Pulmonary hypertension in the newborn

Greenough, Anne; Khetriwal, Babita

doi:10.1016/j.prrv.2005.03.005

Cited by 67 publications

(43 citation statements)

References 36 publications

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“…PPHN was diagnosed if infants were noted to have refractory hypoxemia plus 1 of the 3 following conditions: (1) documented pulmonary hypertension as defined by echocardiographic evidence of elevated pulmonary pressure (right to left or bidirectional shunt), (2) a pre-to postductal partial pressure of oxygen gradient equal to or greater than 20 mm Hg, and (3) a pulse oximetry oxygen saturation (Sp O 2 ) gradient equal to or greater than 10% [12] . An infant was excluded from the study if he or she had major congenital anomalies or cyanotic congenital heart disease.…”

Section: Methodsmentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn Successfully Treated with Beraprost Sodium: A Retrospective Chart Review

Nakwan¹,

Nakwan

Wannaro

2010

Neonatology

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Background: Persistent pulmonary hypertension of the newborn (PPHN) is one of the most serious conditions in neonates resulting in a high mortality and morbidity. New alternative therapies for PPHN have been sought to improve survival and reduce morbidity. Objectives: To report an initial experience of using beraprost sodium (BPS) to treat infants with PPHN and to assess its effect on oxygenation and hemodynamic stability over a 72-hour study period. Methods: The clinical data of neonates who received BPS as an adjunctive therapy for PPHN in our hospital between July 2007 and June 2008 were retrospectively reviewed. Results: During the study period, 7 infants with PPHN were successfully treated with BPS. The mean gestational age and birth weight were 39.3 ± 1.5 weeks and 3,365.7 ± 569.8 g, respectively. BPS was initiated at a median age of 42.7 h after birth (range: 2.1–166.5 h) with a baseline mean oxygen index (OI) of 33.9 ± 15.7 and a baseline mean systolic blood pressure (SBP) of 79.4 ± 9.9 mm Hg. The mean difference of OI at 24, 48 and 72 h following the treatment was –15.7 ± 14.8 (p = 0.043), –18.2 ± 12.3 (p = 0.018) and –16.7 ± 17.5 (p = 0.042), respectively. The mean SBP was significantly reduced as early as 6 h after initiation of treatment (–11.1 ± 11.5 mm Hg, p = 0.034) without changes in heart rate. Three cases were complicated with chronic lung disease, and the remaining 4 cases were normal at hospital discharge. No neurodevelopmental and cardiopulmonary disorders were observed in all cases at 1 year of age. Conclusions: BPS may be used as an alternative treatment for infants with PPHN giving a significant improvement in oxygenation.

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Section: Methodsmentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn Successfully Treated with Beraprost Sodium: A Retrospective Chart Review

Nakwan¹,

Nakwan

Wannaro

2010

Neonatology

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“…In the case of pulmonary hypoplasia, others found a reduced blood flow in the pulmonary artery and reduced diameters of the pulmonary arteries. Because pulmonary blood flow consists of only 15-20% of the cardiac output, a small change will be measured by Doppler in the pulmonary artery [24][25][26][27][28] . However, most blood flow goes through the ductus arteriosus, so probably the small amount of extra blood flow will not be enough to find any changes in the ductal flow, and a second factor may be that the ductus arteriosus is wide open during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Doppler Velocimetry of the Ductus Arteriosus in Normal Fetuses and Fetuses Suspected for Pulmonary Hypoplasia

Gerards¹,

Twisk

Vugt³

2009

Fetal Diagn Ther

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Objective: The purpose of this study was to determine whether the pulsatility index (PI) of the ductus arteriosus could predict the occurrence of pulmonary hypoplasia secondary to congenital disorders or complications during pregnancy. Sample and Methods: In this longitudinal study, 78 uncomplicated pregnancies and 43 pregnancies complicated by various disorders or complications with regard to pulmonary hypoplasia were studied by Doppler sonography between 18 and 35 weeks of gestation. A PI >97.5th percentile was considered abnormal. Results: Using a multilevel modelling, the reference curve of the PI of the ductus arteriosus was created based on 301 measurements. Of the 43 complicated pregnancies, 21 infants (49%) were diagnosed with pulmonary hypoplasia on postmortem examination and/or the clinical and radiological presentation. Using the PI, a sensitivity of 38%, a specificity of 95%, a positive predictive value of 89% and a negative predictive value of 62% were found. Conclusion: The PI of the ductus arteriosus is not useful in predicting the occurrence of pulmonary hypoplasia secondary to congenital disorders or complications during pregnancy.

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“…PHT was diagnosed in neonates with refractory hypoxemia by the presence of a pre-to-postductal partial pressure of oxygen gradient ≥20 mm Hg and documented by echocardiographic evidence of right to left shunt [48,49]. We also noted the use and duration of inhaled nitric oxide (iNO), the responsiveness to it and the consequent use of second-line therapy for PHT, the age at full enteral feeding (days) and the duration of stay in the neonatal intensive care unit (NICU; days) [50].…”

Section: Methodsmentioning

confidence: 99%

Prediction of Neonatal Respiratory Function and Pulmonary Hypertension in Fetuses with Isolated Congenital Diaphragmatic Hernia in the Fetal Endoscopic Tracleal Occlusion Era: A Single-Center Study

Doné¹,

Debeer

Gucciardo³

et al. 2014

Fetal Diagn Ther

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Objective: To correlate prenatal indicators of pulmonary hypoplasia with neonatal lung function and pulmonary hypertension (PHT) in isolated congenital diaphragmatic hernia (iCDH). Materials and Methods: Prospective single-center study on 40 fetuses with iCDH either expectantly managed (n = 13) or undergoing tracheal occlusion (n = 27). Prenatal predictors included observed/expected lung-head ratio (O/E LHR), observed/expected total fetal lung volume, fetal pulmonary reactivity to maternal O₂ administration (Δpulsatility index, ΔPI) and liver-to-thorax ratio (LiTR) as measured in the second and third trimesters. Postnatal outcome measures included survival until discharge, best oxygenation index (OI) and alveolar-arterial oxygen gradient [D(A-a)O₂] in the first 24 h of life and the occurrence of PHT in the first 28 days of life. Results: Median gestational age (GA) at evaluations was 27.2 and 34.3 weeks. GA at delivery was 36.0 weeks, and overall survival was 55%. In the second trimester, measurement of lung size, LiTR and pulmonary reactivity were significantly related to survival and the best OI and D(A-a)O₂.The occurrence of PHT was better predicted by ΔPI and LiTR. Conclusions: O/E LHR, LiTR and vascular reactivity correlate with ventilatory parameters in the first 24 h of life. Occurrence of PHT at ≥28 days was best predicted by LiTR and ΔPI, but not by lung size.

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Pulmonary hypertension in the newborn

Cited by 67 publications

References 36 publications

Persistent Pulmonary Hypertension of the Newborn Successfully Treated with Beraprost Sodium: A Retrospective Chart Review

Persistent Pulmonary Hypertension of the Newborn Successfully Treated with Beraprost Sodium: A Retrospective Chart Review

Doppler Velocimetry of the Ductus Arteriosus in Normal Fetuses and Fetuses Suspected for Pulmonary Hypoplasia

Prediction of Neonatal Respiratory Function and Pulmonary Hypertension in Fetuses with Isolated Congenital Diaphragmatic Hernia in the Fetal Endoscopic Tracleal Occlusion Era: A Single-Center Study

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