Prevalence and outcome of pulmonary arterial hypertension in newborns with perinatal asphyxia

Background: Pulmonary arterial hypertension (PAH) in adults is usually described as mean pulmonary artery pressures of 25 mmHg or more at rest. However, clear cutoff value is not well defined in neonatal age group. Persistent pulmonary hypertension of newborn (PPHN) can be defined as a failure of normal fall in pulmonary vascular resistance at or shortly after birth, leading to shunting of unoxygenated blood into the systemic circulation across foramen ovale or ductus arteriosus. Objective: To study the prevalence and outcome of Pulmonary arterial Hypertension in newborns with perinatal asphyxia. Materials and Methods: This was a prospective observational study in which newborns up to 1 month of age having a history and clinical/laboratorial features of perinatal asphyxia were included in the study. Both inborn and outborn newborns admitted in our Neonatal Intensive Care Unit/neonatal high dependency unit were enrolled in the study. Relevant investigations as and when required for management were done. Echocardiography was done after 48 h of birth, and the findings were noted for the presence of PAH. Second echocardiographic screening was done at 6 weeks of life in all cases. Results: A total number of neonates screened were 41, of which 18 (43.9%) cases had PAH. Out of 18 cases, 8 (44.4%) had a reversal of shunt at the level of patent ductus arteriosus/patent foramen ovale and hence were cases of PPHN. Eleven neonates expired before 6 weeks of age and rest seven cases were screened at 6 weeks. Only one case showed the persistence of PAH at 6 weeks. Conclusion: Perinatal asphyxia was found to have a significant association with the development of PAH, and the mortality was high in neonates with perinatal asphyxia once it is complicated by the development of PAH.