Hypotension In Infants

What is hypotension in infants?

Hypotension is when your infant's blood pressure (BP) is lower than it should be. BP is the pressure inside your infant's blood vessel walls, created by the blood flowing through them. Organs, including the brain, kidneys, and intestines (bowels), need enough blood and oxygen to work properly. With hypotension, your infant's organs may not get enough blood to work well. Your infant's hypotension may be mild, severe (very bad), or life-threatening.

What causes hypotension in infants?

The exact cause of hypotension in infants is not always known. Ask your infant's caregiver for more information about the following:

• Adrenal gland problems: The adrenal glands produce a hormone (body chemical) called cortisol. Cortisol supports the body during times of stress by helping control BP. When your infant is born too early, his adrenal glands may not be fully developed. Your infant's body may not make enough cortisol to support the stress on his body from being born early. Low cortisol may impair the function of your infant's heart, leading to hypotension. Your infant may also have adrenal gland problems if you received steroid medicines before giving birth.
  
  
• Blood loss: Blood loss can decrease the pressure in your infant's blood vessels, causing hypotension. Blood loss may occur during birth, because of an injury to your infant's organs, or due to another medical problem.
  
  
• Heart problems: Your infant may have been born with a heart problem that caused his hypotension. A heart infection and abnormal heartbeats may lead to hypotension. Your infant's heart may not pump as strongly as it should. Your infant may also have an abnormal opening near his heart called a patent ductus arteriosis (PDA). Normally, the ductus arteriosis opening closes after a baby is born. With a PDA, the opening does not close, causing blood to flow the wrong way in the infant's heart. A PDA can lead to hypotension and decreased blood flow to your infant's organs.
  
  
• Medicines: Infants born with high BP may be given medicines to lower their BP, leading to hypotension.
  
  
• Sepsis: Sepsis is an infection in the blood. Sepsis can also lead to septic shock. With septic shock, your infant's BP drops very low and decreases blood flow to his organs and tissues.

What increases my infant's risk of having hypotension?

• Low birth weight and preterm infants: Infants who weigh very little when they are born are at higher risk for hypotension. The smaller the infant is, the higher the risk is for hypotension. The highest risk is for infants who weigh less than 1000 grams (2.2 pounds) at birth. Your infant may be low birth weight because he was born too early. Your infant's heart may not be fully developed if he is born early, leading to hypotension.
  
  
• Medical conditions: Medical conditions, such as necrotizing enterocolitis (dead bowel tissue) may lead to hypotension. If the electrolytes (body salts) in your infant's blood are off balance, he is more likely to have hypotension. Electrolytes include sodium (salt), potassium, bicarbonate, and calcium. When your infant has an electrolyte imbalance, his blood may have too much acid in it, leading to hypotension.
  
  
• Needing a ventilator: A ventilator is a machine that breathes for your infant when he cannot breathe well on his own. The ventilator may cause increased pressure in your infant's chest, leading to hypotension.

What are the signs and symptoms of hypotension in infants?

Your infant may have no symptoms of hypotension. Signs and symptoms may include any of the following:

• Your infant may be breathing faster than what is normal.
  
  
• Your infant's arms, hands, legs, and feet may feel cold.
  
  
• Your infant's heartbeat may be faster or slower than it should be.
  
  
• Your infant's skin may look pale (lighter than usual) or mottled (spotted with different colors).
  
  
• Your infant may be urinating very little or not at all.

How is hypotension in infants diagnosed?

Your infant's caregiver may check and monitor your infant's BP at certain times, or constantly. To check your infant's BP at certain times, a BP cuff is placed on his arm or leg. The BP cuff is attached to a machine and will tighten on your infant's arm or leg when checking his BP. The caregiver may also insert a catheter (tube) into your infant's artery (blood vessel) to monitor his BP constantly. Your infant's caregiver will also check your infant's heart and how well blood is flowing through his body. Your infant's caregiver will also watch how much, and how often, your infant is urinating.

What tests may be needed if my infant has hypotension?

The following tests may help caregivers learn more about your infant's hypotension. The tests may also help your infant's caregiver plan the best treatment for your infant. Ask your infant's caregiver about these and other tests your infant may need:

• Blood gases: These tests are also called arterial blood gases (ABGs). Blood is taken from one of your infant's arteries. ABGs may be done if your infant has trouble breathing or other problems caused by his illness.
  
