An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: incidence, etiology, diagnosis, treatment and outcome

Nakwan, Narongsak; Jain, Suksham; Kumar, Kishore; Hosono, Shigeharu; Hammoud, Majeda S.; Elsayed, Yasser Yahia; Ariff, Shabina; Hasan, Babar; Khowaja, Waqar; Poon, Woei Bing

doi:10.1080/14767058.2018.1536740

Cited by 44 publications

(48 citation statements)

References 16 publications

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“…6,12,19 Reported mortality in PPHN varies in different countries, such as 20.6% in Asian countries, 32% in Portugal, 4%-33% in the USA and 26.6% in Pakistan. 6,8,18,23 In our study increased risk of mortality was noticed in premature infants (6 infants out of 9) who all required mechanical ventilation and those with CDH.…”

Section: Discussionsupporting

confidence: 51%

“…6,7 There are very few studies which have examined the incidence of PPHN in Asian countries. 8 A study from Thailand reported an incidence of PPHN of 2.8 per 1000 live births 9 which was higher than the incidence in USA. And also the mortality and morbidity may be higher in developing countries compared to developed regions.…”

Section: Intravascular Obstruction Due To Hyperviscositymentioning

confidence: 94%

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A retrospective study of predisposing factors and outcome of persistant pulmonary hypertension among newborns at rural tertiary care centre

Yelamali

Mirji

Rajput

2020

Int J Contemp Pediatr

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Background: Persistent pulmonary hypertension in newborns (PPHN) remains a significant cause of perinatal morbidity and mortality. Early recognition of factors that increase the risk of PPHN is of great importance in either to prevent or to treat PPHN optimally. Aim was to study the neonatal predisposing factors, profile and outcome of PPHN.Methods: This retrospective study was conducted in level III neonatal care unit, a rural referral centre of North Karnataka, India from January 2018 to April 2020.Results: During the study period a total of 50 infants with PPHN were identified with the incidence of 5.43/1000 live births. Mean gestation age (±SD) was 38.28±2.49 weeks and mean birth weight (±SD) was 2624±512 gm. The most noted risk factors were meconium aspiration syndrome (42%), birth asphyxia (16%), RDS (10%), positive pressure ventilation at birth (52%) and male gender (62%). Out of 50 infants with PPHN, high mortality was seen in low birth weight babies (66.6%). Use of sildenafil showed increased mortality (56.2%) whereas use of surfactant scored better with decreased mortality of 42.8%.Conclusions: Major risk factors for PPHN are MAS, birth asphyxia, RDS and low birth weight. Poor prognosis is seen in male gender, prematurity and CDH with increased risk of mortality. The use of systemic pulmonary vasodilators can be considered with caution and use of surfactant has a role in management of PPHN.

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Section: Discussionsupporting

confidence: 51%

Section: Intravascular Obstruction Due To Hyperviscositymentioning

confidence: 94%

A retrospective study of predisposing factors and outcome of persistant pulmonary hypertension among newborns at rural tertiary care centre

Yelamali

Mirji

Rajput

2020

Int J Contemp Pediatr

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“…However, the mortality rate (16%) related to PPHN in this study is still high, without any statistically significant changes over time. Nonetheless, the mortality rate is within the higher-end range of high-income countries which ranges between 7 and 15% [ 15 ] and lower-end range of other Asian countries with a mortality rate of 12–40% [ 5 , 6 , 16 , 17 ]. Low mortality in this study compared to other Asian countries could be due to availability of iNO, strict adherence to local practice guidelines, continuous monitoring of the performance and outcome of PPHN with clinical registry, followed by changes in practice related to iNO usage in our unit.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advances in the management of PPHN in the current era, the overall mortality is still high, ranging between 7 and 39% [1,[3][4][5][6]. In addition to the usual general management principles of ill neonates, severe forms of PPHN may require specific treatment modalities that may not be readily available in lower-and-middle income countries (LMIC).…”

