Persistent pulmonary hypertension of the newborn (PPHN): What can we do in low resource setting?
Background Persistent pulmonary hypertension of the newborn remains a challenging problem in neonates. Some cases may be severe and not responsive to conventional respiratory support. Inhaled nitric oxide and extracorporeal membrane oxygenation have improved outcome, but these modalities are expen...
| Main Authors: | , , , , |
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| Format: | Conference or Workshop Item |
| Language: | English English |
| Published: |
2019
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/76478/ http://irep.iium.edu.my/76478/1/poster%20PPHN.pdf http://irep.iium.edu.my/76478/2/Poster%20Presentation-Dr%20Taufiq.pdf |
| Summary: | Background
Persistent pulmonary hypertension of the newborn remains a challenging problem in neonates. Some cases may be severe and not responsive to conventional respiratory support. Inhaled nitric oxide and extracorporeal membrane oxygenation have improved outcome, but these modalities are expensive and unavailable at most hospitals in Malaysia.
Report
A 13-hour-old term female infant with congenital pneumonia was referred for nasal continuous positive airway pressure therapy. She weighed 3,300 grams and was born via elective cesarean section for oblique lie at 38 weeks gestation with rupture of membranes and clear amniotic fluid during delivery. Apgar score was 8 and 9 at 1 and 5 minutes, respectively. She became tachypneic at one hour after delivery and was given nasal prong oxygen, but still in respiratory distress. Chest radiograph showed a homogenous opacity on both lungs. WBC was 34.5x109/L and CRP was 5.31mg/L. She was intubated due to worsening respiratory distress. Despite high setting ventilator, hypoxemia persisted with oxygenation index of 70. Pre- and post-ductal oxygen saturation was 89% and 82%, respectively. Echocardiography showed persistent foramen ovale with right to left shunt, dilated right ventricle and atrium, tricuspid and pulmonary regurgitation. Magnesium sulfate (MgSO4) and sildenafil were started with inotropic support and then oxygenation index improved to 14. After ventilated for 8 days, patient was successfully extubated and then discharged at day 16 of life.
Conclusion
Use of MgSO4 and sildenafil in the absence of iNO and ECMO is still effective to treat PPHN. NICU with adequate equipments and neonatologist are still highly needed in Malaysia. |
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