Clinical spectrum and outcome in neonates with PPHN in rural tertiary care hospital
Abstract
Background: Persistent pulmonary hypertension of the newborn (PPHN) remains a significant challenge in neonatal care, particularly in rural settings where access to advanced therapeutic options is limited. This study aimed to evaluate the clinical spectrum and outcomes of PPHN in a rural tertiary care hospital.
Methods: This prospective observational study was conducted at Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital, Loni, from August 2023 to August 2024. Eighty neonates diagnosed with PPHN were included. Demographic characteristics, clinical presentations, management strategies, and outcomes were analyzed. The severity of PPHN was classified as mild, moderate, or severe based on standardized criteria.
Results: The study population comprised 65% males and 35% females, with 56.3% term and 43.8% preterm neonates. Birth weight distribution showed 66.1% >2500g, 31.3% between 1500-2500g, and 1.3% between 1000-1500g. Growth assessment revealed 73.8% appropriate for gestational age (AGA), 23.8% small for gestational age (SGA), and 2.5% large for gestational age (LGA). Meconium aspiration syndrome emerged as the predominant etiology, followed by birth asphyxia. Moderate PPHN was observed in 48% of cases. High-flow nasal cannula oxygen was required in 70% of neonates, while 43.8% needed escalation to high-frequency oscillatory ventilation. Pharmacological management included sildenafil (75%), milrinone (50%), and dobutamine (32%). The overall survival rate was 78.9%, with mortality predominantly occurring in severe cases requiring mechanical ventilation due to secondary complications.
Conclusion: Early recognition and systematic management of PPHN can achieve favorable outcomes even in resource-limited settings. The study highlights the effectiveness of a staged approach to respiratory support and the importance of standardized treatment protocols. The findings emphasize the need for improved preventive strategies, particularly for meconium aspiration syndrome and birth asphyxia. While resource limitations pose challenges, they need not preclude effective care delivery for neonates with PPHN.
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References
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