Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children.
OBJECTIVE
To determine the efficacy and safety of labetalol for hypertensive crisis in children ≤ 24 months of age.


METHODS
Retrospective chart review. Statistical analysis utilized analysis of variance for continuous data, chi-square tests for nominal data, and linear regression.


METHODS
A 737-bed pediatric teaching institution.


METHODS
Twenty-seven patients ≤ 24 months of age were treated with 37 intravenous infusions of labetalol, nicardipine, or nitroprusside for hypertensive crisis or hypertensive urgency.


METHODS
None.


RESULTS
The primary end point consisted of time to 20% reduction in systolic blood pressure. Primary safety end points measured the prevalence of deleterious effects of labetalol. Continuous infusion of labetalol reduced mean systolic blood pressure by at least 20% in < 8 hrs. This effect was similar to nicardipine and nitroprusside infusions. The reported side effects were similar in each group. Patients receiving labetalol and presenting with ischemic or traumatic brain injury were likely to develop hypotension requiring infusion discontinuation.


CONCLUSIONS
Continuous intravenous labetalol infusion is efficacious for treatment of hypertensive crisis in children ≤ 24 months of age. Aside from patients presenting with ischemic or traumatic brain injury, labetalol was safe to use in this population for hypertensive emergencies and had a satisfactory adverse effect profile. Labetalol may reach dose saturation at a much lower dose in young children in comparison to adults. Clinicians should use caution when initiating labetalol infusions in young patients with brain injury.
Thomas
Christopher A
CA
Department of Pharmacy, Texas Children's Hospital, Houston, Texas, USA. cthoma15@clarian.org
Moffett
Brady S
BS
Wagner
Jeffrey L
JL
Mott
Antonio R
AR
Feig
Daniel I
DI
D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007223:Infant; D007262:Infusions, Intravenous; D007741:Labetalol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D009529:Nicardipine / Q000627:therapeutic use; D009599:Nitroprusside / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D009599:Nitroprusside; D009529:Nicardipine; D007741:Labetalol