title: Mortality associated with pulmonary hypertension in congenital rubella syndrome.
abstract: OBJECTIVE
  Outbreaks of rubella and congenital rubella syndrome (CRS) continue to arise in various countries where a rubella-containing vaccine is not included in the national immunization program. After a large-scale rubella outbreak in 2011, CRS cases emerged in Vietnam. The aim of this study was to clarify the clinical features of these cases with an emphasis on cardiovascular complications and outcomes.
  
  
  METHODS
  From October 2011 to September 2012, we conducted a prospective surveillance study of infants <12 months of age who had manifestations suggesting CRS at the only referral hospital in Khanh Hoa Province. These infants underwent standard examinations, echocardiography, cranial ultrasonography, automated auditory brainstem responses, blood cell count measurements, and rubella-specific antibody testing. Detected cardiovascular defects were regularly followed with echocardiography.
  
  
  RESULTS
  We enrolled 38 cases of CRS characterized by a low birth weight (71%), cardiovascular defects (72%), cataracts (13%), hearing impairment (93%), purpura (84%), hepatosplenomegaly (68%), and thrombocytopenia (76%). Patent ductus arteriosus, the most common cardiovascular complication, was often associated with progressive pulmonary hypertension (PH). As of January 2013, 13 infants (34%) had died, and PH was significantly more frequent among the fatalities (P = .004); however, therapeutic closure of the ductus reversed the PH in several cases.
  
  
  CONCLUSIONS
  PH-associated mortality is high among infants who have CRS in Vietnam. Providing proper assessments, continuous follow-up, and timely intervention for cardiovascular defects is critical for the management of CRS patients. Echocardiography is of diagnostic and prognostic value and can support better clinical management of CRS, even in a developing country setting.
authors.affiliation: Departments of Pediatric Infectious Diseases andDepartments of Tropical Pediatric Infectious Diseases.
authors.forename: Michiko
authors.initials: M
authors.lastname: Toizumi
authors.affiliation: Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan;Pediatrics, and hideki-m@nagasaki-u.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Motomura
authors.affiliation: Department of Pediatrics, Khanh Hoa General Hospital, Nha Trang, Vietnam;
authors.forename: Hien Minh
authors.initials: HM
authors.lastname: Vo
authors.affiliation: Clinical Medicine, Institute of Tropical Medicine, andClinical Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan;
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Pediatrics, Khanh Hoa General Hospital, Nha Trang, Vietnam;
authors.forename: Enga
authors.initials: E
authors.lastname: Pham
authors.affiliation: Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam; and.
authors.forename: Hien Anh Thi
authors.initials: HA
authors.lastname: Nguyen
authors.affiliation: Department of Planning and Research Collaboration, Khanh Hoa Health Service, Nha Trang, Vietnam.
authors.forename: Tho Huu
authors.initials: TH
authors.lastname: Le
authors.affiliation: Departments of Pediatric Infectious Diseases andDepartments of Tropical Pediatric Infectious Diseases.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hashizume
authors.affiliation: Clinical Medicine, Institute of Tropical Medicine, andClinical Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan;
authors.forename: Koya
authors.initials: K
authors.lastname: Ariyoshi
authors.affiliation: Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam; and.
authors.forename: Duc Anh
authors.initials: DA
authors.lastname: Dang
authors.affiliation: Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan;Pediatrics, and.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Moriuchi
authors.affiliation: Departments of Pediatric Infectious Diseases and.
authors.forename: Lay-Myint
authors.initials: LM
authors.lastname: Yoshida
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000150:complications; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality*; D007223:Infant; D008297:Male; D011379:Prognosis; D012410:Rubella Syndrome, Congenital / Q000150:complications* / Q000175:diagnosis; D014744:Vietnam / Q000453:epidemiology
keywords: Vietnam; cardiovascular defects; congenital rubella syndrome; mortality; pulmonary hypertension