Risk Factors of Persistent Pulmonary Hypertension of the Newborn in Neonates with Respiratory Diseases

Hyo Hyeon Cha; Sung Yoon Kim; Mi Ra Park; Hye Sun Yoon

doi:10.14734/kjp.2015.26.4.312

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Cha, Kim, Park, and Yoon: Risk Factors of Persistent Pulmonary Hypertension of the Newborn in Neonates with Respiratory Diseases

Original Article

Korean J Perinatol 2015;26(4):312-320.

Published online: 20 December 2015

DOI: https://doi.org/10.14734/kjp.2015.26.4.312

Risk Factors of Persistent Pulmonary Hypertension of the Newborn in Neonates with Respiratory Diseases

Hyo Hyeon Cha, M.D.¹, Sung Yoon Kim, M.D.¹, Mi Ra Park, Ph.D.², Hye Sun Yoon, M.D.^1,

¹Department of Pediatrics, Eulji University, Seoul Eulji Hospital, Seoul, Korea

²Department of Preventive Medicine, Eulji University, Daejeon, Korea

Correspondence to: Hye Sun Yoon, M.D. Department of Pediatrics, Eulji University, Seoul Eulji Hospital, 68, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea Tel: +82-2-970-8225, Fax: +82-2-970-5441 E-mail: yhs3211@eulji.ac.kr

Received 24 September 2015 Revised 15 October 2015 Accepted 22 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to identify the risk factors of persistent pulmonary hypertension of the newborn (PPHN) in neonates with respiratory diseases.

Methods

We retrospectively analyzed 58 term newborn infants with respiratory diseases who were admitted to the neonatal intensive care unit of the Seoul Eulji Hospital between January 2008 and July 2014 and required airway intubation and mechanical ventilation within 24 hours of admission. The infants were divided into a PPHN group and a non-PPHN group. Their clinical characteristics; diagnoses at admission; initial blood test results; and changes in vital signs, blood gas analysis results, and ventilator parameters that occurred within 48 hours of admission were investigated.

Results

There were 16 infants in the PPHN group and 42 infants in the non-PPHN group. The incidence of secondary PPHN was 27.6%. The incidence of PPHN was significantly higher in infants with respiratory distress syndrome (RDS) associated with extrapulmonary air leakage and meconium aspiration syndrome (MAS) with secondary RDS as the cause. Respiratory rate over 80 breaths/min (P=0.032, OR 11.3, 95%, CI 1.23–103.57) and FiO₂ over 0.8 (P=0.013, OR 16.8, 95% CI 1.82–154.68), when measured 6 hours after admission, were found to be statistically significant risk factors.

Conclusion

The results suggest that there is an increased risk of PPHN during treatment of respiratory diseases when aggravation of tachypnea and increase in ventilator parameters are observed after 6 hours of admission.

Keywords: Persistent pulmonary hypertension of the newborn, Risk factors

References

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Fig. 1.

Vital sign such as (A) Respiratory rate (B) Mean blood pressure (C) Heart rate according to time in PPHN group and Non-PPHN group. ∗P<0.05

Fig. 2.

Blood gas analysis findings such as (A) pH (B) PCO₂ (C) Base excess according to time in PPHN group and Non-PPHN group. ∗P<0.05

Fig. 3.

Ventilatory parameter such as (A) mean airway pressure (B) FiO₂ according to time in PPHN group and Non-PPHN group. ∗P<0.05

Table 1.

Clinical Characteristics of Study Subjects

	PPHN group (n=16)	Non-PPHN group (n=42)	P-value
GA (wk)	39.3±1.5	38.7±1.7	0.177
BW (g)	3,329.4±267.4	3,175.5±308.1	0.085
Male	14 (87.5)	34 (81.0)	0.710
Out born	15 (93.8)	30 (71.4)	0.087
c/section delivery	11 (68.8)	28 (66.7)	0.880
Apgar score
1 minute	6.7±2.6	6.1±2.9	0.471
5 minutes	8.3±1.8	7.8±2.2	0.392
Birth asphyxia	1 (6.3)	3 (7.1)	1.000
Maternal diseases
DM	1 (6.3)	0 (0)	0.276
Chorioamnionitis	0 (0)	1 (2.4)	1.000
PROM	1 (6.3)	4 (9.5)	1.000
Outcome
Discharge	10 (62.5)	42 (100)	<0.001
Transfer	6 (37.5)	0 (0)

Values are expressed as number (percent) or mean ± standard deviation Abbreviations: PPHN, persistent pulmonary hypertension of the newborn; GA, gestational age; BW, birth weight; DM, diabetes mellitus; PROM, premature rupture of membrane.

Table 2.

Initial Diagnosis at Admission

	PPHN group (n=16)	Non-PPHN group (n=42)	P-value
RDS	3 (18.8)	20 (47.6)	0.045
RDS+EAL	4 (25.0)	2 (4.8)	0.043
MAS	0 (0)	6 (14.3)	0.173
MAS+2°RDS	8 (50.0)	6 (14.3)	0.013
MAS+2°RDS+EAL	1 (6.3)	1 (2.4)	0.479
MAS+EAL	0 (0)	3 (7.1)	0.554
Primary EAL	0 (0)	1 (2.4)	1.000
Birth asphyxia	0 (0)	2 (4.8)	1.000
Pneumonia	0 (0)	1 (2.4)	1.000

Values are expressed as number (percent). Abbreviations: RDS, respiratory distress syndrome; EAL, extrapulmonary air leakage; MAS, meconium aspiration syndrome; 2°RDS, secondary respiratory distress syndrome.

Table 3.

Laboratory Findings at Admission

	PPHN group (n=16)	Non-PPHN group (n=42)	P-value
WBC (/uL)	20,609±6,123	18,220±6,582	0.214
Hb (g/dL)	16.7±2.2	16.3±1.4	0.552
Hct (%)	50.2±6.7	49.3±4.3	0.631
Platelet (10³/uL)	274.63±61.60	285.02±61.98	0.570
Calcium (mg/dL)	9.3±0.6	8.9±8.2	0.137
Phosphorus (mg/dL)	6.5±1.1	6.3±1.1	0.595
Glucose (mg/dL)	97.5±32.7	98.9±48.1	0.915
CRP (mg/dL)	0.13±0.4	0.17±0.6	0.797
pH	7.21±0.1	7.25±0.1	0.193
PCO₂ (mmHg)	50.0±10.4	47.1±13.0	0.430
BE (mmol/L)	–6.2±4.4	–7.1±5.4	0.532

Values are expressed as mean±standard deviation. Abbreviations: WBC, white blood cell; Hb, hemoglobin; Hct, hematocrit; CRP, C-reactive protein; BE, base excess.

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