Faculty Collaboration Database

Correlation of echocardiographic markers and therapy in persistent pulmonary hypertension of the newborn. Pediatr Cardiol 2009 Feb;30(2):160-5

Date

09/10/2008

Pubmed ID

18779989

DOI

10.1007/s00246-008-9303-3

Scopus ID

2-s2.0-59449091975 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) causes morbidity and mortality in neonates. High-frequency ventilation (HFV), inhaled nitric oxide (iNO), and extracorporeal membrane oxygenation (ECMO) are used when conventional treatment fails. This study aimed to identify echocardiographic predictors of progression to these therapies before clinical deterioration.

METHODS: Echocardiographic parameters were compared for survival and need for ECMO, HFV, iNO, and prolonged mechanical ventilation (MV, >or=10 days).

RESULTS: Of 63 neonates, 95% survived, with 14% requiring ECMO, 52% requiring HFV, 67% requiring iNO, and 35% requiring MV. The following echocardiographic indices reflecting left ventricular output were decreased in sicker infants: (1) A decreased ascending aortic velocity time integral indicated an increased likelihood of ECMO (p=0.02), iNO (p=0.01), or MV (p=0.05), (2) Shorter transverse aortic arch antegrade ejection time indicated HFV (p<0.01), iNO (p<0.01), and MV (p=0.03), (3) Absent or retrograde transverse aortic diastolic flow correlated with HFV (p=0.01, iNO (p=0.01), and MV (p<0.01). These sicker patients were more likely to have smaller left ventricular end-diastolic areas (p<0.03 for all) and right-to-left atrial shunting (ECMO, HFV, and MV). There were no differences in survival.

CONCLUSIONS: Decreased left ventricular size and output correlates with the need for advanced therapies in infants with PPHN. Early identification may allow more effective management and placement of neonates at risk.

Author List

Peterson AL, Deatsman S, Frommelt MA, Mussatto K, Frommelt PC

Authors

Michele Ann Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering

MESH terms used to index this publication - Major topics in bold

Biomarkers
Bronchodilator Agents
Disease Progression
Echocardiography
Extracorporeal Circulation
Extracorporeal Membrane Oxygenation
Female
Heart Ventricles
High-Frequency Ventilation
Humans
Infant, Newborn
Male
Nitric Oxide
Persistent Fetal Circulation Syndrome
Retrospective Studies
Stroke Volume
Survival Analysis
Time Factors