Progress of genes related to persistent pulmonary hypertension of the newborn / 国际儿科学杂志

Persistent pulmonary hypertension of the newborn(PPHN)is a disease that seriously endangers the life of the newborn caused by one or more factors.The causes mainly include respiratory distress syndrome, meconium aspiration syndrome, infection, congenital diaphragmatic hernia, etc.The pathogenesis of PPHN is still not completely clear, and neurobiochemical, internal environment, genetics and other factors are currently recognized as influencing factors.In recent years, with the rapid development and wide application of genetic testing technology, more and more studies have shown that the occurrence of PPHN may be related to the polymorphism and/or mutation of some genes.This article reviews the research progress of six gene loci that may be related to PPHN in order to provide reference for clinical research.

Application of extracorporeal membrane oxygenation in the treatment of persistent pulmonary hypertension of the newborn / 中国当代儿科杂志

OBJECTIVES@#To study the clinical value of extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).@*METHODS@#A retrospective analysis was performed on the medical data of 11 neonates with PPHN who were treated with ECMO in the Neonatal Intensive Care Unit of Zhongshan People's Hospital from January 2015 to December 2021, involving the neonates' general information, clinical diagnosis, laboratory results, duration of ECMO treatment, complications during ECMO treatment, length of hospital stay, and outcome.@*RESULTS@#Of the 11 neonates, 10 (91%) had successful weaning from ECMO, and 8 (73%) survived. For the 11 neonates, the mean duration of ECMO treatment was (81±50) hours (range: 26 to 185 hours), the mean duration of ventilator use was (198±105) hours (range: 57 to 392 hours), and the mean length of hospital stay was (22±15) days (range: 2 to 49 days). The oxygenation index and blood lactate level were significantly improved after 24 hours of ECMO treatment among the 11 neonates (P<0.05). Ten neonates had significantly reduced pulmonary artery pressure after 24 hours of ECMO treatment (P<0.05). One neonate had a progressive increase in the pulmonary artery pressure during EMCO treatment, succumbing to death. This neonate was diagnosed with alveolar capillary dysplasia based on the histopathological findings of the lung tissue and whole-exome sequencing results. Among the 11 children, 5 had intracranial hemorrhage, 1 had disseminated intravascular coagulation, 1 had gastric hemorrhage, 2 had pulmonary hemorrhage, 1 had renal insufficiency, and 3 had bleeding at the puncture site during ECMO treatment.@*CONCLUSIONS@#ECMO is effective for the treatment of PPHN, however, the high incidence of complications of ECMO treatment suggests that it is important to carefully assess the indications and timing of ECMO treatment and improve the management of ECMO, which can improve the weaning rate and survival rate.

Early risk factors for death in neonates with persistent pulmonary hypertension of the newborn treated with inhaled nitric oxide / 中国当代儿科杂志

OBJECTIVES@#To evaluate the early risk factors for death in neonates with persistent pulmonary hypertension of the newborn (PPHN) treated with inhaled nitric oxide (iNO).@*METHODS@#A retrospective analysis was performed on 105 infants with PPHN (gestational age ≥34 weeks and age <7 days on admission) who received iNO treatment in the Department of Neonatology, Children's Hospital of Nanjing Medical University, from July 2017 to March 2021. Related general information and clinical data were collected. According to the clinical outcome at discharge, the infants were divided into a survival group with 79 infants and a death group with 26 infants. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for death in infants with PPHN treated with iNO. The receiver operating characteristic (ROC) curve was used to calculate the cut-off values of the factors in predicting the death risk.@*RESULTS@#A total of 105 infants with PPHN treated with iNO were included, among whom 26 died (26/105, 24.8%). The multivariate Cox regression analysis showed that no early response to iNO (HR=8.500, 95%CI: 3.024-23.887, P<0.001), 1-minute Apgar score ≤3 points (HR=10.094, 95%CI: 2.577-39.534, P=0.001), a low value of minimum PaO2/FiO2 within 12 hours after admission (HR=0.067, 95%CI: 0.009-0.481, P=0.007), and a low value of minimum pH within 12 hours after admission (HR=0.049, 95%CI: 0.004-0.545, P=0.014) were independent risk factors for death. The ROC curve analysis showed that the lowest PaO2/FiO2 value within 12 hours after admission had an area under the ROC curve of 0.783 in predicting death risk, with a sensitivity of 84.6% and a specificity of 73.4% at the cut-off value of 50, and the lowest pH value within 12 hours after admission had an area under the ROC curve of 0.746, with a sensitivity of 76.9% and a specificity of 65.8% at the cut-off value of 7.2.@*CONCLUSIONS@#Infants with PPHN requiring iNO treatment tend to have a high mortality rate. No early response to iNO, 1-minute Apgar score ≤3 points, the lowest PaO2/FiO2 value <50 within 12 hours after admission, and the lowest pH value <7.2 within 12 hours after admission are the early risk factors for death in such infants. Monitoring and evaluation of the above indicators will help to identify high-risk infants in the early stage.

