Background: Normal blood pressure ranges in critically ill neonates have not been well established leading to variability in diagnosis, and management of systemic hypertension (HTN). ECMO increases afterload, and therefore contributes to HTN. We aim to describe incidence of HTN in ECMO patients in the Pediatric Health Information System (PHIS) database.

Methods: Retrospective cohort of neonates requiring ECMO from January 1, 2010, to December 31, 2020, across the PHIS database using ICD 9/10 codes to ascertain the diagnosis of HTN. We excluded patients with incomplete data, and those with congenital heart disease (CHD). The distributions of categorical variables were summarized with frequencies and percentages. Median and inter-quartile ranges were used for quantitative variables.

Results: A total of 437,014 admissions met criteria, with 4805 (1.1%) required ECMO, of which 200 (4.2%) had a diagnosis of HTN. Of those, 148 (148/200=74%) received an antihypertensive medication by 28 days of life. Vasodilators were most commonly used, with hydralazine being the most prescribed agent. More than half (55.4%) received multiple agents. Half (74/148= 50.0%) received one class of drugs, 51 (34.4%) received two, 19(12.8%) received three, 2(1.4%) received four, and 2(1.4%) received five classes of agents.

Conclusion: There is variability in antihypertensive medication exposure in neonates with systemic hypertension receiving ECMO therapy. A consensus guideline may be beneficial to reduce practice variations.