Section: Introductionmentioning

confidence: 99%

Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia

et al. 2021

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Objective This study aims to determine the immediate outcome of persistent pulmonary hypertension of the newborn (PPHN) and risk factors for mortality in the era of inhaled nitric oxide (iNO). Study design This observational cross-sectional study includes 195 confirmed PPHN with a gestational age of ≥34 weeks without congenital heart disease. Multivariable logistic regression was used to identify risk factors for mortality. Results The mortality rate was 16.4%, with the highest mortality with pulmonary hypoplasia. Of 195, 65% received iNO; 18% were iNO non-responders with the majority having pulmonary hypoplasia. Independent risk factors for mortality were the presence of reversal of flow at the descending aorta, pulmonary hypoplasia, APGAR scores ≤ 5 at 5 min, and idiopathic PPHN with an adjusted odds ratio of 15.9, 7.5, 6.7, and 6.4, respectively. Conclusions Despite the usage of iNO, mortality due to PPHN remains high and is related to etiology and cardiac function.

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“…Over two-thirds of neonates in the neonatal intensive care unit (NICU) require mechanical ventilation due to respiratory failure, and approximately 12–25% of them had refractory hypoxemia [1,2,3]. Inhaled nitric oxide (iNO) has been documented to be effective for the treatment of persistent pulmonary hypertension of newborn (PPHN) and hypoxic respiratory failure in near-term and term-born infants [4,5,6,7,8]. In recent years, iNO has been increasingly prescribed to neonates less than 34 weeks of gestation with respiratory distress syndrome (RDS) [8,9,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

The Off-Label Use of Inhaled Nitric Oxide as a Rescue Therapy in Neonates with Refractory Hypoxemic Respiratory Failure: Therapeutic Response and Risk Factors for Mortality

Hsiao

Yang

Lai

et al. 2019

JCM

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Objectives: The indication of inhaled nitric oxide (iNO) used in preterm infants has not been well defined. Neonates with refractory hypoxemia may benefit from the pulmonary vasodilatory effects of iNO. The aim of this study was to investigate the off-label use of iNO as a rescue therapy. Methods: Between January 2010 and December 2017, all neonates who received iNO as a rescue therapy from a tertiary-level medical center were enrolled, and those who were not diagnosed with persistent pulmonary hypertension of newborn (PPHN) were defined as having received off-label use of iNO. The controls were 636 neonates with severe respiratory failure requiring high-frequency oscillatory ventilation but no iNO. Results: A total of 206 neonates who received iNO as a rescue therapy were identified, and 84 (40.8%) had off-label use. The median (interquartile) gestational age was 30.5 (26.3–37.0) weeks. Neonates receiving iNO had significantly more severe respiratory failure and a higher oxygenation index than the controls (p < 0.001). Respiratory distress syndrome and secondary pulmonary hypertension after severe bronchopulmonary dysplasia (BPD) were the most common causes of the off-label iNO prescription. Of the 84 neonates with off-label use of iNO, 53 (63.1%) had initial improvement in oxygenation, but 44 (52.4%) eventually died. The overall mortality rate was 41.7% (86/206). After multivariate logistic regression, extremely preterm (odds ratio [OR] 5.51; p < 0.001), presence of pulmonary hemorrhage (OR 2.51; p = 0.036) and severe hypotension (OR 2.78; p = 0.008) were the independent risk factors for final mortality. Conclusions: iNO is applicable to be an off-label rescue therapy for premature neonates with refractory hypoxemia due to severe pulmonary hypertension and bronchopulmonary dysplasia.

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An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: incidence, etiology, diagnosis, treatment and outcome

Cited by 44 publications

References 16 publications

A retrospective study of predisposing factors and outcome of persistant pulmonary hypertension among newborns at rural tertiary care centre

A retrospective study of predisposing factors and outcome of persistant pulmonary hypertension among newborns at rural tertiary care centre

Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia

The Off-Label Use of Inhaled Nitric Oxide as a Rescue Therapy in Neonates with Refractory Hypoxemic Respiratory Failure: Therapeutic Response and Risk Factors for Mortality

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