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Abstract

Introduction: Over the last 15 years, there have been changes in the treatment strategies available for the management of persistent pulmonary hypertension of the newborn (PPHN). Methods: Case-based retrospective review of patients admitted to a single tertiary-referral NICU aged 7 days or less between 1998–2012 with a diagnosis of PPHN. Results: 362 patients meeting inclusion criteria were admitted over the study period. Number of patients and baseline patient demographics including: gender, age, gestational age, birth weight, admission diagnosis, paediatric index of mortality (PIM2) score and oxygenation index (OI) at admission have not significantly changed over the last 15 years. Average length of stay remained constant and a decrease in overall mortality rate before discharge was not significant. Rates of referral for ECMO were unchanged but there was a shift over time in the characteristics of those patients that went on to need ECMO support. Almost half (48.1%) of those requiring ECMO support now have a diagnosis of sepsis, in contrast to the earliest period when most (51.7%) had meconium aspiration syndrome. The most common indication for ECMO was previously refractory hypoxaemia, whereas now most (77.7%) of those failing conventional management have more complex air leak or circulatory failure with shock. Those managed with ECMO now have a lower mean OI at admission but higher PIM2 scores. The outcome post ECMO (mean 76.4% survival) has not changed. Conclusions: As strategies for managing meconium aspiration/PPHN have improved, newborns that might previously have been transferred to our institution are now treated in local hospitals and those admitted who might previously have needed ECMO are managed with conventional therapies. Although the number of neonates needing ECMO support has remained constant over the last 15 years, the reasons for failure of conventional management have changed and patients are more likely to have complicating shock/circulatory failure than more straightforward refractory hypoxaemia.