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Survival of infants with persistent pulmonary hypertension without extracorporeal membrane oxygenation
A R Dworetz1, F R Moya, B Sabo
1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510.
Insights
Conservative therapy significantly improved survival rates for infants with persistent pulmonary hypertension, achieving 90% survival without extracorporeal membrane oxygenation (ECMO). This approach contrasts with historical data predicting high mortality without ECMO.
Area of Science:
- Neonatology
- Pediatric Critical Care
Background:
- Persistent pulmonary hypertension of the newborn (PPHN) historically has high mortality rates, especially when criteria for extracorporeal membrane oxygenation (ECMO) are met.
- Previous criteria (Bartlett et al, Short et al) predicted 80-90% mortality without ECMO.
Purpose of the Study:
- To evaluate the effectiveness of a conservative therapeutic approach for PPHN in infants meeting ECMO criteria.
- To compare survival rates before and after adopting a strategy avoiding hyperventilation.
Main Methods:
- Retrospective review of infants diagnosed with PPHN weighing >2 kg, treated between 1980-1981 and 1986-1988.
- Therapeutic comparison: hyperventilation as primary in 1980-1981 vs. conservative (avoiding hyperventilation) in 1986-1988.
Main Results:
- In 1980-1981, survival for ECMO-eligible infants was 17% (Bartlett criteria) and 0% (Short criteria).
- In 1986-1988, survival for ECMO-eligible infants dramatically increased to 90% (Bartlett criteria, P<.02) and 89% (Short criteria, P<.006) with conservative therapy.
- Approximately 90% of infants meeting ECMO criteria survived without ECMO in the later period.
Conclusions:
- A conservative therapeutic approach, avoiding hyperventilation, significantly improves survival in PPHN infants who would otherwise meet ECMO criteria.
- This strategy offers a high survival rate, challenging the necessity of ECMO in selected PPHN cases.
Abstract:
A retrospective evaluation was performed of the survival after conservative therapy of infants with persistent pulmonary hypertension who met the published criteria of Bartlett et al (Pediatrics. 1985;76:479-487) or Short et al (Clinics in Perinatology. 1987;14:737-748) for extracorporeal membrane oxygenation (ECMO) therapy. An 80% to 90% mortality rate can be predicted with these criteria, which are based on historical data, if ECMO is not used. The records of infants with the diagnosis of persistent pulmonary hypertension, weighing greater than 2 kg at birth and who were treated during two time periods, January 1980 to December 1981 [23 patients] and January 1986 to December 1988 [17 patients], were reviewed. During the earlier period, hyperventilation was the mainstay of our therapy, whereas during the later period, a more conservative approach (avoidance of hyperventilation) was adopted. In 1980 to 1981, 1 of the 6 patients (17%) who were eligible for ECMO by criteria of Bartlett et al survived, which is consistent with the published data. However, in 1986 to 1988, 9 of 10 ECMO-eligible patients (90%) survived (P less than .02). The corresponding survival figures using the alveolar-arterial oxygen difference criteria of Short et al were 0 of 5 survivors (0%) in 1980 to 1981 and 8 of 9 (89%) in 1986 to 1988 (P less than .006). These data indicate that approximately 90% of patients who are candidates for ECMO now survive in our institution without the use of that therapy.(ABSTRACT TRUNCATED AT 250 WORDS)