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Efficacy and Safety of Intravenous Labetalol in Acute Hypertensive Crisis in Children

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Abstract

Objective

To determine the efficacy and safety of intravenous (IV) labetalol in the management of hypertensive crisis in children.

Methods

A retrospective chart review of 56 consecutive children (age > 1 mo to ≤ 12 y) with hypertensive crisis admitted to a pediatric intensive care unit (PICU) from July 2009 to 2019.

Results

The proportion of children attaining the primary endpoint (target 95th percentile in > 12 to ≤ 48 h) was significantly more in the group receiving labetalol as first-line or add-on (n = 23) as compared to those not receiving labetalol (n = 33) (62% vs. 30.3%, p = 0.03). Higher proportion of neurological recovery was seen in the labetalol group (56.2% vs. 18.7%, p = 0.02). The proportion of children with hypotension before 12 h was similar in both treatment groups (13% vs. 15%, p = 0.82). The practice variations between two periods of 5 y each (2009–2013 and 2014–2019) showed significantly more use of labetalol in the latter cohort (53% for 2014–2019 vs. 25% for 2009–2013, p = 0.03).

Conclusion

Labetalol, when used alone or as an add-on drug, was more efficacious than IV nitroprusside/nitroglycerine in attaining the primary endpoint in children up to ≤ 12 y of age with hypertensive crisis. Labetalol was safe and associated with higher neurological recovery.

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Authors and Affiliations

  1. Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Sheetal Lad, Manisha Patil, Muralidharan Jayashree, Arun Bansal, Arun Baranwal, Karthi Nallasamy & Suresh Kumar Angurana

Authors
  1. Sheetal Lad
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  2. Manisha Patil
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  3. Muralidharan Jayashree
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  4. Arun Bansal
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  5. Arun Baranwal
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  6. Karthi Nallasamy
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  7. Suresh Kumar Angurana
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Contributions

MJ, SL, MP conceptualized the study design. SL, MP collected the data. MJ, SL, and MP were involved in the analysis and interpretation of data, and wrote the initial draft, which was critically reviewed and approved by all co-authors. MJ is the guarantor of this paper.

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Correspondence to Muralidharan Jayashree.

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Lad, S., Patil, M., Jayashree, M. et al. Efficacy and Safety of Intravenous Labetalol in Acute Hypertensive Crisis in Children. Indian J Pediatr 89, 7–12 (2022). https://doi.org/10.1007/s12098-021-03707-7

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  • DOI: https://doi.org/10.1007/s12098-021-03707-7

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