Pulse oximetry as a simple diagnostic test for persistent pulmonary hypertension of newborn in limited resource settings
DOI:
https://doi.org/10.18203/2349-3291.ijcp20161027Keywords:
Meconium aspiration, PPHN, Pre and post ductal saturation, SildenafilAbstract
Background: Persistent Pulmonary Hypertension of newborn (PPHN), results from the disruption in the normal perinatal fetal- neonatal circulatory transition. The condition remains a difficult neonatal emergency to manage which is mainly attributed to the delay in diagnosis and stabilisation. Although the management of PPHN involves advanced diagnostic and therapeutic interventions, our study highlights that PPHN can be diagnosed even in limited resource settings, with simple bedside evaluation of pre-ductal and post-ductal saturation (Spo2) difference.
Methods: A retrospective study of neonates with PPHN, admitted in NICU, of a government hospital in a limited resource setting, over a period of 6 months.
Results: Out of the 592 neonates admitted during the 6 months period in NICU, PPHN was diagnosed in 26 neonates (4.4%).The incidence was higher for male (57.7%),term gestation (84.6%), and appropriate for gestational age- AGA (88.5%). Meconium aspiration (53.8%) followed by perinatal asphyxia- clear liquor (30.8%) were the most common underlying etiology for PPHN in our study. Around 61.5% were diagnosed with PPHN based on pulse oximetry alone before the first dose of sildenafil, which was confirmed by ECHO later in 75% of the cases. PPHN improved in 92.3% of the study population (24/26 cases), out of which 62.5% were diagnosed based on pulse oximetry alone before intervention.
Conclusions: Our study emphasises that even in peripheral health centres with limited resources, PPHN can be diagnosed by pulse oximetry (pre and post ductal Spo2 difference of >10%) along with clinical assessment. Such critically ill neonates can be initiated on pulmonary vasodilators like sildenafil and stabilised at the earliest that is crucial before referral to a tertiary care centre.
References
Engelbrecht AL. Sildenafil in the management of neonates with PPHN: A rural regional hospital experience. South Afr J Child Health. 2008;2(4). Available from: http://www.ajol.info/ index.php/sajchh/article/view/50513
AK Dutta AS. Advances in Pediatrics. 2nd ed. Jaypee. 2012;105:106.
Cloherty ECEJP. Manual of Neonatal Care. 7th ed. Wolters Kluwer. 2012:435-8.
Abdel Mohsen AH, Amin AS. Risk Factors and Outcomes of Persistent Pulmonary Hypertension of the Newborn in Neonatal Intensive Care Unit of Al-Minya University Hospital in Egypt. J Clin Neonatol. 2013;2(2):78-82.
Myung KP. Pediatric Cardiology for Practitioners. 5th ed. Elsevier. 2011:299-300.
Daga V. Internet Scientific Publications. Available from: http://ispub.com/IJPN/8/1/3701
Zhao Q, Ma X, Ge X, Liu F, Yan W, Wu L. Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. Lancet Lond Engl. 2014;384(9945):747-54.
Mathur NB, Gupta A, Kurien S. Pulse Oximetry Screening to Detect Cyanotic Congenital Heart Disease in Sick Neonates in a Neonatal Intensive Care Unit. Indian Pediatr. 2015;52(9):769-72.
