Intracranial Hemorrhage in Term or Near-term Newborns With Persistent Pulmonary Hypertension

Persistent pulmonary hypertension of the newborn (PPHN) is an essential cause for hypoxic respiratory failure with significant morbidity and mortality in term and near-term neonates. Hydrocortisone has been shown to decrease oxygen dependency and pulmonary hypertension in neonates with meconium aspiration syndrome and animal studies, respectively. We hypothesize that hydrocortisone will improve oxygenation in term and near-term infants with pulmonary hypertension. We performed a retrospective chart review of all infant with PPHN who received intravenous hydrocortisone therapy as a rescue for severe PPHN. Clinical response was objectively measured using, oxygenation index (OI), PaO2/FiO2 ratio, and inotrope score before, during, and after the hydrocortisone course. We found that hydrocortisone administration resulted in significant improvement of systolic blood pressure, OI, and PaO2/FiO2. In conclusion, hydrocortisone increased systolic blood pressure and improved oxygenation in term and near-term infants with persistent pulmonary hypertension. Prospective randomized trials are required to evaluate these findings further.

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Adult Respiratory Distress Syndrome in Full-Term Newborns

PEDIATRICS ◽

10.1542/peds.85.6.1132 ◽

1990 ◽

Vol 85 (6) ◽

pp. 1132-1132

Author(s):

ROGER G. FAIX ◽

MICHAEL A. DIPIETRO

Keyword(s):

Pulmonary Hypertension ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Adult Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Mortality Rates ◽

Full Term ◽

Persistent Pulmonary Hypertension ◽

Term Newborns ◽

The Difference

In Reply.— We appreciate the interest and continuing contributions of Drs Pfenninger and Tschaeppeler. We agree with their assessment that the difference in mortality rates is probably attributable to selection differences. All five of their infants would have been excluded from our series, since proven sepsis and documented persistent pulmonary hypertension were both among the criteria for exclusion. As we noted in our article, the low mortality in our series was not surprising because of such exclusions.

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Neurodevelopmental and medical outcomes of persistent pulmonary hypertension in term newborns treated with nitric oxide

The Journal of Pediatrics ◽

10.1067/mpd.2002.122730 ◽

2002 ◽

Vol 140 (3) ◽

pp. 306-310 ◽

Cited By ~ 78

Author(s):

Paul H. Lipkin ◽

Dennis Davidson ◽

Lynn Spivak ◽

Richard Straube ◽

Jared Rhines ◽

...

Keyword(s):

Nitric Oxide ◽

Pulmonary Hypertension ◽

Persistent Pulmonary Hypertension ◽

Medical Outcomes ◽

Term Newborns

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Increased incidence of Persistent Pulmonary Hypertension of the Newborn following third trimester maternal COVID-19 infection

European Heart Journal ◽

10.1093/eurheartj/ehab724.1843 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Ishqeir ◽

A Nir ◽

I Aptowitzer ◽

M Godfrey ◽

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

Ventricular Hypertrophy ◽

Right Ventricular Hypertrophy ◽

Persistent Pulmonary Hypertension ◽

Third Trimester ◽

Term Neonates ◽

Live Births ◽

Pulmonary Vasodilator ◽

Near Term

Abstract Background Novel coronavirus (COVID-19) has been a world concern since December 2019. The knowledge about vertical transmission and fetal morbidity and mortality from maternal COVID-19 infection is limited. We detected an increase in the number of cases of term and near-term neonates with persistent pulmonary hypertension (PPHN) during the COVID-19 pandemic in 2020. Methods and results We collected data on all newborns with PPHN born between 2018 and 2020. We excluded premature infants (<34+0 weeks) and infants with other significant pathology or genetic syndromes. Compared to 5 cases of PPHN of 22930 live births in 2018, and 6 cases of PPHN of 22270 live births in 2019 (2-year average 0.02%, 95% CI 0.013%-0.043%), there were 16 PPHN cases from 22323 live births in 2020 (0.07%, 95% CI 0.044%-0.12%), a 3 fold increase (p<0.01). We report 5 cases of term and near-term neonates born to mothers who had highly suspected (2) and PCR proven (3) COVID-19 infection during the third trimester of pregnancy, who presented with PPHN during COVID-19 pandemic in 2020. All had otherwise unexplained pulmonary hypertension, right ventricular hypertrophy (RVH) and dilatation. Two patients needed endotracheal intubation, one was supported by nasal continuous positive airway pressure (CPAP) without intubation, two needed O2 support by nasal cannula only ant two newborns (one of them was intubated) needed Nitric oxide (NO) as pulmonary vasodilator therapy. No patient required Extracorporeal membrane oxygenation (ECMO) or died, and no prolonged residual cardiovascular or pulmonary morbidity was recorded during a median follow up of 4.8 months (range 4–6 months). Conclusions The increase in the incidence of PPHN during the COVID-19 pandemic, and the cases presented, suggest an intrauterine effect of maternal COVID-19 infection on the fetal pulmonary circulation. It is possible that the maternal infection affected the fetal pulmonary vascular resistance, or altered the normal decline in the resistance after birth. The right ventricular hypertrophy and dilatation with reduced function may be secondary to this hypothetical increased afterload or a direct effect of the infection. Further studies are warranted to elucidate the pathogenesis and clinical implications of this phenomenon. FUNDunding Acknowledgement Type of funding sources: None.

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