Shock cardiogénico por emergencia hipertensiva en un neonato

Abstract

Introduction : Neonatal arterial hypertension is unusual, mainly in previously healthy newborn children. Clinical presentations vary widely and, in some cases, it is a dramatic life-threatening event. Case report : A 6 days-old girl admitted to intensive care unit with severe cardiogenic shock and metabolic acidosis. Mechanical ventilation was initiated and inotropic support administered due to low systolic function (shortening fraction = 20%). After initial improvement, severe arterial hypertension was evidenced (systolic pressure 50 mmHg above 95 percentile). She had no umbilical catheterization. Renal doppler was normal. Laboratory analysis showed low platelet count and a raised D-dimer. Technecium 99-MAG 3 renal scan showed a decrease in renal flow in the upper right kidney, although magnetic angioresonance was normal. Myocardial function and arterial pressure returned to normal after digital and angiotensin-converting enzyme inhibitor therapy. After infections, low blood flow and anatomic causes were excluded, a believe that a perinatal microangiopathic event may lead to renal lesions with renovascular hypertension. Conclusion : Arterial hypertension must be included in the differential diagnosis of newborns with heart failure and acidosis, due to its severe clinical evolution and specific therapy.