Efficacy and safety of bosentan in the treatment of persistent pulmonary hypertension of the newborn: a Metaanalysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the efficacy and safety of bosentan in the treatment of persistent pulmonary hypertension of the newborn (PPHN).@*METHODS@#Chinese Journal Full-text Database, Weipu Database, Wanfang Data, China Biology Medicine disc, PubMed, Web of Science, Embase, and Cochrane Library were searched for literature on bosentan in the treatment of PPHN published up to August 31, 2021.@*RESULTS@#A total of 8 randomized controlled trials were included for Meta analysis. The results of the Meta analysis showed that compared with the control group, the bosentan treatment group had a significantly lower treatment failure rate (RR=0.23, P<0.001), a significantly greater reduction in pulmonary artery pressure [mean difference (MD)=-11.79, P<0.001)], significantly greater increases in oxygen partial pressure (MD=10.21, P=0.006) and blood oxygen saturation (MD=8.30, P<0.001), and a significantly shorter length of hospital stay (MD=-1.35, P<0.001). The descriptive analysis showed that the bosentan treatment group had a lower degree of tricuspid regurgitation than the control group after treatment. The main adverse reactions of bosentan treatment included abnormal liver function, anemia and edema. The results of subgroup analysis based on treatment regimen, research area, and drug dose were consistent with those before stratification.@*CONCLUSIONS@#Bosentan is effective in the treatment of PPHN. However, when using bosentan, attention should be paid to adverse reactions such as abnormal liver function.

Association of asymmetric dimethylarginine with the pathological process of persistent pulmonary hypertension of the newborn / 中国当代儿科杂志

OBJECTIVES@#To study the change in asymmetric dimethylarginine (ADMA) in the circulation system of full-term infants with persistent pulmonary hypertension of the newborn (PPHN) and its association with treatment response, as well as the possibility of ADMA as a therapeutic target and a marker for treatment response.@*METHODS@#A prospective study was performed. A total of 30 full-term neonates who were diagnosed with PPHN within 3 days after birth were enrolled as the PPHN group, and the neonates without PPHN, matched for gestational age and age, who were treated or observed in the department of neonatology were enrolled as the control group. Serum samples were collected on days 1, 7, and 14 of treatment. The high-performance liquid chromatography-tandem mass spectrometry was used to measure the serum concentrations of L-arginine, ADMA, and its isomer symmetric dimethylarginine (SDMA).@*RESULTS@#For the neonates in the control group, the serum concentrations of ADMA and L-arginine continuously increased and the serum concentration of SDMA continuously decreased within the first 14 days of treatment. On days 1 and 14, there was no significant difference in the serum concentration of ADMA between the control and PPHN groups (P>0.05). On day 7, the PPHN group had a significantly higher serum concentration of ADMA than the control group (P<0.05), while there were no significant differences in serum concentrations of SDMA or L-arginine (P>0.05). Moreover, after 7 days of treatment, the PPHN neonates with a systolic pulmonary arterial pressure (sPAP) of >35 mmHg had a significantly higher serum concentration of ADMA than those with an sPAP of ≤35 mm Hg.@*CONCLUSIONS@#There are continuous increases in the ADMA concentration and the ADMA/SDMA ratio in the circulation system of full-term infants within the first 2 weeks after birth, and this process is accelerated by the pathological process of PPHN, suggesting that ADMA may be involved in the pathologic process of PPHN. A high level of ADMA is associated with the resistance to PPHN treatment, suggesting that inhibition of ADMA might be a potential target of drug intervention to improve the treatment response of PPHN.

