Underlying disease, management strategies and survival rate of neonates diagnosed with persistent pulmonary hypertension of the newborn

Abstract

Background: Management of persistent hypertension of the new-born (PPHN) varies widely around the world. Therapeutic strategies used in management of PPHN in low-and middle-income countries (LMIC) are not well reported. Secondly, the diagnoses associated with PPHN and the survival rates of neonates with PPHN in LMIC is not well known. Objective: To determine the underlying disease, management strategies and survival rate of near-term and term neonates (birth weight >2000 grams) diagnosed with PPHN. Methods: This was a retrospective review of clinical records of near-term and term neonates who were admitted to Chris Hani Baragwanath Hospital (CHBAH), neonatal intensive care unit (NICU) from January 2012 to December 2013 with a diagnosis of PPHN. Results: A total of 1262 neonates were admitted to NICU, of which 470 weighed >2000 grams. Fifty neonates were diagnosed with PPHN which was 4.0% of NICU admissions and 10.6% of near-term or term neonates admitted to NICU. Meconium aspiration syndrome with (44%) and without (42%) birth asphyxia was the most common underlying diagnosis associated with PPHN. Management strategies used were fluid boluses (80%), inotropes (80%), alkalinisation (68%), sildenafil (60%) and inhaled nitric oxide (6%). All-cause mortality rate was 36%. Non-survivors were more likely to have required rescue high frequency oscillatory ventilation than survivors (83.3% vs 25.0%, p<0.001). Conclusion: PPHN accounts for about a tenth of near-term and term neonates requiring mechanical ventilation and is associated with high mortality rate. MAS is the most common underlying diagnosis in neonates with PPHN. Commonly used management strategies are fluids, inotropes, alkalinization and sildenafil