title: Persistent pulmonary arterial hypertension of the newborn.
abstract: Persistent pulmonary hypertension of the newborn (PPHN) characterised by right to left shunting with intense cyanosis is difficult to manage, and in the best of centres carries a 40-60 percent mortality. We report our one year's experience of managing six neonates with PPHN. There were 5 males and 1 female with mean birth weight of 2.59 +/- 0.487 kg and gestation period 39 +/- 2.0 wks and 1 minute Apgar score 2.8 +/- 2.1. Four to six babies were born by cesarean section and 3-6 babies had aspiration pneumonia. All babies presented within 12 hours of age (mean 5.08 +/- 5 hrs) with intense cyanosis and respiratory distress. Diagnosis were confirmed in all by (a) hyperoxia test, (b) simultaneous determination of preductal and postductal paO2 (c) contrast echocardiography and (d) hyperoxia-hyperventilation test. Babies were managed with hyperventilation using mean ventilatory rates of 100 +/- 45 per minute, an inspired oxygen concentration of 100%, peak inspiratory pressures 27 +/- 9 cm of H2O, and expiratory pressures 5 +/- 1.6 cms of H2O, and mean air way pressures of 10.4 +/- 2.7 cms H2O. Alkali therapy was used in 3 of the six babies whereas low dose dopamine was infused in all six babies. Inspite of aggressive ventilatory therapy, only 3 out of 6 babies could be salvaged.
authors.affiliation: Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh.
authors.forename: A
authors.initials: A
authors.lastname: Narang
authors.forename: O N
authors.initials: ON
authors.lastname: Bhakoo
authors.forename: P M
authors.initials: PM
authors.lastname: Nair
authors.forename: V
authors.initials: V
authors.lastname: Bhandari
mesh_terms: D001724:Birth Weight; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000628:therapy*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012121:Respiration, Artificial