Incidence and outcomes of persistent pulmonary hypertension of the newborn in a tertiary referral center, Indonesia

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN), also known as persistent fetal circulation, is a failure of the transition/adaptation process from fetal to extrauterine life with significant morbidity and mortality rates. This study determined the incidence and outcome of PPHN in infants. Methods: From January 2017 to March 2022, an observational study was conducted on newborns with PPHN who were hospitalized in the second and third-level neonatology wards of Prof. Dr. I.G.N.G. Ngoerah Hospital. Based on a clinical and echocardiographic examination, PPHN was confirmed. Missing data on infants were excluded. PPHN incidence and outcomes were the main outcomes. The clinical profile of newborns with PPHN was one of the secondary outcomes. Results: There were 42 neonates, with a median age of 1 (range 0-5 days) day at diagnosis. PPHN occurred in 2.5 cases per 1000 neonates admitted, with 60% male and 40% female. Referrals accounted for 74% of all PPHN cases. The majority of cases were born cesarean delivery (83%), at term (74%), and with birth weights of more than 2500 grams (65%). In 55% of cases, asphyxia history was discovered. The median oxygen index (OI) was 5.3 (range 1.90-57.30), with pneumonia/sepsis accounting for 95% of the causes. The median length of stay was 9.50 days (range 1-89), and 20 (48%) of the 42 cases had death. Conclusion: The incidence of PPHN in a tertiary referral center in Indonesia is 2.5 cases per 1000 patients treated with a 48% mortality rate.