Persistent Pulmonary Hypertension of Non Cardiac Cause in a Neonatal Intensive Care Unit

Abstract

Parenchymal lung diseases are the main cause of persistent pulmonary hypertension of the newborn (PPHN). We aimed to assess the non cardiac conditions associated to PPHN in the newborn and the survival rate over the last 15 years, at our center. A retrospective chart review of the neonates admitted for PPHN from 1996 to 2010 was performed. New therapies were introduced in 2003, and the survival rates between two periods (1996–2002 and 2003–2010) were compared. Out of 6750 newborns, 78 (1.1%) had the diagnosis of PPHN of non cardiac cause. The most prevalent causes were associated to pulmonary hypoplasia (30.7%), infection (24.3%), and aspiration syndromes (15.3%). Many other causes were identified in 33.3%. The overall survival rate was 68%. There was a significant difference on survival rates between the two periods (1996–2002 = 63.8% and 2003–2010 = 71.4%, P = 0.04). Our study showed a myriad of non cardiac aetiologies for PPHN of the newborn, most of them related to lung disease or lung hypoplasia. We observed an improvement in survival rate since 2003, which was associated to the use of new therapies.

Retrospective review of neonates with persistent pulmonary hypertension of the newborn at Charlotte Maxeke Johannesburg Academic Hospital

“…[25] Despite remarkable progress in understanding the pathophysiology and treatment of PPHN, [10,[11][12][13][14] the condition remains a treatment challenge for neonatologists, especially in developing countries, and the associated mortality rate remains high in resource-limited settings. [5][6][7][8][9]26,27] Of the 72 neonates included in our study, 51.4% were female and 52.8% were born by vaginal delivery. Birth weight was appropriate for gestation age in 80.6% of cases in this study.…”

“…These results differ from those of previous studies, which reported PPHN to be associated more with males, being large for gestation age and delivery through caesarean section. [5,6,9,[26][27][28][29] The majority of the neonates included in this study (75%) were born after 37 weeks, the mean gestational age being 38.2 weeks and the mean birth weight 2.94 kg. These results are consistent with evidence that PPHN affects mainly term and post-term neonates.…”

“…[8] PPHN develops due to the failure of circulatory transition at birth, causing the pulmonary artery pressure to remain higher than systemic pressures. [9] A patent ductus arteriosus (PDA) or the right-to-left shunting of blood through a patent foramen ovale (PFO) results in severe hypoxaemia. [1,10,11] PPHN usually affects term or near-term newborns, although preterm neonatess can also be affected.…”

Risk factors and outcomes of persistent pulmonary hypertension of the newborn in neonatal intensive care unit of al-minya university hospital in Egypt

“…[13] The mortality rate of infants with PPHN was estimated to be around 10-20% even with the use of high-frequency ventilation, surfactant, iNO, and ECMO but is much higher when these therapies are not available. [14]…”

Prevalence of Pulmonary Arterial Hypertension on Echocardiography in Newborns with Maternal Risk factors

“…Caesarean section delivery was higher (50%-63.5%) among patients with PPHN as shown in various studies [3,5,6,7,9,10] in both developed and developing countries. In a study by Rocha et al from Portugal the percentage of deliveries by LSCS was 65.3%.…”