| Abstrakt: |
Introduction:Control of hypertension in the intensive care unit is essential in the prevention of stroke, heart failure, and acute kidney injury. Administration of an oral agent that can safely and effectively control hypertension is helpful in weaning continuous pharmacologic infusions and reducing duration of stay. Calcium channel blockers have typically been avoided in children less than one year of age due to concerns for safety and efficacy in the setting of an underdeveloped sarcoplasmic reticulum. The purpose of this study was to review a single-institution experience with amlodipine in patients less than one year of age.Methods:Children less than one year of age with hypertension managed with amlodipine in a cardiovascular intensive care unit from 2009 to 2018 were retrospectively reviewed. Demographics, laboratory values, ventricle status, vitals, concurrent medications, and echocardiograms were reviewed for seven days following the initiation of amlodipine. Adverse effect analysis and effectiveness outcomes were compared between four groups: neonates, infants, single and biventricular hearts. Patients were excluded from analysis for extracorporeal membrane oxygenation, dialysis, ventricular assist devices, amlodipine administration within the previous month, or less than 48 hours of amlodipine administration.Results:Within the study period, 171 patients were eligible for inclusion (neonates n = 37 [22%]; infants n = 134 [78%]; single ventricle anatomy n = 64 [37%]; biventricular anatomy n = 107 [63%]). Amlodipine was initiated at a mean dose of 0.18 ? 0.12 mg/kg/d. Four patients discontinued amlodipine due to clinically significant hypotension. Calcium levels, liver, kidney, and cardiac function were not adversely affected. There were no major adverse events attributed to amlodipine. There was a 4.1% baseline reduction in systolic pressure by day 3 (p < 0.05) which increased to 5.5% by day 7 of therapy (p < 0.005). There were no statistically significant differences due to age or ventricle status.Conclusions:Amlodipine is well tolerated in children less than one year of age regardless of neonatal or ventricle status. Amlodipine should be considered safe and effective in children for control of hypertension regardless of age. |