The early predictive value of vasoactive inotropic score in persistent pulmonary hypertension of the newborn / 中国新生儿科杂志

Objective:To study the early predictive value of vasoactive inotropic score (VIS) for mortality in persistent pulmonary hypertension of the newborn (PPHN).Method:From July 2017 to November 2020, clinical data of infants diagnosed with PPHN (gestational age ≥34 weeks and admission age <7 days) admitted to our department of neonatology were retrospectively analyzed. According to their clinical outcome, the infants were assigned into survival group and death group. Demographics, risk factors of mortality and the series of VIS within 12 hours after admission were collected. These indicators were compared between the two groups to determine the confounding factors of mortality. Logistic regression was used to determine the correlation between VIS and mortality. The predictive value of VIS for the mortality of infants with PPHN was calculated using ROC curve.Result:A total of 105 infants with PPHN were enrolled, including 75 in survival group and 30 in death group. The overall mortality rate was 28.6% (30/105). Compared with survival group, the death group had higher gestational age [(39.1±1.8) weeks vs. (37.9±2.0) weeks], lower Apgar score at 1 minute [8.0 (6.0, 9.3) vs. 9.0 (8.0, 10.0)] and lower PaO 2/FiO 2 within 12 hours after admission [40 (30, 50) vs. 80 (60, 100)]. After adjusting for gestational age, Apgar score at 1min and lowest PaO 2/FiO 2 within 12 hours after admission, the maximal VIS (VISmax) >27.8 within 12 hours after admission was independently correlated with increased risk of mortality ( OR=23.055, 95% CI 4.885~108.800, P<0.001). ROC curve analysis showed that the cut-off value was 27.8, with 70.0% sensitivity and 90.7% specificity predicting mortality (AUC=0.828, Youden index=0.607). Conclusion:VIS could be used as an early predictor of mortality in PPHN. The infants with VISmax greater than 27.8 within 12 hours after admission have increased risk of mortality.

Drug treatment of neonatal persistent pulmonary hypertension / 中国小儿急救医学

Neonatal persistent pulmonary hypertension refers to the continuous increase of pulmonary artery pressure, right heart pressure, right-to-left shunt at foramen ovale and ductus arteriosus level, severe hypoxemia and even respiratory failure after birth.At present, the drug treatments of neonatal persistent pulmonary hypertension include inhaling nitric oxide, sildenafil, milrinone, endothelin receptor antagonists bosentan, prostaglandins and their analogs.This review briefly summarized the progress on the treatment of neonatal persistent pulmonary hypertension.

Expression and clinical significance of IL-1β and IL-1β receptor antagonist in persistent pulmonary hypertension of the newborns secondary to sepsis / 国际儿科学杂志

Objective:To explore the expression and clinical significance of IL-1β and IL-1β receptor antagonist(IL-1ra)in persistent pulmonary hypertension of the newborn(PPHN)secondary to sepsis.Methods:The newborns with sepsis were enrolled in the Department of Neonatal Intensive Care Unit(NICU)of Xi′an Children′s Hospital from January 2018 to November 2020.The newborns with sepsis were divided into two groups: the newborns without PPHN( n=108)were the control group and the newborns with PPHN( n=44)were the experimental group.Clinical data, laboratory examination and bedside echocardiography of all the newborns were collected to analyze the differences between the two groups.The expression levels of IL-1β and IL-1ra in neonatal plasma of the two groups were detected by enzym-linked immunosorbination(ELISA), and their roles in neonatal sepsis with PPHN were further analyzed.The risk factors of neonatal sepsis with PPHN were analyzed by multivariate Logistic regression, and the early prediction value of the risk factors for neonatal sepsis with PPHN were evaluated by the receiver operating characteristic(ROC)curve. Results:There were no significant differences in gestational age[(39.11±0.55)w vs(38.85±0.72)w], birth weight[(3.30±0.49)kg vs(3.24±0.55)kg]and proportions of males[60(55.6%)vs 30(68.2%)]between the two groups( P>0.05). The right ventricular diameter[(9.57±0.35)mm], pulmonary artery pressure[(51.36±5.91)mmHg]and the level of N-terminal brain natriuretic peptide(NT-proBNP)[(25436.83±12343.18)ng/L)]significantly increased in the experimental group than those in the control group[(8.77±0.41)mm, (31.24±5.11)mmHg, (11267.09±4405.48)ng/L, respectively, P<0.05]. Before treatment, the expression levels of plasma IL-1β[(31.24±5.25)ng/L]and IL-1ra[(41.94±10.13)ng/L]in the experimental group were significantly higher than those in the control group[(18.27±4.47)ng/L, (21.47±8.76)ng/L, respectively, P<0.05]. The expression levels of plasma IL-1β[(10.46±3.17)ng/L]and IL-1ra[(10.58±2.94)ng/L]in the experimental group after treatment were significantly lower than those before treatment[(31.24±5.25)ng/L, (41.94±10.13)ng/L , respectively, P<0.05]. Multivariate Logistic regression analysis showed that IL-1β and NT-proBNP were the independent risk factors for neonatal sepsis with PPHN( P<0.05). ROC curve analysis showed that IL-1β and NT-proBNP had the good predictive value for the occurrence of neonatal sepsis with PPHN( P<0.05). IL-1β combined with NT-proBNP has the better predictive value for neonatal sepsis with PPHN. Conclusion:IL-1β combined with NT-proBNP have the high predictive value for PPHN of the newborns secondary to sepsis.

