Persistent Pulmonary Hypertension of the Newborn in Late Preterm and Term Infants in California

Steurer, Martina A.; Jelliffe‐Pawlowski, Laura L.; Baer, Rebecca J.; Partridge, John Colin; Rogers, Elizabeth E.; Keller, Roberta L.

doi:10.1542/peds.2016-1165

Cited by 120 publications

(111 citation statements)

References 52 publications

(37 reference statements)

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“…The association with severe prematurity and PPHN is less clear. Although the incidence of PPHN in premature newborns is thought to be lower than in term or near-term newborns [19], a recent study showed a higher risk of PPHN in late preterm infants than in term infants [20]. In TTTS twins, preterm birth comprises a higher risk of PPHN.…”

Section: Discussionmentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study

Gijtenbeek

Haak²,

Harkel³

et al. 2017

Neonatology

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Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with severe morbidity and mortality. Twin-twin transfusion syndrome (TTTS) is suggested to increase the risk of PPHN. Objectives: To describe the incidence of PPHN in TTTS twins and to identify risk factors in TTTS twins for the development of severe PPHN. Methods: Cases with severe PPHN were extracted from our monochorionic twin database (2002-2016). Severe PPHN was defined as severe hypoxaemia requiring mechanical ventilation and inhaled nitric oxide (iNO) treatment, confirmed by strict echocardiographic criteria. A case-control comparison within TTTS survivors was conducted to identify risk factors for PPHN. Results: The incidence of PPHN in TTTS twins was 4% (24/598, 95% confidence interval [CI] 2.7-5.9%) and 0.4% (2/493, 95% CI 0.1-1.5%) in uncomplicated monochorionic twins (odds ratio [OR] 10.3, 95% CI 2.4-43.9; p = 0.002). Two risk factors were independently associated with PPHN: severe prematurity (OR 3.3, 95% CI 1.0-11.4) and recipient status (OR 3.9, 95% CI 1.4-11.0). In TTTS recipients, another risk factor for PPHN is anaemia at birth (OR 7.2, 95% CI 1.8-29.6). Conclusion: Clinicians caring for neonates with TTTS should be aware of the 10-fold increased risk of PPHN compared to uncomplicated monochorionic twins. PPHN occurs more often in case of premature delivery and in recipient twins, particularly in the presence of anaemia at birth. As the development of severe PPHN is difficult to predict, we advise that all TTTS twins should be delivered in a tertiary care centre with iNO treatment options.

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Section: Discussionmentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study

Gijtenbeek

Haak²,

Harkel³

et al. 2017

Neonatology

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“…The file provides diagnosis and procedure codes based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) [14]. The database has been used in a series of studies examining birth and infant outcomes [15,16]. …”

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study

et al. 2017

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Background: Disparities exist in the rates of preterm birth and infant mortality across different racial/ethnic groups. However, only a few studies have examined the impact of race/ethnicity on the outcomes of premature infants. Objective: To report the rates of mortality and severe neonatal morbidity among multiple gestational age (GA) groups stratified by race/ethnicity. Methods: A retrospective cohort study utilizing linked birth certificate, hospital discharge, readmission, and death records up to 1 year of life. Live-born infants ≤36 weeks born in the period 2007-2012 were included. Maternal self-identified race/ethnicity, as recorded on the birth certificate, was used. ICD-9 diagnostic and procedure codes captured neonatal morbidities (intraventricular hemorrhage, retinopathy of prematurity, periventricular leukomalacia, bronchopulmonary dysplasia, and necrotizing enterocolitis). Multiple logistic regression was performed to evaluate the impact of race/ethnicity on mortality and morbidity, adjusting for GA, birth weight, sex, and multiple gestation. Results: Our cohort totaled 245,242 preterm infants; 26% were white, 46% Hispanic, 8% black, and 12% Asian. At 22-25 weeks, black infants were less likely to die than white infants (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.62-0.94). However, black infants born at 32-34 weeks (OR 1.64; 95% CI 1.15-2.32) or 35-36 weeks (OR 1.57; 95% CI 1.00-2.24) were more likely to die. Hispanic infants born at 35-36 weeks were less likely to die than white infants (OR 0.66; 95% CI 0.50-0.87). Racial disparities at different GAs were also detected for severe morbidities. Conclusions: The impact of race/ethnicity on mortality and severe morbidity varied across GA categories in preterm infants. Disparities persisted even after adjusting for important potential confounders.

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“…While no classification system or inclusion criteria exists for PPHN, three pathophysiologic categories can be used to characterize the underlying pathobiology and help guide understanding during perioperative management. Maladaptation PPHN is seen in neonates with normal pulmonary vasculature but with perinatal factors that produce active pulmonary vascular constriction and impaired vasodilation.…”

Section: Neonatal Phmentioning

confidence: 99%

Current understanding and perioperative management of pediatric pulmonary hypertension

Latham

Yung

2018

Pediatric Anesthesia

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Summary Pediatric pulmonary hypertension is a complex disease with multiple, diverse etiologies affecting the premature neonate to the young adult. Pediatric pulmonary arterial hypertension, whether idiopathic or associated with congenital heart disease, is the most commonly discussed form of pediatric pulmonary hypertension, as it is progressive and lethal. However, neonatal forms of pulmonary hypertension are vastly more frequent, and while most cases are transient, the risk of morbidity and mortality in this group deserves recognition. Pulmonary hypertension due to left heart disease is another subset increasingly recognized as an important cause of pediatric pulmonary hypertension. One aspect of pediatric pulmonary hypertension is very clear: anesthetizing the child with pulmonary hypertension is associated with a significantly heightened risk of morbidity and mortality. It is therefore imperative that anesthesiologists who care for children with pulmonary hypertension have a firm understanding of the pathophysiology of the various forms of pediatric pulmonary hypertension, the impact of anesthesia and sedation in the setting of pulmonary hypertension, and anesthesiologists’ role as perioperative experts from preoperative planning to postoperative disposition. This review summarizes the current understanding of pediatric pulmonary hypertension physiology, preoperative risk stratification, anesthetic risk, and intraoperative considerations relevant to the underlying pathophysiology of various forms of pediatric pulmonary hypertension.

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Persistent Pulmonary Hypertension of the Newborn in Late Preterm and Term Infants in California

Cited by 120 publications

References 52 publications

Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study

Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study

Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study

Current understanding and perioperative management of pediatric pulmonary hypertension

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