Impact of management strategies on the outcome of persistent pulmonary hypertension of the newborn

ABSTRACT

The authors have indicated that they have no financial relationships relevant to this article to disclose. The study aims to evaluate associated risk factors and determine the impact of management strategies on the outcome of Pulmonary Hypertension of the Newborn [PPHN]. Prospective descriptive study included 40 neonates having PPHN. All patients received conventional therapy for PPHN, in case of failure, sildenafil was added as adjuvant therapy. The study included 23 males, 17 females with mean gesfational age 37.25 +/- 2.6 weeks. PPHN male patients had significant higher systolic pulmonary artery pressure [SPAP] and higher mortality rate compared to females [7/23 [30.4%] versus 1/17 [5.9%], P=0.04]. Infants of diabetic mothers had significant higher mortality rate [P=0.003]. Components of the blood gases; PH, PCO2, HCO3 had improved dramatically after completion of the different lines of treatment [p=0.0001]. A statistical significant drop of SPAP after application of different modalities of treatment [P=0.001]. Adding sildenafil was effective in reducing SPAP below 40 mmHg and in decreasing duration of NICU stay [P=0.0001, P=0.001 respectively]. The overall mortality rate was 8/40 neonates [20%] whereas the mortality among patients who received sildenafil in addition to conventional therapy was 1/14 neonates [7.7% of those group with P=0.001]. In absence of inhaled Nitric oxide, conventional therapy is effective in the management of PPHN. Use of oral sildenafil as an adjuvant therapy is effective in reduction of pulmonary artery pressure and hospital stay