Hipertensão pulmonar persistente neonatal: análise do diagnóstico e tratamento / Pulmonary hypertension of the newborn: analysis of diagnoses and treatment

Objetivos: Descrever fatores de risco, perfil do recém-nascido, alterações ecocardiográficas, tratamento e desfecho da Hipertensão Pulmonar Persistente Neonatal em uma unidade de cuidados terciários na cidade de Joinville/SC, Brasil. Métodos: Estudo descritivo observacional transversal envolvendo a avaliação dos prontuários dos neonatos com sinais clínicos de hipertensão pulmonar, comprovação ecocardiográfica e internação em Unidade de Terapia Intensiva no período de um ano. Foram coletados dados fetais, maternos, ecocardiográficos, tratamentos e desfechos. Resultados: Foram estudados 29 recém-nascidos. A mediana da idade gestacional foi de 37,4 semanas, 65,5% dos partos foram realizados por via alta e 48,3% das mães realizaram acompanhamento pré-natal de alto risco. O peso de nascimento variou de 585 a 4270g, 58,6% dos pacientes eram do sexo feminino, 48,3% dos recém-nascidos apresentaram Índice de Apgar <7 no 1º minuto. Ao estudo ecocardiográfico, 62,1% dos pacientes apresentaram shunt cardíaco direito-esquerdo e a pressão pulmonar média calculada foi de 40,5 mmHg (26,3-66,0). As drogas mais utilizadas foram Milrinona, Óxido Nítrico Inalatório e Alprostadil. A amostra contou com 6 óbitos. Não houve valor de p significativo nas variáveis devido a limitação na quantidade da amostra estudada. Conclusão: O perfil do RN encontrado foi de neonatos do gênero feminino, a termo, com nascimento por via alta. Os sinais clínicos de hipertensão pulmonar foram observados na maioria dos pacientes sendo demonstrado grau leve pelas alterações ecocardiográficas. Não houve diferença significativa na comparação das medicações utilizadas e o tempo de suporte ventilatório comparado a severidade da doença. A taxa de mortalidade foi semelhante a outros estudos.

Objectives: To describe risk factors, newborn profile, echocardiographic changes, treatment and outcome of Persistent Pulmonary Hypertension of Newborn diagnosed in a hospital in the South of Brazil. Methods: This was a cross-sectional descriptive study. The research was performed with medical records of newborns presenting clinical signs of pulmonary hyperterion, echocardiographic changes and neonatal ICU for one year. Our variables included neonatal data, maternal data, echocardiographic data, treatments and outcomes. Results: We studied 29 newborns. The median gestational age was 37.4 weeks, 65.5% of deliveries were cesarean and 48.3% of mothers underwent high-risk prenatal care. Birth weight ranged from 585 to 4270 g, 58.6% were female patients, 48.3% of newborns had Apgar score <7 in the first minute. Among the echocardiographic changes, we found 62.1% of patients with right-to-left cardiac shunt and mean pulmonary pressure calculated was 40.5 mmHg (26.3-66.0). The main prescribed drugs were Milrinone, Inhaled Nitric Oxide and Alprostadil (Prostaglandin E1 agonist). The total sample had 6 deaths. Due the limitation of the amount of the sample studied, an insignificant p-value was obtained in all variables. Conclusion: The profile of the newborn was female genre, with term pregnancy, by cesarian. Clinical signs of pulmonary hypertension were observed in most of patients, and mild levels were demonstrated by echocardiographic changes. There was no significant difference in the comparison between the medications used and the duration of ventilatory support associated with the severity of the disease. The mortality rate was similar to other studies.

