Clinical profile of persistent pulmonary hypertension in new born: experience in an extramural institution

Harish S., Kamalarathnam C. N.


Background: Persistent pulmonary artery hypertension of the new born (PPHN) has an incidence of 1.9 per 1000 live births with a mortality of 12 to 29%. In our tertiary care referral institute, the mortality was relatively high. A department audit was undertaken which will help us to introspect and to reason out the factors favouring survival and mortality in our NICU.

Methods: Neonates with the diagnosis of PPHN from January 2016 to December 2016 were identified from our department database. After excluding cardiac causes of pulmonary hypertension, transport, prenatal, perinatal and post-natal data, treatment details and outcome information was collected from case records. The statistical analysis was calculated with SPSS software. Mean, standard deviation was calculated for continuous variables. Chi square test and Fischer’s exact test was used to test the association between categorical variables and t test for continuous variables.

Results: The incidence PPHN in our unit was 1.5%. The average duration of hospital stay was 17 days. Among the 45.7 % of babies, PPHN was secondary to MAS, followed by CDH (22.3 %). Based on oxygenation index, 15 babies, 42.3% had mild, 10 babies, 28.6% had moderate, 8 babies, 22.3% had severe PPHN and 3 babies ,8.6% had severe PPHN. Overall mortality was 42.3%. SpO2 on arrival at emergency room, adequacy of cardiorespiratory during transport and presence of shock is significantly associated with mortality.

Conclusions: This study show MAS and CDH are common causes of PPHN. Severity of illness at arrival was predictive of high mortality. Prior stabilization and adequate transport may improve outcomes.


CDH, MAS, Neonates, PPHN

Full Text:



Goldsmith JP, Karotkin E. Assisted ventilation of the neonate. Elsevier Health Sciences; 2016:658.

Fox WW, Gewitz MH, Dinwiddie R, Drummond WH, Peckham GJ. Pulmonary hypertension in the perinatal aspiration syndromes. Pediatr. 1977;59(2):205-11.

Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, Partridge JC, Rogers EE, Keller RL. Persistent pulmonary hypertension of the newborn in late preterm and term infants in California. Pediatrics. 2017;139(1):e20161165f.

Walsh-Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatr. 2000;105(1):14-20.

Konduri GG, Kim UO. Advances in the Diagnosis and Management of Persistent Pulmonary Hypertension of the Newborn. Pediatr Clin North Am. 2009;56(3):579-600.

Roofthooft MT, Elema A, Bergman KA, Berger RM. Patient characteristics in persistent pulmonary hypertension of the newborn. Pulmonary Medicine. 2011;2011.

Malik M, Nagpal R. Emerging role of sildenafil in neonatology. Indian Pediatr. 2011;48(1):11-3.

Choudhary M, Meena MK, Chhangani N, Sharma D, Choudhary JS, Choudhary SK. To study prevalence of persistent pulmonary hypertension in newborn with meconium aspiration syndrome in western Rajasthan, India: a prospective observational study. J Matern Fetal Neonatal Med. 2016;29(2):324-7.

Hsieh WS, Yang PH, Fu RH. Persistent pulmonary hypertension of the newborn: experience in a single institution. Acta Paediatr Taiwanica Taiwan Er Ke Yi Xue Hui Za Zhi. 2001;42(2):94-100.

Heritage CK, Cunningham MD. Association of elective repeat cesarean delivery and persistent pulmonary hypertension of the newborn. Am J Obstet Gynecol. 1985;152(6)(1):627-9.

Gustav R, Baptista MJ, Guimarães H. Persistent pulmonary hypertension of non-cardiac cause in a Neonatal Intensive Care Unit. Pulmonary Med. 2012: 818971.

Konduri GG, Solimano A, Sokol GM, Singer J, Ehrenkranz RA, Singhal N, et al. A randomized trial of early versus standard inhaled nitric oxide therapy in term and near-term newborn infants with hypoxic respiratory failure. Pediatr. 2004;113(3):559-64.

Brownlee EM, Howatson AG, Davis CF, Sabharwal AJ. The hidden mortality of congenital diaphragmatic hernia: a 20-year review. J Pediatr Surg. 2009;44(2):317-20.

Boloker J, Bateman DA, Wung JT, Stolar CJH. Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg. 2002;37(3):357-66.

Navarrete CT, Devia C, Lessa AC, Hehre D, Young K, Martinez O, et al. The role of endothelin converting enzyme inhibition during group b streptococcus–induced pulmonary hypertension in newborn piglets. Pediatr Res. 2003;54(3):387-92.

Srinivas SK, Edlow AG, Neff PM, Sammel MD, Andrela CM, Elovitz MA. Rethinking IUGR in preeclampsia: dependent or independent of maternal hypertension? J Perinatol. 2009;29(10):680-4.

Kaufmann P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod. 2003;69(1):1-7.