A retrospective study of predisposing factors and outcome of persistant pulmonary hypertension among newborns at rural tertiary care centre

Abstract

Background: Persistent pulmonary hypertension in newborns (PPHN) remains a significant cause of perinatal morbidity and mortality. Early recognition of factors that increase the risk of PPHN is of great importance in either to prevent or to treat PPHN optimally. Aim was to study the neonatal predisposing factors, profile and outcome of PPHN.Methods: This retrospective study was conducted in level III neonatal care unit, a rural referral centre of North Karnataka, India from January 2018 to April 2020.Results: During the study period a total of 50 infants with PPHN were identified with the incidence of 5.43/1000 live births. Mean gestation age (±SD) was 38.28±2.49 weeks and mean birth weight (±SD) was 2624±512 gm. The most noted risk factors were meconium aspiration syndrome (42%), birth asphyxia (16%), RDS (10%), positive pressure ventilation at birth (52%) and male gender (62%). Out of 50 infants with PPHN, high mortality was seen in low birth weight babies (66.6%). Use of sildenafil showed increased mortality (56.2%) whereas use of surfactant scored better with decreased mortality of 42.8%.Conclusions: Major risk factors for PPHN are MAS, birth asphyxia, RDS and low birth weight. Poor prognosis is seen in male gender, prematurity and CDH with increased risk of mortality. The use of systemic pulmonary vasodilators can be considered with caution and use of surfactant has a role in management of PPHN.