Role of oral sildenafil in neonates with persistent pulmonary hypertension of newborn

Persistent pulmonary hypertension of newborn is a devastating condition and leads to morbidity and mortality. Even after the increasing use of' NO, ECMO and HFO many patients succumb to death. About 50% of the patients either have rebound hypertension or do not respond to the treatment. Hence the role of phosphodiesterase inhibitors (sildenafil) need to be evaluated. Methods is authors report a retrospective case series of 24 patients with PPHN admitted in NICU and treated with oral sildenafil. Results sildenafil was started on all patients on a mean of 1.46 days and stopped on mean of 3.8 days. Initial fio2 was 100%, which after starting sildenafil decreased gradually to 50% on mean of 10 days. Average length of stay in NICU was 20 days. 17(70.8%) patients survived whereas 7 (29%) expired No improvement in oxygen Index after 48 hours (p<0.05) was the independent predicting risk factor for PPHN related mortality in the expired patients.Conclusion are oral sildenafil can be a used in conjunction with other treatment modalities for PPHN especially in resource limited settings.

Association between corticotropin releasing hormone receptor 1 (rs4458044)polymorphism and persistent pulmonary hypertension of the newborn / 中华实用儿科临床杂志

Objective To investigate the association between rs4458044 site of corticotropin releasing hormone receptor 1 (CRHR1) polymorphism and persistent pulmonary hypertension of the newborn (PPHN).Methods Eighty-five blood specimens were collected from newborns with PPHN in Affiliated Hospital of Jining Medical University between March 2012 and March 2018,and 50 blood specimens were collected from healthy newborns as controls.The basic clinical data,clinical laboratory results,distribution of CRHR1 (rs4458044) polymorphism were retrospectively analyzed by t-test andx2 test.Results No significant difference existed in gender,gestational age,birth weight and 1 minute Apgar score between newborns with PPHN and the normal controls (all P ＞ 0.05).Significant difference existed in auxiliary ventilation time and maximum oxygenation index between newborns with PPHN and the normal controls (all P ＜ 0.05).Gene frequency of CRHR1 (rs4458044) GG,CG and CC gene types in newborns with PPHN and controls was 2.35％,43.53％,54.12％ and 50.00％,38.00％,12.00％,respectively.The CG/CC gene type was significantly higher in newborns with PPHN than the normal controls (P ＜ 0.05).The CG/CC gene type newborns had a higher risk for getting PPHN than GG gene type newborns (GG gene type as reference,C G gene type OR =24.34,95％ CI:5.20-113.87,P =0.00;CC gene type OR =95.83,95％ CI:17.99-510.49,P =0.00).Auxiliary ventilation time and maximum oxygenation index of newborns carrying C allele were higher than those without carrying C allele.Conclusion CRHR1 (rs4458044) polymorphism is closely associated with PPHNs.

Association between corticotropin releasing hormone receptor 1 (rs4458044) polymorphism and persistent pulmonary hypertension of the newborn / 中华实用儿科临床杂志

Objective@#To investigate the association between rs4458044 site of corticotropin releasing hormone receptor 1 (CRHR1) polymorphism and persistent pulmonary hypertension of the newborn (PPHN).@*Methods@#Eighty-five blood specimens were collected from newborns with PPHN in Affiliated Hospital of Jining Medical University between March 2012 and March 2018, and 50 blood specimens were collected from healthy newborns as controls.The basic clinical data, clinical laboratory results, distribution of CRHR1 (rs4458044) polymorphism were retrospectively analyzed by t-test and χ2 test.@*Results@#No significant difference existed in gender, gestational age, birth weight and 1 minute Apgar score between newborns with PPHN and the normal controls (all P>0.05). Significant difference existed in auxiliary ventilation time and maximum oxygenation index between newborns with PPHN and the normal controls (all P<0.05). Gene frequency of CRHR1 (rs4458044) GG, CG and CC gene types in newborns with PPHN and controls was 2.35%, 43.53%, 54.12% and 50.00%, 38.00%, 12.00%, respectively.The CG/CC gene type was significantly higher in newborns with PPHN than the normal controls (P<0.05). The CG/CC gene type newborns had a higher risk for getting PPHN than GG gene type newborns (GG gene type as reference, CG gene type OR=24.34, 95%CI: 5.20-113.87, P=0.00; CC gene type OR=95.83, 95%CI: 17.99-510.49, P=0.00). Auxiliary ventilation time and maximum oxygenation index of newborns carrying C allele were higher than those without carrying C allele.@*Conclusion@#CRHR1 (rs4458044) polymorphism is closely associated with PPHNs.