  
• Blood tests: Your infant may need blood taken for tests. The blood may be taken from your infant's arm, hand, finger, foot, heel, or IV. An IV is a tube placed in your infant's vein (blood vessel). Blood tests can give caregivers more information about your infant's health condition. Your infant may need to have blood drawn more than once.
  
  
• Capillary refill time: A caregiver will press an area of your infant's skin, usually a finger or toe, until it becomes white. The caregiver will let go and count how many seconds it takes for the area to turn pink. Testing your infant's capillary refill time can show caregivers how well your infant's blood is moving through his body.
  
  
• Echocardiogram: This test is also called an echo. Sound waves are used to show pictures of the size and shape of your infant's heart. The echo can also show how well the heart is pumping and how well blood flows through it. The echo pictures are shown on a TV-like screen. The whooshing noise that you may hear is the sound of blood flowing through the heart.

How is hypotension in infants treated?

If your infant's organs are getting enough blood and oxygen, he may not need treatment for his hypotension. Caregivers will watch your infant closely for signs of poor organ blood flow. Treating your infant's hypotension may resolve his symptoms and correct his BP. Treatment may improve the blood flow to his organs and allow him to grow and develop as he should. Ask your infant's caregiver for more information about these and other treatments your infant may need:

• Medicines:
  
  
  • Antibiotics: Your infant may be given antibiotic (germ-killing) medicine if his hypotension is caused by a blood infection.
    
    
  • Heart medicines: Heart medicines may be given to increase your infant's blood pressure. Heart medicines may also improve the blood flow to your infant's organs.
    
    
  • Steroids: Steroid medicine may be given to help increase your infant's blood pressure. Steroids may also be given to treat adrenal gland problems if that is what caused your infant's hypotension.
  
  
• Blood transfusion: During a blood transfusion, your infant will get whole blood, or parts of blood, through an IV. You may be worried that your infant will get AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for HIV (the virus that causes AIDS), hepatitis, and West Nile Virus.
  
  
• Intravenous liquids: If your infant's hypotension is caused by blood or fluid loss, he may be given liquids in his IV. The liquids may have electrolytes and sugar in them to replace what has been lost.
  
  
• Ventilator: Your infant may need an endotracheal (ET) tube to help him breathe. An ET tube is put in your infant's mouth or nose, and goes into the trachea (windpipe). The ET tube will be connected to a ventilator. The ET tube will be taken out when your infant is breathing better.

What are the risks of hypotension in infants?

• Medicines to treat your infant's hypotension may cause high BP or a fast heartbeat. Medicines may cause your infant to have high blood sugar levels, and he may get infections more easily. Certain medicines may slow your infant's growth, or cause damage to his stomach, intestines, or brain. IV medicines that leak out of the vein and tube may cause skin and tissue damage. If your infant gets more IV liquid than his body can hold, he may get volume overload. Volume overload may lead to heart or lung problems.
  
  
• Tubes placed in your infant's blood vessels may cause a blood infection or blood clots. Blood clots can cause pain and swelling, and it can stop blood from flowing where it needs to go in your infant's body. The blood clot may break loose and travel to your infant's lungs or brain. A blood clot in your infant's lungs can cause chest pain and trouble breathing. A blood clot in your infant's brain can cause a stroke. These problems can be life-threatening. Even with treatment, your infant's hypotension may not improve, causing poor blood flow to his organs. If your infant's organs cannot work properly, he may die.
  
  
• Without treatment, hypotension can decrease the blood flow to your infant's organs. Poor organ blood flow can cause the organs to stop working. Poor blood flow to your child's brain may cause brain damage. If your infant's hypotension is not treated, he may die.

When should I call my infant's caregiver?

Call your infant's caregiver if:

• Your infant has a fever (increased body temperature).
  
  
• Your infant is sick, vomiting (throwing up), or having diarrhea (loose bowel movements).
  
  
• You have questions or concerns about your infant's condition, treatment, or care.

When should I seek immediate help for my infant?

Seek care immediately or call 911 if:

• Your infant is having trouble breathing, or is breathing faster than his caregiver says he should.
  
  
• Your infant is having trouble, or is not able to, breastfeed or drink from a bottle.
  
  
• Your infant is urinating very little or not at all.
  
  
• Your infant's arms, hands, legs, or feet feel cold.
  
  
• Your infant's heart is beating faster than caregivers say it should.
  
  
• Your infant's skin is pale or mottled.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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