Persistent pulmonary arterial hypertension of the new born

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Abstract
Persistent pulmonary hypertension of the newborn (PPHN) characterised by right to left shunting with intense cyanosis is difficult to manage, and in the best of centres carries a 40–60 percent mortality. We report our one year's experience of managing six neonates with PPHN. There were 5 males and 1 female with mean birth weight of 2.59±0.487 kg and gestation period 39±2.0 wks and 1 minute Apgar score 2.8±2.1. Four to six babies were born by cesarean section and 3–6 babies had aspiration pneumonia. All babies presented within 12 hours of age (mean 5.08±5 hrs) with intense cyanosis and respiratory distress. Diagnosis were confirmed in all by (a) hyperoxia test, (b) simultaneous determination of preductal and postductal paO2 (c) contrast echocardiography and (d) hyperoxia-hyperventilation test. Babies were managed with hyperventilation using mean ventilatory rates of 100±45 per minute, an inspired oxygen concentration of 100%, peak inspiratory pressures 27±9 cm of H2O, and expiratory pressures 5±1.6 cms of H2O, and mean air way pressures of 10.4±2.7 cms H2O. Alkali therapy was used in 3 of the six babies whereas low dose dopamine was infused in all six babies. Inspite of aggressive ventilatory therapy, only 3 out of 6 babies could be salvaged.