scholarly journals Title: Clinical Profile of Persistent Pulmonary Hypertension in Neonates with Role of Sildenafil in its Outcome: Rural India NICU Experience

2021 ◽  
pp. 324-336
Author(s):  
Sunil Pathak ◽  
Deepika Bhil ◽  
Sakshi Prabodh ◽  
Manish Rasania ◽  
Saurabh Kumar ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Meconium Aspiration Syndrome ◽  
Conventional Ventilation ◽  
Persistent Pulmonary Hypertension ◽  
Mortality And Morbidity ◽  
Etiological Factors ◽  
Poor Outcome ◽  
Resource Limited ◽  
Early Onset Sepsis ◽  
Incidence Risk

Background: Persistent pulmonary hypertension of newborn (PPHN) result from failure of normal fall in pulmonary vascular resistance at or shortly after birth. It is associated with high mortality and morbidity. Objectives: To estimate incidence, risk factors; and outcome within limited resources – conventional ventilation, sildenafil, dobutamine and milrinone therapy. Methods: This prospective study was carried out on cases of PPHN admitted between March 2017 to August 2018. PPHN was suspected clinically, and then confirmed by echocardiography. Results: Out of 2811 inborn live births 12 (0.43%) developed PPHN. Out of total 942 NICU admissions, PPHN was diagnosed in 40(4.2%). 32 (80%) were full term, 6 (15%) were late preterm and 2(5%) were post term neonates. 25(62.5%) were male. Major etiological factors were asphyxia 19(47.5%), EOS (early onset sepsis) 18(45%) and MAS (meconium aspiration syndrome)  12(30%). 20(50%) responded to oral sildenafil and dobutamine therapy, 6 more responded with addition of milrinone. The overall survival rate was 26(65%) and poor outcome in 14 (35%) in our study. Median duration of respiratory support was 1.5(1 – 6) days in those with poor outcome and 6(4 – 7) in those survived. Duration of hospital stay was 1.5(1 – 6) days in poor outcome and 17(13 – 22) in those survived. Conclusions: Asphyxia, EOS and MAS are common causes of PPHN. Severity of respiratory distress on admission is correlated with mortality rather than etiological factors. Conventional ventilation, dobutamine, sildenafil and milrinone therapy are mainstay of treatment of PPHN cases in resource limited settings, and helps to reduce mortality to some extent. 

Persistent Pulmonary Hypertension and ECMO

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 809-810
Author(s):  
ELCHANAN BRUCKHEIMER ◽  
ARTHUR I. EIDELMAN
Keyword(s):  
Pulmonary Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Meconium Aspiration Syndrome ◽  
Persistent Pulmonary Hypertension ◽  
Major Category ◽  
Inclusion Criteria ◽  
Meconium Aspiration ◽  
Membrane Oxygenation ◽  
Respiratory Treatment ◽  
The Relationship

To the Editor.— We read with interest Dr Gross' letter1 concerning the relationship between inborn and outborn infants with persistent pulmonary hypertension and the relevance of "classical" extracorporeal membrane oxygenation (ECMO) inclusion criteria and outcome of therapy. We wholly agree with his observation that early skilled respiratory treatment of infants with persistent pulmonary hypertension to a large extent can obviate the need for ECMO, and we wish to report our experience. As has been noted, the major category of patients requiring ECMO are those with severe meconium aspiration syndrome.2

An unusual cause of refractory persistent pulmonary hypertension of the newborn: anomalous origin of one pulmonary artery

2013 ◽  
Vol 24 (3) ◽  
pp. 543-545
Author(s):  
Nilufer Guzoglu ◽  
Fatma Nur Sari ◽  
Nahide Altug
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Innominate Artery ◽  
Persistent Pulmonary Hypertension ◽  
Anomalous Origin ◽  
Cardiac Malformation ◽  
Mortality And Morbidity ◽  
Congenital Cardiac Malformation

AbstractPersistent pulmonary hypertension of the newborn is a source of considerable mortality and morbidity. Anomalous origin of one pulmonary artery, an uncommon congenital cardiac malformation, is a rare cause of persistent pulmonary hypertension. Here, we report the case of a patient with an anomalous origin of one pulmonary artery from the innominate artery who presented with persistent pulmonary hypertension refractory to treatment.

scholarly journals Hydrocortisone Improves Oxygenation Index and Systolic Blood Pressure in Term Infants With Persistent Pulmonary Hypertension

