Neonatal pulmonary hypertension in the NICU: a 10-year single-center experience

Neonatal pulmonary hypertension(PHT) is a significant cause of morbidity and mortality in newborns. Early diagnosis and treatment of pulmonary hypertension are critical for preventing long-term respiratory and cardiovascular complications. The aim of this study is to contribute to the literature by investigating the differences between neonates with PHT who receive medical treatment and those who do not, the relationship between echocardiographic measurements and the initiation of treatment, and the differences between preterm and term neonates. In this retrospective cohort study, 75 neonates diagnosed with pulmonary hypertension and treated in the neonatal intensive care unit were retrospectively analyzed. The diagnosis of PHT was established by echocardiography with estimation of pulmonary artery pressure via tricuspid regurgitation jet velocity measurement. Right Ventricular Systolic Pressure(RVSP)measurements were recorded as RVSP1 for the first two days, RVSP2 between days 3-7, and RVSP3 after 7 days. For statistical evaluation, patients were divided into two groups based on whether they received medical treatment for PHT and were compared. The group receiving PHT treatment was further divided into preterm (< 37 weeks) and term (≥ 37 weeks) neonates and compared. Among the 7578 patients in the neonatal intensive care unit, 75 (1.07%) were diagnosed with pulmonary hypertension. 47 of these patients received PHT treatment. The treatment group had a greater gestational age and higher birth weight. There was no significant difference in laboratory parameters between the groups receiving and not receiving PHT treatment. However, in the group not receiving PHT, patients with low RVSP measurements had lower CRP values. The duration of invasive and non-invasive mechanical ventilation was longer in the group receiving PHT treatment. RVSP2 and RVSP3 values were higher in the treatment group. The RVSP1-2 difference was significant in the treatment group. In echocardiographic evaluation, persistently elevated pulmonary artery pressure measured by tricuspid regurgitation jet velocity after the third day is strongly associated with PHT treatment. Neonates with initial RVSP lower than 40 mmHg and negative CRP did not require pulmonary hypertension treatment.