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Persistent pulmonary hypertension of the neonate and asymmetric growth restriction
M C Williams1, L E Wyble, W F O'Brien
1Department of Obstetrics and Gynecology, University of South Florida, Tampa, USA. mwilliam@com1.med.usf.edu
Insights
Low ponderal index in newborns is linked to a higher risk of persistent pulmonary hypertension of the neonate (PPHN) and the need for extracorporeal membranous oxygenation. Small for gestational age (SGA) was not associated with PPHN.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatal Research
Background:
- Persistent pulmonary hypertension of the neonate (PPHN) is a critical condition in newborns.
- Understanding factors influencing PPHN risk and severity is crucial for improved outcomes.
- Nutritional status and fetal development may play a role in neonatal pulmonary health.
Purpose of the Study:
- To investigate the association between PPHN and indicators of fetal growth, specifically small for gestational age (SGA) and low ponderal index.
- To determine if these growth markers predict the need for extracorporeal membranous oxygenation (ECMO) in neonates with PPHN.
Main Methods:
- A case-control study involving 86 infants with PPHN and 430 matched controls.
- Infants were assessed for SGA and low ponderal index, defined as below the tenth percentile for gestational age.
- Logistic regression was used to analyze associations, controlling for factors like Apgar scores and umbilical arterial pH.
Main Results:
- Low ponderal index was significantly associated with PPHN (OR 5.4).
- Low ponderal index remained an independent predictor of PPHN after adjusting for confounding variables (OR 4.0).
- A low ponderal index was strongly correlated with the need for ECMO in PPHN infants (P < .001).
Conclusions:
- Diminished neonatal nutritional status, indicated by a low ponderal index, increases the risk and severity of PPHN.
- Fetal developmental factors, including nutritional status, significantly impact neonatal pulmonary status.
- Low ponderal index is a valuable marker for identifying neonates at higher risk for severe PPHN and its complications.
Objective:
To evaluate the possible associations between persistent pulmonary hypertension of the neonate, need for extra-corporeal membranous oxygenation, small for gestational age (SGA), and low ponderal index for gestational age in infants with persistent pulmonary hypertension of the neonate and in matched controls.
Methods:
Eighty-six infants with persistent pulmonary hypertension of the neonate delivered from 1991 to 1994 at our hospital were matched with 430 contemporaneous control singleton neonates. Birth weight and ponderal indices (100 x weight/length3) less than the tenth percentile for gestational age and gender were defined as SGA and low ponderal index, respectively. We assessed associations between these markers, the presence of persistent pulmonary hypertension of the neonate, and the need for extracorporeal membranous oxygenation.
Results:
Low ponderal index was associated with persistent pulmonary hypertension of the neonate (odds ratio [OR] 5.4), whereas SGA was not. Low ponderal index (OR 4.0) was an independent correlate of persistent pulmonary hypertension of the neonate after adjustment with logistic regression for 5-minute Apgar scores less than 7, umbilical arterial pH less than 7.10, and presence of meconium. Low ponderal index was associated with need for extracorporeal membranous oxygenation in neonates with persistent pulmonary hypertension (P < .001).
Conclusion:
Fetal developmental events may significantly affect neonatal pulmonary status. Diminished neonatal nutritional status, as measured by low ponderal index for gestational age, is associated with increased risk of persistent pulmonary hypertension of the neonate and severity of the disease process.