We reviewed records of 13 neonates with the discharge diagnosis of PPHN(persistent pulmonary hypertension of the newborn) who were admitted to the 2 newborn intensive care nurseries of Yonsei university medical center from Jan. 1985 to June 1990.
The mean birth weight of 13 infants was 3.04 ±0.59kg and mean gestational age was 37.8±3.6 we,:ks:8(62%) had a gestational age of 38 weeks or more with 5 less than 36 weeks gestatio on. In the latter group, 4 of the 5(80%) cases were associated with hyaline membrane disease. There vere ten boys and three girls. ,
The )rimary diagnoses associated with PPHN were as follows:neonatal asphyxia(9), hyaline membrane disease(5), meconium aspiration synedrome(4), wet lung syndrome(3), pneumonia Vor sepsis(2), amniotic fluid aspiration(1), and polycythemia(1).
The analysis of perinatal risk factors revealed that advanced maternal age, multigravidity, multilarity, maternal anemia, maternal fever, preeclampsia, meconium stanined, and premature rupture of amniotic membrane were associated with PPHN. In addition, cesarean section(especially e ective repeat section delivery), nonvertex presentation, and fetal distress were also found :o be significant.
Cyanosis and tachypnea associated with a systolic heart murmur were the predominant presenting signs and were first noted immediately after birth in 9 infnats and between 4 and 12 hours after birth in 4 infants. Other signs and laboratory findings were hypothermia(3), hypotension (4), increased Sz sound(5), hepatomegaly(6), cardiomegaly(4), and hypocalcemia(6). Electrocardiograms performed in 8 infants had right ventricular hypertrophy(2), general voltage decrease (2), and ST segment depression(1).
Treatment of all infants included mechanical ventilation with high concentrations of inspired (.Aygen and paralysis with pancuronium bromide. Of those, 8 underwent sustained hyperventilation. In addition, 11 infnats received a combination of dopamine and tolazoline, 6 babies we-re treated with calcium gluconat.e, and three infants were treated with digoxin infusion. Five other infants were treated with combined infusions of dopamine and either dobutamine or isoproterenol.
Of 13 babies with PPHN, 4(31%) ultimately died, pulmonary complications included air leak in 5 and the development of bronchopulmonary dysplasia in 2 infants. Other complications were hypoxic ischemic encephalopathy in 5 intraventricular hemorrhage in 1 baby, acute renal failure in 2 babies, pneumoperitoneum in 1 baby, and ricket in 1 baby.
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