Persistent Pulmonary Hypertension of the Newborn at Nakhon Phanom Hospital

Abstract

his retrospective study was to review patients with persistent pulmonary hypertension of the newborn (PPHN) at Nakhon phanom hospital from April 2011 to May 2017. The purpose of this study was to describe the prevalence, demographic pattern, clinical description, treatment, complication outcome and mortality rate. The results howed that the prevalence of persistent pulmonary hypertension of the newborn were 1.12 – 2.96 per 1,000 live births. 19 of 32 diagnosed PPHN newborns were males (59.40%). Thai nationality 28 cases (87.50%). 56.20% were delivered by normal labour. 13 newborns (40.60%) were transfer from other hospitals with average age 5.17 hours. The average gestational age were 40.42 ± 2.56 weeks, birth weight 3,243.13 ± 665.72 grams and the Apgar score at 1, 5 and 10 minutes were 6.42 ± 3.12, 7.90 ± 2.55 และ 8.50 ± 2.36 respectively. The diagnosed PPHN age was 6.19 (0.33 – 30) hours. The most common cause of PPHN was MAS (78.10%). The PPHN newborns were on CMV setting MAX PIP 17 ± 2.58 cmH2O, MAX PEEP 4.13 ± 0.92 cmH2O and mandatory rate 80.65 ± 19.65 times/minute. Max mean airway pressure and amplitude in HFOV setting were 18.45 ± 4.96 cmH2O and 33.40 ± 7.34 respectively. The newborns received crystalloid (NSS) 29 cases (90.62%), FFP 23 cases (71.90%), PRC 12 cases (37.50%) and NaHCO3 10 cases (31.25%). All of them received inotropic drugs. The average dose of dopamine, dobutamine, epinephrine and norepinephrine were 17.97 ± 3.99, 18.91 ± 3.00, 1.48 ± 0.87 and 1.61 ± 0.47 mcg/kg/min respectively. MgSO4, sildenafil, intravenous iloprost and iloprost with milrinone were used for pulmonary blood pressure reducing in PPHN newborns for 5 cases (15.60%), 7 cases (21.90%), 5 cases (15.60%) and 1 cases (3.10%) respectively. Gastrointestinal bleeding was found 34.40% as the most common complication in this study. Mortality rate was 59.40%. The died newborns group had higher SBP, MAP than the survivor group with statistically significant (p < 0.05) and shorter length of stays than the survivor group with statistically significant (p < 0.01). The followed survivors had normal development at 2 years old was 57.14% and delayed development 1 case (14.29%). Conclusion The mortality rate of PPHN was high. The majority cause was meconium aspiration syndrome that could be preventable. Therefore, the development of healthcare personnel knowledge, skill performance and effective neonatal care networks should be established for decrease in mortality rate.