Clinical outcomes of neonates with persistent pulmonary hypertension in a teaching hospital, Eastern India

Background: Persistent pulmonary hypertension of the newborn (PPHN) is characterized by severe arterial hypoxaemia caused by increased pulmonary vascular resistance with resultant shunting through fetal channel (at the atrial and ductal level). Mortality of neonates due to PPHN ranges from 10-20%.

Objectives: To describe the clinical outcomes of neonates presenting with PPHN in a tertiary care hospital.

Method: It is a hospital based prospective observational study, conducted from June 2016 to December 2018. All late preterm and term babies having respiratory distress and profound hypoxia were included in the study after confirmation of pulmonary hypertension by echocardiography.

Results:Our study highlighted hyaline membrane disease (HMD) as the most common cause of PPHN in preterm neonates whereas meconium aspiration syndrome (MAS) was mostly found in term neonates. Survival rate of PPHN with MAS, HMD, congenital diaphragmatic hernia, pulmonary hypoplasia and idiopathic PPHN was 77%, 72%, 50%, 50% and 100% respectively. Left ventricular dysfunction was found in 28% babies who had died. Mean admission pH among survivors was 7.29 (7.25-7.32) and mean admission pH among non-survivors was 7.19 (7.11-7.26). Mean maximum oxygenation index (OI) among survivors was 19.4 (19.6-24.23) whereas the same in non survivors was 42.4 (23.8-60). Mortality rate increased to 66% if the OI was>40.

Conclusions: PPHN is a serious and often fatal condition, associated with a high mortality (30%). Admission pH, maximum oxygenation index, Apgar score <5 at 5 minutes, presence of left ventricular dysfunction and requirement of multiple inotropes were found to be significant predictors of higher mortality.

Sri Lanka Journal of Child Health, 2021; 50(2): 272-279