2019 ◽  
Vol 13 ◽  
pp. 117955651988891 ◽  
Author(s):  
Mahdi Alsaleem ◽  
Aysha Malik ◽  
Satyan Lakshminrusimha ◽  
Vasantha HS Kumar
Keyword(s):  
Blood Pressure ◽  
Pulmonary Hypertension ◽  
Systolic Blood Pressure ◽  
Animal Studies ◽  
Oxygenation Index ◽  
Retrospective Chart Review ◽  
Meconium Aspiration Syndrome ◽  
Persistent Pulmonary Hypertension ◽  
Term Infants ◽  
Near Term

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.

scholarly journals Postnatal causes and severity of persistent pulmonary Hypertension of Newborn

2021 ◽  
Vol 37 (5) ◽  
Author(s):  
Muhammad Sohail Arshad ◽  
Mudasser Adnan ◽  
Hafiz Muhammad Anwar-ul-Haq ◽  
Arif Zulqarnain
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Gestational Age ◽  
Distress Syndrome ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
Persistent Pulmonary Hypertension ◽  
High Morbidity ◽  
Meconium Aspiration

Background & Objective: Persistent pulmonary hypertension of the newborn (PPHN) is described as severe respiratory failure along with hypoxaemia. PPHN is known to be linked with high morbidity and mortality around the world. This study was planned to determine the postnatal causes and assess the severity of persistent pulmonary hypertension of newborn in babies presenting to the Children’s Hospital, Multan. Methods: This observational study was conducted at the Department of Paediatric Cardiology, The Children Hospital &Institute of Child Health, Multan, Pakistan from July to December 2019. A total of 122 confirmed cases of PPHN admitted having gestational age above 34 weeks were enrolled. Demographic data of the newborns was recorded along with maternal medical history, pregnancy status and postnatal causes of PPHN. Severity of PPHN was also recorded. Results: Out of a total of 122 cases of PPHN, 81 (66.3%) were male. Majority, 78 (64.0%) had gestational age above 37 weeks. Mode of delivery as cesarean section was noted in 70 (57.4%). Meconium aspiration syndrome 52 (42.6%), birth asphyxia 48 (39.3%), respiratory distress syndrome 23 (18.8%) and sepsis 33 (27.0%) were found to be the commonest causes of PPHN. Severe PPHN was found to be the most frequent, noted among 63 (51.6%) while Moderate PPHN was observed in 40 (32.8%) and Mild PPHN in 19 (15.6%). Morality was noted among 26 (21.3%) of cases. Conclusion: Meconium aspiration syndrome, birth asphyxia and respiratory distress syndrome were the commonest postnatal causes of PPHN. Severe PPHN was found to be the most frequent form of PPHN. doi: https://doi.org/10.12669/pjms.37.5.2218 How to cite this:Arshad MS, Adnan M, Anwar-ul-Haq HM, Zulqarnain A. Postnatal causes and severity of persistent pulmonary Hypertension of Newborn. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.2218 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Surfactant dysfunction disorder masquerading as meconium aspiration syndrome and persistent pulmonary hypertension of the newborn

2021 ◽  
Vol 14 (1) ◽  
pp. e239169
Author(s):  
Shelly Gupta ◽  
Gopal Agrawal ◽  
Manish Balde ◽  
Sanjay Wazir
Keyword(s):  
Pulmonary Hypertension ◽  
Exome Sequencing ◽  
Hyaline Membrane Disease ◽  
Meconium Aspiration Syndrome ◽  
Term Infant ◽  
Persistent Pulmonary Hypertension ◽  
Meconium Aspiration ◽  
Missense Variation ◽  
History Of ◽  
Surfactant Dysfunction

About 10% of term neonates present with respiratory distress at birth. The most common aetiologies include transient tachypnoea of the newborn, pneumonia and meconium aspiration syndrome (MAS). Hyaline membrane disease (HMD) in a term infant occurs either as primary HMD, secondary surfactant deficiency or congenital surfactant dysfunction. A detailed history supported with appropriate radiological and laboratory investigations can help a clinician reach a diagnosis. We report a case of surfactant dysfunction disorder which presented as severe MAS and persistent pulmonary hypertension of the newborn. In the infant described, the significant history of a sibling death with severe neonatal respiratory disease led us to think of diffuse developmental lung diseases especially surfactant dysfunction syndromes. Exome sequencing detected a heterozygous missense variation in exon 21 of the ATP binding cassette protein member 3 (ABCA3) gene. Based on the clinical picture supported with the exome sequencing, a diagnosis of surfactant dysfunction disorder (ABCA3 deficiency) was confirmed.

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