School-age outcomes of newborns treated for persistent pulmonary hypertension

Abstract

Objective: The aim of this study was to describe the school-age outcome of a cohort of children treated with intensive care support for persistent pulmonary hypertension of the newborn (PPHN).Study Design: From 187 term newborns treated for PPHN as neonates, 109 were seen at school age (73% of 150 survivors and 58.2% of the original cohort). Of these 109 term newborns, 77 were treated with inhaled nitric oxide (iNO); of which 12 received extracorporeal membrane oxygenation (ECMO). The remaining 32 received conventional management with no exposure to iNO. Patients were seen at school age (mean 7.1 years). A medical history and physical exam were completed, growth was measured, and chest X-ray and echocardiogram were performed. Psychometric assessments included the Wechsler Scales (Preschool or Child), Vineland Adaptive Behavior Scales, Kaufman Test of Educational Achievement, Children's Category Test, Wisconsin Card Sorting Test and Achenbach Child Behavior Checklist.Results: Medical, neurodevelopmental and social/emotional/behavioral outcome did not differ between children treated with iNO, with or without ECMO, and those managed with no exposure to iNO. Overall, 24% had respiratory problems, 60% had abnormal chest X-rays and 6.4% had some sensorineural hearing loss. The cohort performed at the average level for full scale IQ, adaptive function, academic achievement, higher-order cognition and executive functioning, and social/behavioral/emotional functioning. Overall, 9.2% of the cohort had a full scale IQ less than 70 and 7.4% had an IQ from 70 to 84. Conclusion:The outcome for this cohort of children treated as newborns for PPHN, which included a large group of infants exposed to iNO, was comparable to previous reports of children treated with ECMO or conventionally. Journal of Perinatology (2010) 30, 127-134; doi:10.1038/jp.2009 published online 1 October 2009 Keywords: persistent pulmonary hypertension of the newborn; inhaled nitric oxide; school-age outcome Introduction Inhaled nitric oxide (iNO) has been found to be an effective and safe treatment for persistent pulmonary hypertension (PPHN) in the term and near-term newborns.1-5 The use of iNO has been found to improve oxygenation and decrease the need for extracorporeal membrane oxygenation (ECMO) in term newborns with acute respiratory failure and PPHN.

Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors

“…Rosenberg et al investigated school age outcomes of infants treated with iNO for PPHN and did not find an association between iNO and adverse neurodevelopmental outcome. [36] Interestingly, though, a trend towards poorer outcome in children with CDH treated with iNO was noted, with a 33% rate of moderate or severe handicap in this subgroup.…”

Maternal alcohol consumption during pregnancy and child’s cognitive performance at 6–8 years of age in rural Burkina Faso: an observational study

“…It was used to examine the effect of different exposures including health conditions like traumatic injuries (Moore, Donders & Thompson, 2004; Donders & Nesbit-Greene, 2004; Horneman & Emanuelson, 2009), brain dysfunction (Allen, Knatz & Mayfield, 2006; Bello, Allen & Mayfield, 2008), diseases (Rosenberg et al, 2010), marihuana and cocaine (Fried, Watkinson & Gray, 2005; Ga et al, 2015), disabilities (Hinton et al, 2004), chemical products (Debes et al, 2006; Wright et al, 2006; Jurewicz, Polańska & Hanke, 2013), and alcohol (Mattson et al, 1998). CCT-1 is an individually administered standardized test for children from 5 to 8 years to test their ability to solve problems on the basis of corrective feedback.…”

Pathophysiology, Management, and Outcome of Persistent Pulmonary Hypertension of the Newborn: A Clinical Review

“…The rate of neurodevelopmental disabilities including cognitive delays and hearing deficit can be seen in 6.4% of PPHN survivors (42). Feeding problems and short term respiratory morbidities can be seen also in 24% of PPHN survivors (42).…”

“…The rate of neurodevelopmental disabilities including cognitive delays and hearing deficit can be seen in 6.4% of PPHN survivors (42). Feeding problems and short term respiratory morbidities can be seen also in 24% of PPHN survivors (42). Rosenberg et al found no differences in medical, neurodevelopmental, and social/emotional/behavioral outcomes at school age, between children with PPHN who were treated with iNO, with or without ECMO, and infants who were treated without exposure to iNO (42).…”

“…Feeding problems and short term respiratory morbidities can be seen also in 24% of PPHN survivors (42). Rosenberg et al found no differences in medical, neurodevelopmental, and social/emotional/behavioral outcomes at school age, between children with PPHN who were treated with iNO, with or without ECMO, and infants who were treated without exposure to iNO (42). In a study at 18–24 months of age, inhaled NO was not associated with an increase in neurodevelopmental, behavioral, or medical abnormalities in infants who were treated for PPHN with or without iNO (43).…”