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

Abstract

Background:Persistent pulmonary hypertension of the newborn (PPHN) result from the failure of the normal fetal-to-neonatal circulatory transition is associated with substantial infant mortality and morbidity.Objective:To estimate the possible risk factors and assess the outcome of these cases.Materials and Methods:Prospective study was performed enrolling all full-term and post-term newborn admitted to the NICU from January 2009 to April 2012, All neonates were subjected to complete history and physical examination, laboratory data including a complete blood count, arterial blood gases, blood glucose, serum electrolytes, and blood culture to exclude sepsis. Cases with PPHN had a continuous pulse oximeter, blood pressure and electrocardiography monitoring. Chest X-ray and echocardiogarphy were carried out to verify shunt and exclude structural congenital heart disease.Results:Out of the studied 640 infants, 32 infants (5%) developed PPHN, Meconium aspiration, birth asphyxia, hyaline membrane diseases, neonatal septicemia, post-term birth being large for gestational age, cesarean section, maternal overweight, and diabetes mellitus were associated with an elevated risk for PPHN. All neonates treated with O2, 10 neonates with Mg sulphate, 16 with oral sildenafil and 12 with mechanical ventilation. After 6 months follow-up, 12 (37.54%) improved and followed-up without sequelae, 4 (12.5%) developed some neurodevelopmental impairment, 8 (25%) died, 3 (9.3%) developed chronic lungs diseases, 2 (6.2%) developed hearing defects and another 3 (9.3%) missed follow-up.Conclusion:PPHN was found in 5% of the studied population. Meconium aspiration, birth asphyxia, neonatal septicemia, post-term were associated with an elevated risk for PPHN. As this is a unit based study, a comprehensive countrywide survey on PPHN in Egypt is recommended to determine any regional differences in disease incidence.

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.…”

“…[4] The reported overall mortality ranges from 4% to 33% in developed countries [2] and from 25% to 48% in developing countries. [5,6] In South Africa (SA), previous studies reported the incidence of PPHN to be 1.1%, with a mortality rate of 31% at Tygerberg Children's Hospital [7] and 48% at Chris Hani Baragwanath Academic Hospital. [8] PPHN develops due to the failure of circulatory transition at birth, causing the pulmonary artery pressure to remain higher than systemic pressures.…”

Pulse oximetry as a simple diagnostic test for persistent pulmonary hypertension of newborn in limited resource settings

“…The most common underlying cause for PPHN in our study was meconium aspiration (53.8%), which was also supported by Abdel Mohsen, et al (50%). 4 Perinatal asphyxia-clear liquor (30.8%) was the second common cause for PPHN in our study. Our centre with limited resources, does not have 24hours ECHO.…”

“…At birth, B. Within 3 days after birth, C. >3 days after birth based on the study done by Abdel Mohsen, et al 4 The diagnostic modality before the first dose of sildenafil was divided as a) 4 limb Spo 2 alone b) 4 limb Spo 2 + ECHO. The outcome of PPHN and the overall outcome of the neonate was also noted.…”

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%.…”