Effect of inhaled nitric oxide with mechanical ventilation in persistent pulmonary hypertension of newborn / 中国小儿急救医学

Objective@#To study the clinical effect of inhaled nitric oxide(iNO) with mechanical ventilation for the neonates with persistent pulmonary hypertension of newborn(PPHN).@*Methods@#A total of 40 neonates with PPHN poorly responding with routine treatment were treated with iNO therapy.Pulmonary artery pressure, blood gas ion analysis and respiratory function changes were observed at different time points before and after iNO.@*Results@#Treatment with iNO resulted in a rapid decrease in pulmonary artery pressure from(54.95±17.08) mmHg(1 mmHg=0.133 kPa) to(20.40±14.26) mmHg.Oxygenation of 40 cases improved in the first 0.5~1 hour after iNO therapy, the values of mean airway pressure(MAP)declined from(13.98±2.40)cmH2O(1 cmH2O=0.098 kPa) to(12.44±2.69)cmH2O, oxygenation index(OI)decreased from 26.89±18.62 to 13.84±5.52, PaO2/FiO2 increased from(60.34±23.49) mmHg to(144.46±23.49) mmHg, and the value of pH increased from 7.31±0.14 to 7.37±0.07.Furthermore, within 48 hours after treatment, PaO2/FiO2 and pH increased gradually, while MAP and OI decreased gradually, which all had statistical differences(P<0.01).@*Conclusion@#Mechanical ventilation combined with iNO therapy in the treatment of PPHN can rapidly improve the oxygenation status of neonates, reduce pulmonary vascular resistance, and then improve the survival rate and long-term prognosis.

Study progress of chorioamnionitis and lung disease in preterm infants / 中华实用儿科临床杂志

Preterm birth is a major cause of perinatal mortality and long-term morbidity, chorioamnionitis (CAM) is a common cause of preterm birth and characterized by inflammation.CAM produces variety of inflammatory factors in fetal, results in structural and functional impairment, and affects the contractile function of pulmonary blood vessels, so, CAM can have impact on the morbidity of lung disease in premature, and it may even affect the long-term pulmonary function.

Effect of inhaled nitric oxide with mechanical ventilation in persistent pulmonary hypertension of newborn / 中国小儿急救医学

Objective To study the clinical effect of inhaled nitric oxide ( iNO) with mechanical ventilation for the neonates with persistent pulmonary hypertension of newborn(PPHN). Methods A total of 40 neonates with PPHN poorly responding with routine treatment were treated with iNO therapy. Pulmona-ry artery pressure,blood gas ion analysis and respiratory function changes were observed at different time points before and after iNO. Results Treatment with iNO resulted in a rapid decrease in pulmonary artery pressure from(54. 95 ± 17. 08) mmHg(1 mmHg＝0. 133 kPa) to(20. 40 ± 14. 26) mmHg. Oxygenation of 40 cases improved in the first 0. 5 ~1 hour after iNO therapy,the values of mean airway pressure(MAP) de-clined from(13. 98 ± 2. 40) cmH2 O(1 cmH2 O＝0. 098 kPa) to(12. 44 ± 2. 69) cmH2O,oxygenation index (OI)decreased from 26. 89 ± 18. 62 to 13. 84 ± 5. 52,PaO2/FiO2 increased from(60. 34 ± 23. 49) mmHg to (144. 46 ± 23. 49) mmHg,and the value of pH increased from 7. 31 ± 0. 14 to 7. 37 ± 0. 07. Furthermore, within 48 hours after treatment,PaO2/FiO2 and pH increased gradually,while MAP and OI decreased gradu-ally,which all had statistical differences(P<0. 01). Conclusion Mechanical ventilation combined with iNO therapy in the treatment of PPHN can rapidly improve the oxygenation status of neonates,reduce pulmonary vascular resistance,and then improve the survival rate and long-term prognosis.

Study progress of chorioamnionitis and lung disease in preterm infants / 中华实用儿科临床杂志

Preterm birth is a major cause of perinatal mortality and long-term morbidity,chorioamnionitis (CAM) is a common cause of preterm birth and characterized by inflammation.CAM produces variety of inflammatory factors in fetal,results in structural and functional impairment,and affects the contractile function of pulmonary blood vessels,so,CAM can have impact on the morbidity of lung disease in premature,and it may even affect the long-term pulmonary function.

