:Infant, Very Low Birth Weight D007363:Intensive Care Units, Neonatal D016015:Logistic Models D008297:Male D018811:Maternal Exposure D015999:Multivariate Analysis D014481:United States
prematurity hypertension neonate Pharmacotherapy very low birth weight