Clinical Research Article | Published:

Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates—AWAKEN]

  • A Correction to this article was published on 08 August 2018



Hypertension occurs in up to 3% of neonates admitted to the Neonatal Intensive Care Unit (NICU), and is a potentially under-recognized condition. The aim of this study was to examine the incidence of documented and undiagnosed hypertension from the 24-center Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database, and to assess risk factors for hypertension according to gestational age.


Diagnosed hypertension was documented if an infant had a discharge diagnosis of hypertension and/or discharged on antihypertensive medications. Undiagnosed hypertension was defined when infants did not have a diagnosis of hypertension, but >50% of the lowest mean, diastolic and systolic blood pressure recordings were >95th percentile for gestational age.


Of the 2162 neonates enrolled in the study, hypertension was documented in 1.8%. An additional 3.7% were defined as having undiagnosed hypertension. There was a significant correlation with neonatal hypertension and acute kidney injury (AKI). Additional risk factors for neonatal hypertension were hyperbilirubinaemia, Caucasian race, outborn, vaginal delivery, and congenital heart disease. Protective factors were small for gestational age, multiple gestations, and steroids for fetal maturation.


Neonatal hypertension may be an under-recognized condition. AKI and other risk factors predispose infants to hypertension.

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The following individuals served as collaborators and site investigators for the AWAKEN study. They collaborated in protocol development and review, local IRB submission, data collection, and participated in drafting or review of the manuscript:

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  • 08 August 2018

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  1. 1.

    Chaudhari, T. et al. Neonatal hypertension—a long-term pilot follow-up study. Res. Rep. Neonatol. 3, 37–43 (2013).

  2. 2.

    Flynn, J. T. Neonatal hypertension: diagnosis and management. Pediatr. Nephrol. 14, 332–341 (2000).

  3. 3.

    Flynn, J. T. Hypertension in the neonatal period. Curr. Opin. Pediatr. 24, 197–204 (2012).

  4. 4.

    Seliem, W. A., Falk, M. C., Shadbolt, B. & Kent, A. L. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr. Nephrol. 22, 2081–2087 (2007).

  5. 5.

    Carey, B. E. Neonatal systemic hypertension. Newborn. Infant. Nurs. Rev. 2, 105–110 (2002).

  6. 6.

    Batisky, D. L. Neonatal hypertension. Clin. Perinatol. 41, 529–542 (2014).

  7. 7.

    Dionne, J. M., Abitbol, C. L. & Flynn, J. T. Hypertension in infancy: diagnosis, management and outcome. Pediatr. Nephrol. 27, 17–32 (2012).

  8. 8.

    Watkinson, M. Hypertension in the newborn baby. Arch. Dis. Child Fetal Neonatal Ed. 86, F78–F88 (2002).

  9. 9.

    Sahu, R. et al. Systemic hypertension requiring treatment in the neonatal intensive care unit. J. Pediatr. 163, 84–88 (2013).

  10. 10.

    Sharma, D., Pandita, A. & Shastri, S. Neonatal hypertension: an undiagnosed condition, a review article. Curr. Hypertens. Rev. 10, 1–8 (2014).

  11. 11.

    Georgieff, M. K., Mills, M. M., Gomez-Marin, O. & Sinaiko, A. R. Rate of change of blood pressure in premature and full term infants from birth to 4 months. Pediatr. Nephrol. 10, 152–155 (1996).

  12. 12.

    Kent, A. L., Kecskes, Z., Shadbolt, B. & Falk, M. C. Blood pressure in the first year of life in healthy infants born at term. Pediatr. Nephrol. 22, 1743–1749 (2007).

  13. 13.

    Blowey, D. L., Duda, P. J., Stokes, P. & Hall, M. Incidence and treatment of hypertension in the neonatal intensive care unit. J. Am. Soc. Hypertens. 5, 478–483 (2011).

  14. 14.

    Zubrow, A. B. et al. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicentre study. J. Perinatol. 15, 470–479 (1995).

  15. 15.

    Adelman, R. D. Neonatal hypertension. Pediatr. Clin. North. Am. 25, 99–110 (1978).

  16. 16.

    Jetton, J. G. et al. Assessment of worldwide acute kidney injury epidemiology in neonates: design of a retrospective cohort study. Front. Pediatr. 4, 1–11 (2016).