Progress of extracorporeal membrane oxygenation in persistent pulmonary hypertension of the newborn / 中华实用儿科临床杂志

Persistent pulmonary hypertension of the newborn (PPHN) is a serious disease that endangers the life of a newborn.Currently,extracorporeal membrane oxygenation is an important component of life support for PPHN patients who is ineffective of the conventional treatment.In recent years,the domestic related reports have gradually increased.This paper summarizes the related research results at home and abroad in recent years,and expounds its application progress.

Secuestro pulmonar una infrecuente causa de hipertensión pulmonar persistente en el recién nacido reporte de un caso / Pulmonary sequestration an uncommon cause of persistent pulmonary hypertension in the newborn case report

Resumen La hipertensión pulmonar persistente del recién nacido (HPPRN) es una entidad frecuente en las unidades de cuidados intensivos neonatales (UCIN), sin embargo, algunas de sus causas pasan desapercibidas, debido a su baja frecuencia y poca asociación con esta patología. A propósito de un caso en nuestra UCIN, en un neonato a término que presentó HPPRN secundario a una malformación pulmonar, raramente asociada con esta patología en este grupo etareo, ya que se encontró mayor disposición a factores propios del nacimiento, y noxas maternas. El paciente presentó dificultad respiratoria horas después de su nacimiento, con evolución y persistencia de su sintomatología, por lo que se necesitó de diversos medios diagnósticos para establecer su etiología. Es importante destacar que el primer ecocardiograma doppler no mostró ninguna alteración anatómica o funcional, reportado normal; con posterior empeoramiento clínico del neonato, por lo que se ordenó un control ecocardiografico, y se evidenció una presión pulmonar estimada de 71 mmHg; se continuó el estudio etiológico con imágenes complementarias, en esta caso una tomografia de tórax contrastada, y finalmente fue corroborado con un cateterismo cardiaco, lo cual permitió a su vez, manejo terapéutico y corrección de anomalía estructural de vasos pulmonares.

Abstract Persistent pulmonary hypertension of the newborn (PPHN) is a common feature in neonatal intensive care units (NICUs), but some of its causes go unnoticed due to their low frequency and low association with this pathology. A case in our NICU, in a term neonate who presented PPHN secondary to a pulmonary malformation, rarely associated with this pathology in this age group, since it was found more disposition to factors of the birth, and maternal noxas. The patient presented respiratory difficulty hours after birth, with evolution and persistence of their symptoms, which required different diagnostic methods to establish their etiology. It is important to note that the first Doppler echocardiogram did not show any anatomical or functional alterations, which were normal; With subsequent clinical worsening of the neonate, so that an echocardiographic control is ordered, evidencing an estimated pulmonary pressure of 71 mmHg; The etiological study was followed with complementary images, in this case, a contrast-enhanced chest tomography, and finally it was corroborated with cardiac catheterization, allowing, in turn, therapeutic management and correction of structural abnormality of pulmonary vessels.

Efecto de la administración prenatal de melatonina en pulmones de neonatos de oveja crónicamente hipóxicos / Effect of prenatal administration of melatonin on lungs of chronic hypoxic sheep neonates

Introducción: Las patologías que podrían motivar el ingreso a una Sala de Reanimación (SR) son múltiples, y asimismo, presentarse en cualquier momento, independientemente del sexo y la edad. A pesar de esta versatilidad, no existen investigaciones que describan la realidad chilena y la literatura extranjera es escasa. En consecuencia, nuestro estudio buscó caracterizar clínico-demográficamente a los pacientes ingresados a SR del Hospital San Juan de Dios de Los Andes, Chile. Materiales y métodos: Estudio de corte transversal. Se trabajó con base de datos anonimizada. El tamaño muestral calculado fue de al menos 1014 sujetos (intervalo de confianza de 95%, precisión de 3%). Se incluyeron los ingresos entre enero de 2013 y junio de 2016, obteniendo una muestra de 1018 pacientes. Variables estudiadas: sexo, edad, diagnóstico general, diagnóstico específico, mes y horario. Se trabajó con Microsoft Excel® utilizando estadística descriptiva. Aprobado por comité éticocientífico. Resultados: 58,1% (n=593) hombres; 42,5% (n=434) mayores de 64 años. Diagnósticos generales más frecuentes: cardiovascular (50,3%) (n=512), neurológico (16,3%) (n=166) y traumático (11,7%) (n=119). Diagnósticos específicos más frecuentes: taquiarritmia (15,9%) (n=162) e infarto miocárdico (12,6%) (n=128). La mayor cantidad de ingresos se registró en enero, febrero y junio (promedio 28 ingresos), y entre las 20 y 00 hrs (22,8%) (n=232). Discusión: Existe un amplio predominio de las enfermedades cardiovasculares.La distribución por mes, sexo y edad parece estar supeditada al comportamiento de dicho grupo; no así la distribución por horarios, ya que las enfermedades cardiovasculares suelen presentarse matinalmente. En general, nuestros resultados coinciden con la literatura extranjera disponible

