Retrospective review of neonates with persistent pulmonary hypertension of the newborn at Charlotte Maxeke Johannesburg academic hospital (CMJAH)
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Date
2016-10-28
Authors
Harerimana, I
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Abstract
Background: 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.
Description
Research report submitted in partial fulfilment of requirements for a Master of Medicine
degree in Paediatrics and Child Health (MMed).
November 2014