Hypertension in a Premature Baby: An Uncommon Cause

While dealing with extremely premature babies, doctors are accustomed to managing low blood pressure and shock. Hypertension is extremely uncommon; in fact, even coarctation that causes hypertension in adults commonly manifests as a shock in newborns. Max Super Speciality Hospital, Shalimar Bagh, had a pre-term baby with early onset sepsis and respiratory complications of prematurity that required intensive care. Within a few days, these conditions seemed to be coming under control, but unexpectedly, routine blood pressure recordings started showing readings consistently above normal. An echocardiogram showed a failing left ventricle, and renal function tests (RFT) started deteriorating - all pointing towards a hypertensive emergency. The baby was immediately started on intravenous anti-hypertensives and a workup for the cause of secondary hypertension was immediately begun. 

Renal ultrasound revealed a thrombus in the left renal artery, originating in the abdominal aorta. Subcutaneous enoxaparin was started and ressures could be controlled, but the need for anti-hypertensives persisted. The next day the right lower limb developed early features of ischemia, and repeat doppler showed that the thrombus had extended to occlude the right common iliac despite enoxaparin. Cardiology and CTVS consultation were taken, and the multidisciplinary team decided to shift to intravenous unfractionated heparin avoiding high-risk thrombolysis at this stage. 

The early detection, graded approach and experience of the multidisciplinary team worked, and the clinical parameters showed improvement and doppler documented gradual but consistent reduction in thrombus load. After two weeks of therapy, the baby was discharged after documenting the complete resolution of the thrombus and without any long-term sequelae.