Hypertension

Evidence  

https://www.e-cep.org/journal/view.php?number=20125555532 

Kathleen Altemose and Janis M. Dionne 

Some neonates, especially those who are premature, may experience hypertension while in the neonatal intensive care unit (NICU). The most common causes are prematurity-related, and the hypertension usually resolves over the first 1–2 years of life. Unfortunately, the increasing population of NICU graduates is at risk for later cardiovascular and kidney disease in childhood and adulthood. This population requires careful attention to blood pressure and weight throughout their life course. 

Education 

What is blood pressure? 
Blood pressure is how hard the blood pushes on the walls of the blood vessels when the heart pumps. 

• The top number (systolic) shows the pressure when the heart beats. 

• The bottom number (diastolic) shows the pressure when the heart rests. 

Blood pressure measurements are written this way: 120/80 mmHg (millimeter Mercury as the unit of blood pressure) 

What is high blood pressure (Hypertension)? 

High blood pressure means the numbers are higher than they should be. This can happen if: 

• The baby has a problem with the heart or kidneys. 

• The baby was born early (premature). 

• The baby has chronic lung disease. 

• There was a blood clot in a kidney blood vessel (sometimes from a tube in the belly button or because the baby was very unwell after birth). 

• The baby has certain illnesses, tumours, thyroid problems, or inherited conditions (problems that run in families). 

• Some medicines or drugs can also cause high blood pressure. 

What are the signs? 
Most babies don’t show any signs, so it can be easy to miss. Sometimes, signs do appear, but they usually come from the health problem that is causing the high blood pressure, not the blood pressure itself. These may include: 

• Blue-looking skin 

• Not growing or gaining weight 

• Getting sick often with urine (wee) infections 

• Looking pale 

• Breathing fast 

If the blood pressure is very high, a baby may have: 

• Irritability (very unsettled) 

• Seizures (fits) 

• Trouble breathing 

• Vomiting 

Blood pressure rises as the baby grows. Like weight and other measurements in babies, there is a range what is considered a normal blood pressure at different ages. It is normal that blood pressure varies depending of the level of activity of the baby (sleeping or awake or hungry) and time of day. The diagnosis of high blood pressure is never made just from a single measurement alone. For a baby born at term in the first week of life, the upper limit of what is considered a normal blood pressure is approximately 90/60 mmHg. The normal values in the first two years of life then depend on the body size and sex of the child. No single number will apply for all infants.  

If the blood pressure stays high over a number of measurements on different days, the healthcare team may give medicines. These will help lower the blood pressure and keep the heart and kidneys safe. The medicine and dose are chosen carefully for each baby.

Babies in the neonatal unit have their blood pressure checked often. This helps doctors and nurses see if treatment is working and to keep the baby safe. 

It is important that babies born early and those that were unwell after birth and needed admission to the neonatal unit have regular blood pressure checks throughout childhood and when becoming young adults. 

Empowerment  

Having a baby in the neonatal unit can feel overwhelming, especially if your baby has high blood pressure. Remember you are an important part of your baby’s care team. 

• Stay involved: You can be with your baby during checks and ask the doctors or nurses to explain what the blood pressure numbers mean. 

• Ask questions: If you don’t understand something, it’s okay to ask again. Your baby’s healthcare team wants you to feel confident and included. 

• Healthy routines matter: Once your baby is stable, things like a healthy diet, safe play, and regular check-ups as they grow will support their heart and blood pressure. 

• Follow the care plan: Even if your baby looks well, medicines, special feeds, or regular blood pressure checks may still be needed.  

• You are not alone: Many parents feel scared or worried. Talking to your baby’s healthcare team, support groups, or other families who have been in the neonatal unit can help. 

Useful Links 

Hypertension Australia 

https://www.hypertension.org.au 

Health Direct Australia 

https://www.healthdirect.gov.au/what-is-a-healthy-blood-pressure 

The Stroke Foundation 

https://strokefoundation.org.au/about-stroke/prevent-stroke/high-blood-pressure 

The Heart Foundation  

https://www.heartfoundation.org.au/bundles/your-heart/blood-pressure-and-your-heart 

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