parenchymal renal disease, and chronic lung disease of prematurity Additionally, coarctation of the aorta, hyperthyroidism, congenital adrenal hyperplasia (CAH), and increased intracranial pressure can cause neonatal hypertension and can be life threatening if left untreated Most infants with hypertension are asymptomatic When symptoms are present, they are often nonspecific (lethargy, poor feeding, apnea) and not necessarily correlate with the degree of hypertension Initial evaluation should include blood pressure measurement in all four extremities, urinalysis, urine culture, blood urea nitrogen, serum creatinine, electrolytes, and calcium It is important to note that the absence or presence of hematuria, proteinuria, or azotemia vary in this age group and cannot be used in isolation to diagnose renovascular disease If the history and physical examination are suggestive of endocrine, neurologic, or intoxication causes of hypertension, additional testing may be needed Renal ultrasonography (US) with Doppler evaluation should also be included to evaluate for renovascular and parenchymal disease Echocardiography should be considered to assess left ventricular function Determining when to institute pharmacotherapy for hypertension is based on the underlying etiology, severity of hypertension, and presence of symptoms The decision to initiate therapy should be done in consultation with pediatric nephrologist