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A Comprehensive Study of Clinical Biomarkers, Use of Inotropic Medications and Fluid Resuscitation in Newborns with Persistent Pulmonary Hypertension

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Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is associated with high morbidity and mortality. This study evaluated clinical outcomes in PPHN in relation to echocardiographic (EC) markers, score of neonatal acute physiology, perinatal extension, version II (SNAPPE II) scores, inotropic agent use, and the amount of fluid received as boluses. In this retrospective chart analysis of 98 neonates with PPHN born at >34 weeks’ gestation, we compared two cohorts of newborns: those who received inhaled nitric oxide and mechanical ventilation only, and who survived to discharge (Group 1); and those who required extracorporeal membrane oxygenation (ECMO) or who died (Group 2). Of 21 EC parameters assessed, seven were significantly different between Group 1 and Group 2. Eleven (24.4 %) newborns in Group 2 had decreased left ventricular (LV) function, compared with three (5.1 %) in Group 1 (p = 0.011). Median SNAPPE II scores were significantly higher in Group 2 than in Group 1 (p < 0.001). Newborns in Group 2 also received a significantly higher amount of fluid as boluses during the first 7 days of hospitalization compared with Group 1 (p = 0.018). Following logistic regression analysis, only the difference in total SNAPPE II score retained statistical significance (p < 0.001); however, the total amount of fluid administered as boluses trended higher (p = 0.087) for newborns in Group 2. Our findings show that SNAPPE II scores may help guide counseling for parents of newborns with PPHN regarding the likelihood of death or the need for ECMO. Limiting fluid boluses may improve outcomes in newborns with high SNAPPE II scores and decreased LV function.

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Abbreviations

EC:

Echocardiogram

ECMO:

Extracorporeal membrane oxygenation

EF:

Ejection fraction

FDA:

Food and drug administration

FS:

Shortening fraction

HIE:

Hypoxic ischemic encephalopathy

iNO:

Inhaled nitric oxide

IVSd:

Interventricular septal wall thickness in diastole

IVSs:

Interventricular septal wall thickness in systole

LA:

Left atrial

LV:

Left ventricular

LVIDd:

Left ventricular diastolic diameter

LVPWd:

Left ventricular posterior wall thickness in diastole

LVPWs:

Left ventricular posterior wall thickness in systole

MAS:

Meconium aspiration syndrome

PA:

Pulmonary artery

PDA:

Patent ductus arteriosus

PPHN:

Persistent pulmonary hypertension of the newborn

RA:

Right atrial

RAP:

Right atrial pressure

RDS:

Respiratory distress syndrome

RV:

Right ventricular

RVDd:

Right ventricular diastolic diameter

RVSP:

Right ventricular systolic pressure

SNAPPE II:

Score for neonatal acute physiology, perinatal extension, version II

TR:

Tricuspid regurgitation

TRPG:

Tricuspid regurgitation pressure gradient

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Acknowledgments

We wish to thank Dr. Kamat, Professor of Pediatrics at the Children’s Hospital of Michigan, and Dr. Naheed, Division Chair of Pediatric Cardiology at John H Stroger Jr Hospital of Cook County for their valuable suggestions.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA

    Janardhan Mydam

  2. Division of Neonatology, John H Stroger Jr Hospital of Cook County, 1901 West Harrison Street, Chicago, IL, USA

    Janardhan Mydam

  3. Children’s Research Center of Michigan, Wayne State University, Detroit, MI, USA

    Marwan Zidan

  4. Division of Neonatal-Perinatal Medicine, The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI, USA

    Nitin Shashikant Chouthai

Authors
  1. Janardhan Mydam
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  2. Marwan Zidan
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Correspondence to Nitin Shashikant Chouthai.

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Mydam, J., Zidan, M. & Chouthai, N.S. A Comprehensive Study of Clinical Biomarkers, Use of Inotropic Medications and Fluid Resuscitation in Newborns with Persistent Pulmonary Hypertension. Pediatr Cardiol 36, 233–239 (2015). https://doi.org/10.1007/s00246-014-0992-5

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  • DOI: https://doi.org/10.1007/s00246-014-0992-5

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