Persistent pulmonary hypertension of newborn tied to higher mortality, sepsis

Persistent pulmonary hypertension of the newborn (PPHN) is a common phenomenon in infants with moderate or severe hypoxic ischaemic encephalopathy (HIE), a recent study has shown. Moreover, PPHN is linked to lung disease, sepsis and increased mortality.

Drawing from two randomized trials of therapeutic hypothermia, researchers analysed the information of 303 infants with HIE, of whom 22 percent (n=67; mean gestational age at birth 38.7±1.8 weeks; 57 percent male) had PPHN. Maternal hypertension (6 percent vs 16 percent) and uterine rupture (3 percent vs 13 percent; p<0.05 for both) were all significantly less common in the PPHN group.

Meconium aspiration syndrome (39 percent vs 7 percent), pulmonary haemorrhage (12 percent vs 3 percent), sepsis (12 percent vs 3 percent), cardiac dysfunction by echo (27 percent vs 5 percent), cardiomegaly (15 percent vs 1 percent) and systemic hypotension (65 percent vs 28 percent) were all significantly more common in infants with vs without PPHN (p<0.05 for all).

Patients with PPHN also had a significantly longer duration of hospital stay (26.0±21.3 vs 16.4±14.3 days; p<0.05).

In-hospital mortality was likewise significantly higher in those with PPHN (27 percent vs 16 percent; p<0.05), though the significance was attenuated upon adjusting for baseline HIE severity (adjusted odds ratio [OR], 1.52; 95 percent CI, 0.76–3.02; p=0.24).

Notably, in those with moderate HIE, the PPHN vs no-PPHN group had significantly higher mortality rates (18 percent vs 8 percent; adjusted OR, 2.73; 1.01–7.39; p=0.048).