Introduction: Neonatal pulmonary hypertension (NPHT) caused by chronic hypobaric hypoxia during gestation is associated with oxidative stress and currently lacks of an effective treatment. The aim of this study was to evaluate the effects of melatonin administrated on pregnant sheep on endothelium-dependent vascular reactivity and expression of eNOS, COX-1 and COX-2 on the lungs of lambs gestated and born under chronic hypobaric hypoxia. Material and method: Ten pregnant ewes under chronic hypoxia of highlands (3600 masl) were divided in two groups: 1. Control group (CN), treated with vehicle (5 ml/d ethanol 1, 4%), and 2. Melatonin group (MM), treated with melatonin during gestation (10 mg/d in 5 ml ethanol 1, 4%), during the last third of gestation. Results: Ewes gave birth spontaneously and without assistance, and we obtained lung tissue from 12 days old lambs to determine endothelial vascular reactivity by wire myography. In addition, eNOS, COX-1 and COX-2 RNA and protein expression were measured through RT-PCR and Western Blot, respectively. Discussion: The endothelium dependent vasodilation response was significantly enhanced in MM. Further, MM showed a significant increase in eNOS, COX-1 and COX-2 protein levels, relative to CN group. In conclusion, prenatal melatonin induces endothelium dependent vasodilation mechanisms and positively modulates eNOS-NO and prostanoids pathways, which may favour a treatment for NPHT caused by chronic hypoxia at high-altitude

Analysis of the risk factors of persistent pulmonary hypertension in neonates / 中华实用儿科临床杂志

Objective To investigate the high risk factors of persistent pulmonary hypertension (PPHN) in preterm and full-term neonates.Methods Fifty-six newborns with PPHN were divided into preterm neonates group and the full-term neonates group according to their gestational ages.The relationship between PPHN and high risk factors such as the primary diseases,mother's complications during pregnancy,and the prognosis were analyzed retrospectively in each group.A retrospective review of lung samples of 3 neonates who died of respiratory failure were carried out.Results Thirty-one (55.36％) out of 56 neonates with PPHN including 27 preterm and 29 full-term newborns had parenchyma diseases.The first and the second primary diseases were meconium aspiration syndrome (MAS,9/29 cases,31.03％) and congenital heart diseases (8/29 cases,27.59％) in the full-term group,and respiratory distress syndrome (RDS,16/27 cases,59.26％) and infection (8/27 cases,29.63％) in preterm group,respectively.There were 15 cases (55.56％) whose mothers had complications during pregnancy among the 27 preterm neonates,and 8 ca ses (27.59％) among the 29 full-term neonates.The morbidity of mothers' complications during pregnancy in preterm neonates was higher than that in full-term neonates (x2 =4.519,P =0.034).The mortality rate was 33.33％ (9/27cases) in the preterm neonates group while 27.59％ (8/29 cases) in the full-term neonates group.There was no significant difference in mortality rate between each group (x2 =0.218,P =0.640).The primary diseases were RDS (9/9cases,100％) and MAS (4/8 cases,50％) in preterm and full-term neonates who died of PPHN,respectively.One case of pulmonary hypertensive vascular remodeling,1 case of alveolar capillary dysplasia (ACD) and 1 case of interstitial pneumonia were found in 3 lung samples of neonates died of PPHN.Conclusions The ratio of preterm increased in neonates with PPHN.RDS and infection were the first two primary diseases in preterm neonates with PPHN.MAS was the first primary disease in full-term neonates with PPHN.Primary pulmonary hypertension should be considered for neonates with severe PPHN.