Clinical spectrum and outcome determinants in persistent pulmonary hypertension of the newborn in a tertiary care centre: a cross-sectional study

Background: Persistent pulmonary hypertension of the newborn (PPHN) is a serious neonatal condition characterized by elevated pulmonary vascular resistance after birth, resulting in hypoxemia. It may be associated with perinatal risk factors such as birth asphyxia, meconium aspiration syndrome, respiratory distress syndrome, and sepsis. Early diagnosis and appropriate management are essential to improve neonatal outcomes. This study aims to assess the risk factors, clinical profile, treatment modalities, and outcomes in newborns with PPHN. Methods: This cross-sectional study was conducted in the Level 3 neonatal unit in Western India, data of the neonates diagnosed to have PPHN on echocardiography admitted during the period from October 2019 till July 2021 were recorded. The normality of the continuous data was tested by Shapiro-Wilk test. The continuous variables were analysed by Mann-Whitney U test and Kruskal-Wallis test. Post-hoc Dunn’s test is used to do pairwise comparisons. Categorical data is analysed using Fisher’s Exact test. P<0.05 are accepted as indicative of statistical significance. Results: Total 36 neonates were included in the study with incidence of 8.2 per 1000 live births with mortality of 27.8% with better survival in inborn neonates. Resuscitation at birth in neonates correlated with the severity of PPHN. ABG parameters showing metabolic and respiratory acidosis, hypoxemia and poor oxygenation indices were associated with mortality. On Echocardiography, parameters like right to left shunt across PDA/PFO, right ventricular dysfunction and septal position deviated to left were associated with mortality. Requirement of surfactant, multiple inotropes, HFOV and iNO were independently associated with mortality. Conclusions: PPHN is a disease with significant mortality and long-term morbidity which can be prevented with timely intervention, targeted Echocardiography, monitoring of parameters and requires multiple modalities of treatment.