Correlation of Echocardiographic Markers and Therapy in Persistent Pulmonary Hypertension of the Newborn

Peterson, Amy L.; Deatsman, Sara; Frommelt, Michele A.; Mussatto, Kathy A.; Frommelt, Peter C.

doi:10.1007/s00246-008-9303-3

Cited by 39 publications

(34 citation statements)

References 13 publications

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“…Tricuspid regurgitant velocity is used to estimate pulmonary artery pressure, although the precision of the technique is debatable [18]. In previous studies in this population, a tricuspid regurgitant jet has been observed in 70-86% of infants [4,15,16,19]. Other signs of elevated right sided-pressures such as bidirectional or right-to-left shunt across the ductus or atrium have been reported in 73-91% and 73-100% cases respectively [15,16].…”

Section: Discussionmentioning

confidence: 93%

“…Peterson and colleagues evaluated whether conventional ECHO indices on the day of presentation could predict the need for "advanced therapies", such as iNO, ventilation, high frequency oscillation and ECMO [19]. Infants who needed these therapies had lower LVO reflected by a decreased ascending aortic VTI, shorter transverse aortic arch ejection time and absent or retrograde transverse aortic diastolic flow, smaller LV end-diastolic area and right-to-left atrial level shunting [19]. There were no significant correlates with death.…”

Section: Discussionmentioning

confidence: 99%

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Echocardiographic correlates of persistent pulmonary hypertension of the newborn

Aggarwal¹,

Natarajan²

2015

Early Human Development

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Echocardiographic correlates of persistent pulmonary hypertension of the newborn

Aggarwal¹,

Natarajan²

2015

Early Human Development

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“…They are, in general, mechanically ventilated, sedated and often paralyzed with muscle relaxants. 20,21 Therefore, procedures such as suctioning, changing endotracheal tubes, bathing and repositioning should be kept to a minimum. Early treatment with surfactant prevents the development of PFC in cases with lung issues.…”

Section: Discussionmentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn: Analysis of 181 cases over one Year

Fatema

2018

Cardiovasc. j.

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Background: Persistent pulmonary hypertension (PPHN) is the persistence of the high pulmonary arterial pressure after birth which is a characteristic of the fetal circulation. PPHN is associated with substantial infant mortality and morbidity. Various treatment protocol are used according to the need of the patient. This study aimed to see the spectrum of the disease and its outcome in Bangladesh.Methods: 181 newborn babies were diagnosed as persistent pulmonary hypertension or persistent fetal circulation. After establishing diagnosis, all cases were kept in NICU and various management plans were prescribed according to necessity of a specific case. Repeat echocardiography was done after 72 hours to see the response of treatment. Residual congenital cardiac lesions were managed later on.Results: Most of the patient (69.06%) was diagnosed at first week of life. Minimum age of the patient was 1 day and maximum age 23 days. Among 181 cases 109 (66.22%) were male and 72(39.77%) were female. Associated congenital lesions like atrial septal defect was found in 52 (28.72%) cases, patent ductus arteriosus (PDA) was found in 14 (7.73%) cases and ventricular septal defect (VSD) was found in 2 (1.10%) cases. Combination of ASD & PDA was found in 75 (44.33%) cases. Systolic pulmonary artery pressure was more than 60 mmHg in 103 (56.91%) cases, more than 50 mmHg in 53 (29.28%) cases and more than 30 mmHg in 25 (13.81%) cases. Most of the patient (100%) received high flow oxygen therapy along with anti failure (66.30%) and sildenafil 98 (54.14%) therapy as per requirement of the patient. Complete cure was achieved in 95.58% cases and mortality was only 1.10%.Conclusion: These data showed a very impressive outcome of the PPHN in Bangladeshi Newborn even with minimally invasive management.Cardiovasc. j. 2018; 11(1): 17-22

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“…It help rule out CHD, document right-to-left shunt and estimate PAP from Doppler velocity measurement of tricuspid regurgitation jet [22]. Finally, some cases may require cardiac catheterization to confirm the diagnosis by direct visualization of cardiopulmonary anatomy.…”

Section: Diagnosismentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn: Recent Advances in the Management

Agarwal

2013

Int J Clin Pediatr

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Persistent pulmonary hypertension of the newborn (PPHN) is a medical emergency in the neonatal period, which occurs due to failure of normal postnatal transition of fetal circulation. Despite availability of numerous treatment modalities, associated mortality and morbidity remain high. Therefore, awareness of predisposing conditions, and early diagnosis and management may help improving outcome in PPHN. To provide an overview of anatomic and functional anomalies of PPHN, and available treatment options with special focus on recent advances in the diagnosis and management of this potentially lethal illness. MEDLINE, EMBASE, The Cochrane Library, and Google Scholar databases were searched (inception until Nov-2012) using terms "persistent pulmonary hypertension of newborn", "hypoxemic respiratory failure", "nitric oxide", "sildenafil", "milrinone" and "prostacyclin" without any language restriction. www.clinicaltrials.gov website was searched for relevant ongoing trials. Additionally, manual review of article bibliographies was done for potentially relevant studies. Strategies for the management of PPHN are undergoing metamorphosis. Gentle ventilation and high-frequency ventilation have replaced prior hyperventilation strategy. Currently, iNO is the only FDA-approved selective pulmonary vasodilator for infants with hypoxemic respiratory failure/PPHN; however, it has poor/no response in upto 30% cases. Recent studies have provided evidences for the use of other therapeutic agents such as PDE-inhibitors, magnesium sulphate and prostacyclin analogues. Finally, recent laboratory studies have demonstrated the role of oxidant stress as well as potential use of free radical scavengers for example, superoxide dismutase and catalase in the management of PPHN. Assisted ventilation and pharmacologic manipulation are the mainstays of treatment of PPHN. Limited availability of the gold standard treatment option namely iNO, especially in resource-limited countries, leads to increasing use of alternative therapeutic options such as PDE-inhibitors (sildenafil and milrinone). However, as any single therapy can not be labelled as a magic bullet for PPHN, further clinical trials are required to demonstrate the efficacy and safety of available therapeutic options as well as to develop newer strategies targeted to the underlying pathophysiology.

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Correlation of Echocardiographic Markers and Therapy in Persistent Pulmonary Hypertension of the Newborn

Abstract: Decreased left ventricular size and output correlates with the need for advanced therapies in infants with PPHN. Early identification may allow more effective management and placement of neonates at risk.

Cited by 39 publications

References 13 publications

Echocardiographic correlates of persistent pulmonary hypertension of the newborn

Echocardiographic correlates of persistent pulmonary hypertension of the newborn

Persistent Pulmonary Hypertension of the Newborn: Analysis of 181 cases over one Year

Persistent Pulmonary Hypertension of the Newborn: Recent Advances in the Management

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