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

B. C. Yelamali, Gangadhar S. Mirji, Mirnalini Rajput


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.


Birth asphyxia, Meconium aspiration syndrome, Persistent pulmonary hypertension of newborn, Positive pressure ventilation

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Pedersen J, Hedegaard ER, Simonsen U, Krüger M, Infanger M, Grimm D. Basic Clin Pharmacol Toxicol. 2018;123(4):392-406.

Mathew B, Lakshminrusimha S. Persistent pulmonary hypertension in the newborn children. Basel. 2017;4(8):63.

Sharma M, Mohan KR, Narayan S, Chauhan L. Persistent pulmonary hypertension of the newborn: a review. Med J Armed Forces India. 2011;67(4):348-53.

Chandrasekharan P, Kozielski R, Kumar VH, Rawat M, Manja V, Ma C, et al. Early use of inhaled nitric oxide in preterm infants: is there a rationale for selective approach? Am J Perinatol. 2016;34:428-40.

Swier NL, Richards B, Cua CL, Lynch SK, Yin H, Nelin LD, Smith CV, Backes CH. Pulmonary vein stenosis in neonates with severe bronchopulmonary dysplasia. Am J Perinatol. 2016;33:671-7.

Sukys WMC, Tyson JE, Wright LL. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics. 2000;105(1):14-20.

Hageman JR, Adams MA, Gardner TH. Persistent pulmonary hypertension of the newborn. Trends in incidence, diagnosis, and management. Am J Dis Child. 1984;138(6):592-5.

Nakwan N, Jai S. An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: incidence, etiology, diagnosis, treatment and outcome. J Maternal Fetal. 2018;3:45-9.

Nakwan N, Pithaklimnuwong S. Acute kidney injury and pneumothorax are risk factors for mortality in persistent pulmonary hypertension of the newborn in Thai neonates. J Maternal Fetal Neonatal Med. 2016;29:1741-6.

Goldenberg RL, McClure EM. Maternal, fetal and neonatal mortality: lessons learned from historical changes in high income countries and their potential application to low-income countries. Maternal Health Neonatol Perinatol. 2015;1:3.

Marter LJ. Persistent pulmonary hypertension of the newborn. In: Cloherty JP, Eichenwald EC, Stark AR, editors. Manual of Neonatal Care. 6th ed. Lippincott Williams and Wilkins; Philadelphia: 2008:358-364.

Lakshminrusimha S, Keszler M. Persistent pulmonary hypertension of the newborn. Neo Reviews. 2015;16(12):e681.

Konduri GG, Vohr B, Robertson C, Sokol GM, Solimano A, Singer J, et al. Early inhaled nitric oxide therapy for term and nearterm newborn infants with hypoxic respiratory failure: neurodevelopmental follow-up. J Pediatr. 2007;150(3):235-40.

Robertson CM, Tyebkhan JM, Hagler ME, Cheung PY, Peliowski A, Etches PC. Late-onset, progressive sensorineural hearing loss after severe neonatal respiratory failure. Otol Neurotol. 2002;23(3):353-6.

Lipkin PH, Davidson D, Spivak L, Straube R, Rhines J, Chang CT. Neurodevelopmental and medical outcomes of persistent pulmonary hypertension in term newborns treated with nitric oxide. J Pediatr. 2002;140(3):306-10.

Joaquim EB, Cabral I, Belik J. Persistent pulmonary hypertension of the newborn: recent advances in pathophysiology and treatment. J Pediatr. 2013;89(3):226-42.

Hsieh WS, Yang PH, Fu RH. Persistent pulmonary hypertension of the newborn: Experience in a single institution. Acta Paediatr Taiwan. 2001;42:94-100.

Rocha G, Baptista MJ, Guimarães H. Persistent pulmonary hypertension of noncardiac cause in a neonatal intensive care unit. Pulm Med. 2012;2012:818-971.

Sardar S, Pal S, Mishra R. A retrospective study on the profile of persistent pulmonary hypertension of newborn in a tertiary care unit of Eastern India. J Clin Neonatal. 2020;9:18-26.

Nair J, Lakshminrusimha S. Update on PPHN: Mechanisms and treatment. Semin Perinatol. 2014;38:78-91.

Kelly LE, Ohlsson A, Shah PS. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev. 2017;2:467-77.

El Shahed Al, Dargaville PA, Ohlsson A, Soll R. Surfactant for meconium aspiration syndrome in term and late preterm infants. Cochrane Database Syst Rev. 2014;12:CD002054.

Razzaq A, Quddusi AL, Nizami N. Risk factors and mortality among newborns with persistent pulmonary hypertension. Pak J Med Sci. 2013;29(5):1099-104.