Kidney Week

Abstract: FR-PO0929

Timing and Initial Medication Patterns of Antihypertensive Therapy in Neonatal Hypertension of Unknown Etiology

Session Information

• Pediatric Nephrology: Genetic Diseases, Development, Neonatal Nephrology, Glomerular Diseases, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Yang, Emma, Cohen Children's Medical Center, New York, New York, United States

Emma Yang

• Castellanos, Laura J., Cohen Children's Medical Center, New York, New York, United States

Laura J. Castellanos, MD

• Basalely, Abby Miriam, Cohen Children's Medical Center, New York, New York, United States

Abby Miriam Basalely, MD, MS

• Shen, Carol L., Cohen Children's Medical Center, New York, New York, United States

Carol L. Shen, MD

• Frank, Rachel, Cohen Children's Medical Center, New York, New York, United States

Rachel Frank, CNN, RN

• Sethna, Christine B., Cohen Children's Medical Center, New York, New York, United States

Christine B. Sethna, MD, MEd

Background

Neonatal hypertension is uncommon and often occurs in medically complex infants. The timing of antihypertensive initiation and early treatment patterns remain incompletely characterized. This study described timing of antihypertensive initiation, initial medication choice, and selected pre-treatment neonatal exposures among NICU infants with hypertension of unknown etiology.

Methods

A retrospective cohort study was conducted of infants admitted to Northwell Health NICUs over a 10-year period who had neonatal hypertension of unknown etiology and received antihypertensive therapy. Secondary hypertension was excluded. Timing of initiation was calculated as days from birth to first antihypertensive administration. Gestational age, birthweight, first antihypertensive medication, and selected neonatal exposures occurring before first antihypertensive therapy, including necrotizing enterocolitis, sepsis, and umbilical line exposure, were summarized descriptively.

Results

Among 54 infants (70.4% male, gestational age 28.6 weeks [IQR 26–37], birthweight 1025 g [IQR 840–2695]), the median time to first antihypertensive initiation was 55.5 days [IQR 7.75–90.5]. Therapy began within the first week in 11 infants (20.4%). The most common initial agents were amlodipine in 18 (33.3%), clonidine in 11 (20.4%), hydralazine in 9 (16.7%), and enalapril in 8 (14.8%). Before initiation, sepsis was documented in 12 infants (22.2%), umbilical line exposure in 1 (1.9%), and necrotizing enterocolitis in none.

Conclusion

Antihypertensive therapy for neonatal hypertension of unknown etiology was initiated across a broad postnatal time range. Initial medication choice varied, suggesting heterogeneity in treatment approaches. These preliminary findings support further evaluation of blood pressure and antihypertensive initiation in NICU infants.

Funding

• NIDDK Support