Intravenous nicardipine as a first-line antihypertensive drug in neonates

Objective: Prospective recording of IV nicardipine efficacy and safety as a first-line antihypertensive drug in neonates. Patients: Twenty neonates (15 pre-term) with systemic hypertension due to steroids administration (n = 14), polycystic kidney disease (n = 1), renal vein thrombosis (n = 1), coarctation of aorta (n = 1) or from an undetermined cause (n = 3). Interventions: The initial nicardipine dosage was 0.5 mu g/kg/min in 17 patients. The maximal nicardipine dosage was 0.74 +/- 0.41 mu g/kg/ min (0.5-2.0). The duration of treatment was 14.6 +/- 11.6 days. Results: Systolic blood pressure significantly decreased after 3, 6, 12, 24 and 48 h of nicardipine treatment (-20 +/- 11 %, -19 +/- 10 %, -20 +/- 8 %, -20 +/- 10 % and -20 +/- 12 %, respectively). The decrease in blood pressure remained significant over the subsequent days of treatment. No hypotension or other clinical side effects were observed. Conclusions: Both additional pharmacokinetic and pharmacodynamic studies remain mandatory to improve the dosage regimens and assess the efficacy and safety of nicardipine infusion in hypertensive neonates.