  17. 17.

    Jetton J. G., et al. Neonatal acute kidney injury incidence and outcomes: Findings from the multi-center, multi-national Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) observational cohort study. Lancet Child Adoles. Health 1, 184–194 (2017).

  18. 18.

    Kent, A. L. & Chaudhari, T. Determinants of neonatal blood pressure. Curr. Hypertens. Rep. 15, 426–432 (2013).

  19. 19.

    Engle, W. D. Blood pressure in the very low birth weight neonate. Early Hum. Dev. 62, 97–130 (2001).

  20. 20.

    Cantinotti, M. et al. Strengths and limitations of current pediatric blood pressure nomograms: a global overview with a special emphasis on regional differences in neonates and infants. Hypertens. Res. 38, 577–587 (2015).

  21. 21.

    Kent, A. L., Kecskes, Z., Shadbolt, B. & Falk, M. C. Normative blood pressure data in the early neonatal period. Pediatr. Nephrol. 22, 1335–1341 (2007).

  22. 22.

    Task Force on Blood Pressure Control in Children. Report of the second task force on blood pressure control in children—1987. Pediatrics 79, 1–25 (1987).

  23. 23.

    Fanaroff, J. M. & Fanaroff, A. A. Blood pressure disorders in the neonate: hypotension and hypertension. Semin. Fetal Neonatal Med. 11, 174–181 (2006).

  24. 24.

    Jetton, J. G. & Askenazi, D. J. Update on acute kidney injury in the neonate. Curr. Opin. Pediatr. 24, 191–196 (2012).

  25. 25.

    Zappitelli, M. et al. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr. Res. 82, 569–573 (2017).

  26. 26.

    Seckl, J. R. Physiologic programming of the fetus. Clin. Perinatol. 25, 939–964 (1998).

  27. 27.

    Hsu, C. Y. et al. Elevated BP after AKI. JASN 27, 914–923 (2016).

  28. 28.

    Askenazi, D. J. et al. 3–5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 69, 184–189 (2006).

  29. 29.

    Vivante, A. et al. Childhood history of resolved glomerular disease and risk of hypertension during adulthood. JAMA 311, 1155–1157 (2014).

  30. 30.

    Guyton, A. C. Blood pressure control—special role of the kidneys and body fluids. Science 252, 1813–1816 (1991).

  31. 31.

    Stec, D. E., Hosick, P. A. & Granger, J. P. Bilirubin, renal hemodynamics, and blood pressure. Front. Pharmacol. 3, 1–7 (2012).

  32. 32.

    O’Sullivan, M. J., Kearney, P. J. & Crowley, M. J. The influence of some perinatal variables on neonatal blood pressure. Acta Pediatr. 85, 849–853 (1996).

  33. 33.

    Uhari, M. Changes in blood pressure during the first year of life. Acta Pediatr. Scand. 69, 613–617 (1980).

  34. 34.

    Vohr, B. R. et al. Early predictors of hypertension in prematurely born adolescents. Acta Pediatr. 99, 1812–1818 (2010).

  35. 35.

    Launer, L. J., Hofman, A. & Grobbee, D. E. Relation between birth weight and blood pressure: longitudinal study of infants and children. BMJ 307, 1451–1454 (1993).

  36. 36.

    Pejkovic, B., Peco-Antic, A. & Marinkovic-Eric, J. Blood pressure in non-critically ill preterm and full-term neonates. Pediatr. Nephrol. 22, 249–257 (2007).

  37. 37.

    LeFlore, J. L., Engle, W. D. & Rosenfeld, C. R. Determinants of blood pressure in very low birth weight neonates: lack of effect of antenatal steroids. Early Hum. Dev. 59, 37–50 (2000).

  38. 38.

    Kent, A. L. et al. Do maternal- or pregnancy-associated disease states affect blood pressure in the early neonatal period? Aust. N. Z. J. Obstet. Gynaecol. 49, 364–370 (2009).

  39. 39.

    Lurbe, E. et al. First-year blood pressure increase steepest in low birthweight newborns. J. Hypertens. 25, 81–86 (2007).

