Prevalence and factors associated with hypertension among neonates admitted to the NICU, Kawempe National Referral Hospital.

Abstract

Background Neonatal hypertension is a known complication amongst sick neonates that requires urgent attention. This raises the need to have the condition diagnosed during routine care check-up of sick neonates. However, blood pressures are not usually routinely monitored in many health units in Uganda hence the diagnosis is missed even in very sick neonates. The aim of this study was to determine the prevalence and factors associated with hypertension among neonates admitted to a Neonatal Intensive Care Unit (NICU) in Uganda. Methods This was a cross sectional study involving neonates admitted to NICU in Kawempe hospital between November 2020 & April 2021. We consecutively selected 428 neonates and had their blood pressure taken on the day of recruitment using an oscillometric blood pressure machine (Omron©). A diagnosis of hypertension was made in those whose average blood pressure was >95th centile for age. Independent variables like gestational age, mode of delivery, history of chronic illnesses like hypertension were collected using a questionnaire and results like serum creatinine, from blood samples taken noted. Data was analyzed using Stata Version 15 as descriptive statistics, the prevalence of hypertension was calculated as the proportion of neonates with hypertension out of the total neonates enrolled, and logistic regression for the associations. Results: Of the 428 neonates assessed, 234(53.4%) were female. The mean gestational age(±SD) in weeks was 37.3±3.1 with a median post-menstrual age (IQR) of 38.1(36.1-40.1), 65.5% had a birthweight ≥ 2500gm. Of the 428 enrolled participants, 30 (7.0%) had hypertension and 25/30 (84.3%) of these neonates were born before 37weeks of gestation. Gestational age was the only factor found to be significantly associated with hypertension (aOR=67.5, 95% CI-6.74-675.8 p=<0.001). Acute Kidney Injury was not associated with hypertension in this study. Conclusion and recommendations: The prevalence of hypertension in this study population at 7% was relatively high. Neonates with a lower gestational age were found to have higher odds of having hypertension in this study. We recommend that all neonates, especially pre-terms, admitted to the NICU have their blood pressures monitored during admission to enable early diagnosis and prompt management of hypertension. Further studies are needed to evaluate the etiology and consequences for hypertension amongst neonates in resource limited settings. Keywords: Neonate, Hypertension, Pre-terms, Acute kidney injury