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

Abstract

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.

Management of neonatal pulmonary hypertension-a survey of neonatal intensive care units in India

“…We found parenchymal lung diseases to be the most common non-cardiac cause of PPHN followed by birth asphyxia and sepsis. This was consistent with findings of other observational studies on PPHN [9,10].…”

Comparison of the efficacy of inhaled versus infused milrinone in the management of persistent pulmonary hypertension of the newborn in resource‐limited settings: A randomized clinical trial

“…According to previous research, injectable milrinone may improve the prognosis of infants with iNO-resistant PPHN. 23,28 Mat Bah et al…”

“…reported a poorer prognosis in iNO-resistant PPHN neonates, especially those with the idiopathic type. 23 Dillard et al reported that infants who were nonrespondent to iNO and received adjuvant milrinone had a better prognosis, better oxygenation, and fewer hemodynamic changes. 28 Nevertheless, in some cases, the addition of milrinone to iNO had no significant effects on the improvement of treatment.…”

“…According to previous research, injectable milrinone may improve the prognosis of infants with iNO‐resistant PPHN 23,28 . Mat Bah et al reported a poorer prognosis in iNO‐resistant PPHN neonates, especially those with the idiopathic type 23 . Dillard et al reported that infants who were nonrespondent to iNO and received adjuvant milrinone had a better prognosis, better oxygenation, and fewer hemodynamic changes 28 .…”

“…Although in reference books, the standard treatment for PPHN includes iNO, 5,6 PPHN is resistant to iNO in some cases. Mat Bah et al reported that iNO resistance deteriorates the prognosis of PPHN, especially if PPHN is idiopathic (primary) 23 . Also, management of primary PPHN remains controversial, and in many cases, combination therapy with multiple drugs is required.…”