Persistant Pulmonary Hypertension of the Newborns at Pathum Thani Hospital - ภาวะความดันเลือดปอดสูงในทารกแรกเกิดในโรงพยาบาลปทุมธานี

Abstract

           Persistant pulmonary hypertension (PPHN) was a cause of death among in term and postterm neonates at Pathum Thani hospital. The objective of the retrospective descriptive and analytic study was to determine prevalence treatment outcome of treatment death rate in PPHN neonates by reviewing their medical records from February 2005 to January 2008. Descriptive statistics, Fisher’s exact test and Mann-Whitney U test were used to describe the situation analysis and analytical part accordingly. Twenty-three newborns were diagnosed as effected by PPHN and five of them refered to Queen Sirikit National Institute of Child Heath. The prevalence of PPHN was reported to be 2.23 per 1000 live births resulting in a mortality rate of 66.11 percent, mostly associated with meconium aspiration syndrome (13 cases 72.22%) and birth asphyxia (11 case 61.11%).

            All newborns with PPHN were on conventional mechanical ventilation setting with mean pear inspiratory pressure (PIP) of 25.72, SD 4.46) cm H2O, positive end expiratory pressure (PEEP) 5.06, SD 1.21) cm H2O intermittent meandatory rate (IMV) 87.78, SD 21.71). The mean initial (Aa) DO2 was 625.19, SD 4.37) mmHg and the mean age when diagnosed was 21, SD 10.92 hours.

          The most common complications were sepsis, pneumonia, seizure, chronic lung disease and pneumothorax. Duration of required mechanical ventilation, length of oxygen administration, and lengths of hospital stay were no significant different between survivors and non survivors. Fentanyl and dormicun were drugs of choice sedating neonates whereas inotropic agents were dopamine and  dobutamine. Normal saline and fress frozen plasma were used as volume expander.

Key words: persistant pulmonary hypertension ofnewborn,meconium aspiration syndrome, high frequencyoscillator ventilation, nitric oxide