Retrospective review of neonates with persistent pulmonary hypertension of the newborn at Charlotte Maxeke Johannesburg academic hospital (CMJAH)

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dc.contributor.authorHarerimana, I
dc.date.accessioned2016-10-28T11:55:19Z
dc.date.available2016-10-28T11:55:19Z
dc.date.issued2016-10-28
dc.descriptionResearch report submitted in partial fulfilment of requirements for a Master of Medicine degree in Paediatrics and Child Health (MMed). November 2014en_ZA
dc.description.abstractBackground: Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome characterised by high pulmonary pressure, low systemic pressures and severe hypoxemia due to failure of circulation transition after birth. Objective: The aim of the study was to determine the incidence, describe the risk factors, patient’s characteristics, and treatment strategies for PPHN at CMJAH over the last 8 years and discuss the possible need of ECMO treatment in our settings. Patients and methods: This was a retrospective descriptive study. I reviewed the computer database and medical records of infants who had a discharge diagnosis of PPHN from January 2006 to December 2013. The study included term and preterm, inborn and outborn infants. PPHN diagnosis was mainly based clinical suspicion. Patients with congenital cyanotic heart defect were excluded. Results: The incidence of PPHN was estimated at 0.33 per 1000 live births in our unit. Out of 81 infants who had a discharge diagnosis of PPHN 72 patients were included in the study. Of the 72 patients 37(51.4%) were female, 38 (52.8%) born by vaginal delivery and 44(61.1%) were inborn. Most of them (75%) were born at term and had an appropriate weight for gestation age. The mean birth weight was 2.94 kg (SD 0.69) while mean gestation age was 38.2 weeks (SD3.3). Meconium aspiration syndrome (MAS) seen in 43 patients (59.7%) was the most frequent underlying disease followed by pneumonia that was seen in 9 patients (12.5 %). Of the 72 patients 67(93.1%) were treated with mechanical ventilation and only18.1% of them required high frequency oscillatory ventilation. Magnesium sulfate and Sildenafil were used in 12 patients (16.7%) and 9 patients (12.5%) respectively, while inhaled nitric oxide and extracorporeal membrane oxygenation were not available. Of the 72 patients 25(34.7%) died. The patients’ characteristics were similar between survivors and nonsurvivors. The need for inotropic support was associated with a poor outcome. Conclusion: PPHN was uncommon in our unit, but its management is still a challenge since it was associated with a high mortality. The leading cause of PPHN was MAS which can possibly be prevented by improving both antenatal and intrapartum obstetric care by good management of at-risk pregnancies. In our settings, the reduction of MAS incidence, adequate neonatal resuscitation, surfactant replacement therapy and early initiation of assisted ventilation for depressed infants with MAS could be cost- effective measures in preventing PPHN. ECMO therapy is very expensive and labour intensive, thus its use is limited in lowand middle- income countries including South Africa.en_ZA
dc.description.librarianMT2016en_ZA
dc.identifier.urihttp://hdl.handle.net/10539/21317
dc.language.isoenen_ZA
dc.titleRetrospective review of neonates with persistent pulmonary hypertension of the newborn at Charlotte Maxeke Johannesburg academic hospital (CMJAH)en_ZA
dc.typeThesisen_ZA
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