National survey of diagnosis and management of persistent pulmonary hypertension of the newborn.
The diagnosis and management of persistent pulmonary hypertension of the newborn remains controversial. A national survey was performed to analyze recent trends in the incidence, diagnosis, management, and survival of patients with persistent pulmonary hypertension of the neonate. Sixty-six institutions from all geographical regions responded. The overall admission incidence was 3.9% +/- 2.6%. Secondary persistent pulmonary hypertension of the neonate was more common than primary. Unexplained hypoxemia, ductal level right-to-left shunting, echocardiography, and a positive response to hyperventilation were all used frequently (in at least 79% of institutions) to diagnose persistent pulmonary hypertension of the neonate. The majority of institutions considered a positive response to hyperventilation to be determined by an increase of PaO2 by 30 mm Hg with a concomitant decrease in PaCO2 to 25 mm Hg. Approximately 70% of institutions use varying ventilator techniques (ie, with or without hyperventilation), but the majority use hyperventilation predominantly. Almost all (greater than 90%) institutions used muscle paralytic agents and pulmonary vasodilators. Tolazoline was the first choice of pulmonary vasodilator therapy. The overall survival rate of persistent pulmonary hypertension of the newborn was 77.4% +/- 13.4%. Survival rate did not differ between different geographic areas of the country. There was a trend noted for improved survival with less use of muscle paralyzing agents. Yet despite varying treatment protocols, survival rates are improving.
Weigel
T J
TJ
Department of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
Hageman
J R
JR
D002245:Carbon Dioxide / Q000097:blood; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D010100:Oxygen / Q000097:blood; D010197:Pancuronium / Q000627:therapeutic use; D010547:Persistent Fetal Circulation Syndrome / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D012121:Respiration, Artificial; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
D002245:Carbon Dioxide; D010197:Pancuronium; D010100:Oxygen