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The authors would also like to thank the outstanding work of the following clinical research personnel and colleagues for their involvement in AWAKEN: Ariana Aimani, Samantha Kronish, Ana Palijan, MD, Michael Pizzi—Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Laila Ajour, BS, Julia Wrona, BS—University of Colorado, Children’s Hospital Colorado, Aurora, Colorado, USA; Melissa Bowman, RN—University of Rochester, Rochester, New York, USA; Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse Cristina Pareja Valarezo, MD—Holtz Children’s Hospital, University of Miami, Miami, Florida, USA; Sarah Cashman, BS, Madeleine Stead, BS—University of Iowa Children’s Hospital, Iowa City, Iowa, USA; Jonathan Davis, MD, Julie Nicoletta, MD—Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA; Alanna DeMello—British Columbia Children’s Hospital, Vancouver, British Columbia, Canada; Lynn Dill, RN—University of Alabama at Birmingham, Birmingham, Alabama, USA; Emma Perez-Costas PhD—university of Alabama at Birmingham, Birmingham, Alabama, USA; Ellen Guthrie, RN—MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA, Nicholas L. Harris, BS, Susan M. Hieber, MSQM—C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA; Katherine Huang, Rosa Waters—University of Virginia Children’s Hospital, Charlottesville, Virginia, USA; Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell—Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA; Nilima Jawale, MD—Maimonides Medical Center, Brooklyn, New York, USA; Emily Kane—Australian National University, Canberra, Australia; Vijay Kher, DM, Puneet Sodhi, MBBS—Medanta Kidney Institute, The Medicity Hospital, Gurgaon, Haryana, India; Grace Mele—New York College of Osteopathic Medicine, Westbury, New York, USA; Patricia Mele, DNP—Stony Brook Children’s Hospital, Stony Brook, New York, USA; Charity Njoku, Tennille Paulsen, Sadia Zubair—Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA; Emily Pao—University of Washington, Seattle Children’s Hospital, Seattle, Washington, USA; Becky Selman RN, Michele Spear, CCRC—University of New Mexico Health Sciences Center Albuquerque, New Mexico, USA; Melissa Vega, PA-C—The Children’s Hospital at Montefiore, Bronx, New York, USA); and Leslie Walther RN—Washington University, St. Louis, Missouri, USA.

NKC Contributors

David T. Selewski5, MD, Subrata Sarkar5, MD, Alison Kent6, MD, Jeffery Fletcher6, PhD, Carolyn L Abitbol7, MD, Marissa DeFreitas7, MD, Shahnaz Duara, MD, Jennifer R. Charlton8, MD, Jonathon Swanson8, MD, Ronnie Guillet9, MD, Carl D’Angio9, MD, Ayesa Mian9, MD, Erin Rademacher9, MD, Maroun J. Mhanna10, MD, Rupesh Raina10, MD, Deepak Kumar10, MD, Namasivayam Ambalavanan11, MD, Ayse Akcan Arikan12, MD, Christopher J. Rhee12, MD, Stuart L. Goldstein13, MD, Amy T. Nathan13, MD, Alok Bhutada14, MD, Shantanu Rastogi14, MD, Elizabeth Bonachea15, MD, Susan Ingraham15, MD, John Mahan15, MD; Arwa Nada15, MBBCH, Patrick D.16 Brophy, MD, Tarah T. Colaizy16, MD, Jonathan M. Klein16, MD, F. Sessions Cole17, MD, T. Keefe Davis17, MD, Joshua Dower18, BS, Lawrence Milner18, MD, Alexandra Smith18, MD Mamta Fuloria19, MD, Kimberly Reidy19, MD, Frederick J. Kaskel19, MD, Jason Gien20, MD, Katja M. Gist20, DO, Mina H. Hanna21, MD, Sangeeta Hingorani22, MD, Michelle Starr22, MD, Catherine Joseph23, MD, Tara DuPont23, MD, Robin Ohls23, MD, Amy Staples23, MD, Surender Khokhar24, MD, Sofia Perazzo25, MD, Patricio E. Ray25, Mary Revenis25, MD, Anne Synnes26, MDCM, Pia Wintermark27, MD, and Michael Zappitelli27, MD


Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings for the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), as well as support for some of the AWAKEN investigators at UAB (LBJ, RJG). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB), and is funded by Children’s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Finally, the AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (CTSC, NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356).

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The authors declare no competing interests.

Correspondence to Alison L. Kent.

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