Risk Factors for Persistent Pulmonary Hypertension of the Newborn and Determining the Clinical Prognosis

Öz

Objective: Persistent pulmonary hypertension of the newborn (PPHN) is a serious clinical condition that developed through the persistence of high pulmonary vascular resistance during the transition period and results in severe morbidities and mortality. This study aims to determine the risk factors for developing PPHN and to evaluate the prognosis, morbidities, and mortality. Materials and Method: This retrospective study was conducted between January 2017 and January 2019. Hospital records of infants who needed neonatal intensive care were evaluated retrospectively in terms of etiological causes of PPHN, clinical prognosis of neonates, morbidities, and mortality rates. Results: A total of 29,650 infants were born during the 2-year study period, 920 of whom were admitted to a neonatal intensive care unit, of which 50 developed PPHN. Of the infants who developed PPHN, 66% were preterm and 52% were female. The most common etiology related to developing PPHN is congenital pneumonia (65%) in term infants and respiratory distress syndrome (100%) in preterm infants. The second most common etiology is perinatal asphyxia for both term and preterm infants. Morbidities such as patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia were higher in the preterm group, with mortality rates also being significantly higher in preterm infants. Conclusion: Persistent pulmonary hypertension of the newborn is a serious clinical condition that may result in high neonatal mortality even when appropriate cardiopulmonary support is given. Mortality and mortality-related morbidities are thought to be able to be decreased by defining the risk factors for developing PPHN.

Anahtar Kelimeler

• Persistent pulmonary hypertension
• neonates
• preterm

Yenidoğanlarda Persistan Pulmoner Hipertansiyon Risk Faktörleri, Klinik ve Prognozun Belirlenmesi

Öz

Amaç: Yenidoğanın persistan pulmoner hipertansiyonu (PPHN) geçiş döneminde pulmoner vasküler direncin yüksek kalması sonucu gelişen önemli morbidite ve mortalite ile sonlanabilen ciddi bir klinik durumdur. Bu çalışmada PPHN tanısıyla izlenen yenidoğan bebeklerde risk faktörlerinin belirlenmesi, klinik prognozun, mortalite ve morbiditelerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Retrospektif gözlemsel bu çalışmada Ocak 2017-Ocak 2019 tarihileri arasında Yenidoğan Yoğun Bakım Ünitesinde (YYBÜ) PPHN tanısıyla izlenen bebeklerin verileri hastane kayıtlarından incelenmiş, PPHN etiyolojisi, bebeklerin klinik bulguları, morbiditeler ve mortalite değerlendirilmiştir. Bulgular: İki senelik çalışma periyodunda toplam 29.650 bebek dünyaya geldi, bebeklerin 920’si YYBÜ’de yatırıldı ve 50 bebekte PPHN saptandı. PPHN gelişen olguların %66’sı prematüre ve %52’si kız idi. PPHN gelişimi ile ilişkilendirilen en sık etiyolojik faktör term bebeklerde konjenital pnömoni (%65) iken, preterm bebeklerde respiratuar distres sendromu (%100) idi. Her iki grupta da en sık ikinci etiyolojik faktör perinatal asfiksi idi. Patent duktus arteriyozus, intraventriküler kanama, nekrotizan enterokolit ve bronkopulmoner displazi gibi morbiditeler PPHN gelişen preterm bebeklerde daha sık görülürken, mortalite oranı da preterm grupta daha yüksek bulundu. Tartışma: Persistan pulmoner hipertansiyon, uygun kardiyorespiratuvar destek ve güncel tedavilere rağmen yüksek neonatal mortaliteye sahip ciddi bir durumdur. Pulmoner hipertansiyon gelişimi ve mortalite üzerine etkili risk faktörlerinin belirlenmesi ile mortalite ve ilişkili morbiditelerin azaltılabileceği düşünülmektedir.

Anahtar Kelimeler

• persistan pulmoner hipertansiyon
• yenidoğan
• preterm

Kaynakça

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