Persistent pulmonary hypertension – The neonatal period and evaluation at 2 years of age

Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is a condition in which the pulmonary vessels fail to dilate at birth. It can be the consequence of a wide array of diseases, such as pneumonia, congenital diaphragmatic hernia, meconium aspiration syndrome and hyaline membrane disease. It has an incidence of 1-2 per 1,000 newborns and it can have pulmonary, neurologic and developmental consequences. We conducted a retrospective study with the aim of analyzing the causes, morbidities and comorbidities, management and mortality of PPHN in newborns hospitalized in our neonatal intensive care unit (NICU) and to evaluate respiratory, neurologic and developmental morbidity at 2 years of age. A total of 77 children, born between 1996 and 2012, were studied. Twenty-six (33.8%) deceased. The mortality, as well as the need for resuscitation, inhaled nitric oxide (iNO), diuretics, and vasopressor support, was higher in patients with the severe form of PPHN. The need for vasopressor support was the only factor associated with a higher mortality. We found a reduction of 17.8% in mortality rates after the introduction of iNO, sildenafil and extracorporeal membrane oxygenation (ECMO). Congenital diaphragmatic hernia was the most common cause of PPHN. Pneumonia was more frequent before 2003. There was no significant difference in the morbidity and mortality between the two time periods (before and after 2003). On the follow-up of 37 of the remaining 51 patients, we did not find differences in the morbidity of patients comparing those with the severe vs. non-severe forms of the condition.
An evaluation over the years of admitted newborns with PPHN in our NICU is mandatory to confirm a relationship between the new treatment strategies and the better outcome of the patients.