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Published on: October 19, 2013
School-age outcomes of newborns treated for persistent pulmonary hypertension
A A Rosenberg1, N R Lee, K N Vaver
1Department of Pediatrics, University of Colorado Denver School of Medicine and The Children's Hospital, Aurora, CO 80045, USA. adam.rosenberg@ucdenver.edu
Insights
Children treated for persistent pulmonary hypertension of the newborn (PPHN) showed comparable school-age outcomes, regardless of inhaled nitric oxide (iNO) or extracorporeal membrane oxygenation (ECMO) treatment. Long-term neurodevelopmental and behavioral results were similar across treatment groups.
Area of Science:
- Pediatrics
- Neonatology
- Pediatric Pulmonology
Background:
- Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition requiring intensive care.
- Treatment advancements include inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO).
- Long-term outcomes for children treated for PPHN are crucial for understanding the impact of these interventions.
Purpose of the Study:
- To evaluate the school-age outcomes of children treated for PPHN.
- To compare outcomes between infants treated with iNO (with or without ECMO) and those receiving conventional management.
- To assess medical, neurodevelopmental, and psychosocial functioning in this cohort.
Main Methods:
- A cohort of 187 term newborns treated for PPHN was followed up at school age (mean 7.1 years).
- 109 survivors underwent medical evaluations, growth measurements, and psychometric assessments.
- Treatments included inhaled nitric oxide (iNO), ECMO, and conventional management.
Main Results:
- No significant differences in medical, neurodevelopmental, or psychosocial outcomes were observed between treatment groups.
- Overall, the cohort demonstrated average performance in IQ, adaptive function, academic achievement, and executive functioning.
- Specific findings included 24% with respiratory problems, 60% with abnormal chest X-rays, and 6.4% with sensorineural hearing loss.
Conclusions:
- School-age outcomes for children treated for PPHN were comparable across different intensive care strategies, including iNO and ECMO.
- The study suggests that modern intensive care for PPHN leads to favorable long-term neurodevelopmental and functional outcomes.
- These findings support current treatment approaches for PPHN and provide valuable data on long-term pediatric health.
Objective:
The aim of this study was to describe the school-age outcome of a cohort of children treated with intensive care support for persistent pulmonary hypertension of the newborn (PPHN).
Study Design:
From 187 term newborns treated for PPHN as neonates, 109 were seen at school age (73% of 150 survivors and 58.2% of the original cohort). Of these 109 term newborns, 77 were treated with inhaled nitric oxide (iNO); of which 12 received extracorporeal membrane oxygenation (ECMO). The remaining 32 received conventional management with no exposure to iNO. Patients were seen at school age (mean 7.1 years). A medical history and physical exam were completed, growth was measured, and chest X-ray and echocardiogram were performed. Psychometric assessments included the Wechsler Scales (Preschool or Child), Vineland Adaptive Behavior Scales, Kaufman Test of Educational Achievement, Children's Category Test, Wisconsin Card Sorting Test and Achenbach Child Behavior Checklist.
Result:
Medical, neurodevelopmental and social/emotional/behavioral outcome did not differ between children treated with iNO, with or without ECMO, and those managed with no exposure to iNO. Overall, 24% had respiratory problems, 60% had abnormal chest X-rays and 6.4% had some sensorineural hearing loss. The cohort performed at the average level for full scale IQ, adaptive function, academic achievement, higher-order cognition and executive functioning, and social/behavioral/emotional functioning. Overall, 9.2% of the cohort had a full scale IQ less than 70 and 7.4% had an IQ from 70 to 84.
Conclusion:
The outcome for this cohort of children treated as newborns for PPHN, which included a large group of infants exposed to iNO, was comparable to previous reports of children treated with ECMO or conventionally.
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