1
|
Bandiya P, Madappa R, Joshi AR. Etiology, Diagnosis and Management of Persistent Pulmonary Hypertension of the Newborn in Resource-limited Settings. Clin Perinatol 2024; 51:237-252. [PMID: 38325944 DOI: 10.1016/j.clp.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Persistent Pulmonary Hypertension of the Newborn (PPHN) is more common in Low and middle income countries (LMICs) due to high incidence of sepsis, perinatal asphyxia and meconium aspiration syndrome. Presence of hypoxic respiratory faillure and greater than 5% difference in preductal and post ductal saturation increases clinical sucipision for PPHN. The availability of Inhaled nitric oxide and extracorporaeal membrane oxygenation is limited but pulmonary vasodilators such as sildenafil are readily available in most LMICs.
Collapse
Affiliation(s)
- Prathik Bandiya
- Department of Neonatology, Neonatal Unit, 1st Floor, Indira Gandhi Institute of Child Health, South Hospital complex, Dharmaram college Post, Bangalore - 560029
| | - Rajeshwari Madappa
- Department of Pediatrics, SIGMA Hospital, P8/D, Thonachikoppal -Saraswathipuram Road, Mysore -570009 Karnataka, India.
| | - Ajay Raghav Joshi
- Department of Pediatrics, SIGMA Hospital, P8/D, Thonachikoppal -Saraswathipuram Road, Mysore -570009 Karnataka, India
| |
Collapse
|
2
|
Zhang H, Keszler M. Mechanical ventilation in special populations. Semin Perinatol 2024; 48:151888. [PMID: 38555219 DOI: 10.1016/j.semperi.2024.151888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Optimal respiratory support can only be achieved if the ventilator strategy utilized for each individual patient at any given point in the evolution of their disease process is tailored to the underlying pathophysiology. The critically ill newborn infant requires individualized patient care when it comes to mechanical ventilation. This can only occur if the clinician has a good understanding of the different pathophysiologies of a variety of conditions that can lead to respiratory failure. In this chapter we describe the key pathophysiological features of bronchopulmonary dysplasia, meconium aspiration syndrome and lung hypoplasia syndromes with emphasis on congenital diaphragmatic hernia. We review available evidence to guide management an provide specific recommendations for pathophysiologically-based mechanical ventilation support.
Collapse
Affiliation(s)
- Hyayan Zhang
- Department of Neonatology, Perelman School of Medicine at the University of Pennsylvania, Newborn and Infant Chronic Lung Disease Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neonatology, Guangzhou Women and Children Medical Center, Guangzhou, China
| | - Martin Keszler
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| |
Collapse
|
3
|
Ma J, Tang S, Shen L, Chen L, Li X, Li W, Wu L, Shi Y. A randomized single-center controlled trial of synchronized intermittent mandatory ventilation with heliox in newborn infants with meconium aspiration syndrome. Pediatr Pulmonol 2021; 56:2087-2093. [PMID: 33831271 DOI: 10.1002/ppul.25390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/02/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to investigate the beneficial effects of synchronized intermittent mandatory ventilation (SIMV) with heliox in newborn infants with meconium aspiration syndrome (MAS). METHODS Seventy-one newborn infants with MAS in the neonatal intensive care unit (NICU) of Daping Hospital of Army Medical University were enrolled in the trial. Infants treated with SIMV were randomized and divided into the heliox group (n = 35) and control group (n = 36). The heliox group received heliox for 6 h followed by air-oxygen mixed gas, and the control group received air-oxygen mixed gas. The primary outcome measures were PaO2 /FiO2 (P/F) and the extubation time. The secondary outcome measures were the incidence of mechanical ventilation complications, hospital length of stay in the NICU, blood gas analysis, and inflammation markers. RESULTS The P/F in the heliox group was significantly better than that in the control group (p < .001). The extubation time and hospital length of stay in the NICU in the heliox group were shorter than those in the control group (p < .001). The inflammation markers at 6 h and myocardial injury markers at 24 h were decreased compared with those at 0 h, and those in the heliox group were more significantly decreased than those in the control group ([interleukin {IL}-6/IL-8/tumor necrosis factor α] p < .001, [C-reaction protein] p = .012; [creatine kinase] p < .001, [CK-MB] p = .041). CONCLUSION Heliox appears to be more effective in reducing the length of ventilation and increasing carbon dioxide eliminations than an air-oxygen mixture in infants with MAS under the support of SIMV.
Collapse
Affiliation(s)
- Juan Ma
- Department of Pediatrics, North-Kuanren General Hospital, Chongqing, China.,Department of Pediatrics, Daping Hospital, Army Medical University, Chongqing, China
| | - Shifang Tang
- Department of Pediatrics, North-Kuanren General Hospital, Chongqing, China
| | - Leilei Shen
- Department of Pediatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Long Chen
- Department of Neonatology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Li
- Department of Pediatrics, Daping Hospital, Army Medical University, Chongqing, China
| | - Wanwei Li
- Department of Pediatrics, Daping Hospital, Army Medical University, Chongqing, China
| | - Li Wu
- Department of Pediatrics, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuan Shi
- Department of Neonatology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
4
|
Nakwan N, Chitrapatima C. Risk factor analysis of persistent pulmonary hypertension of the newborn in meconium aspiration syndrome in Thai neonates. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_118_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Abqari S, Ahmed T, Firdaus U, Shahab T, Ali S. Status of pulmonary artery pressures on echocardiography among high-risk newborns. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_24_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Gad S, Alkhalafawi A, Raza S, Hesham M, Sheta M. Value of Neutrophil to Lymphocyte Ratio in Early Prediction of Meconium Aspiration Syndrome. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1720958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractMeconium aspiration syndrome (MAS) is a serious neonatal condition. Prediction of MAS is challenging particularly in low-resource setting. Neutrophil to lymphocyte ratio (NLR) is a new simple index used for diagnosis of many inflammatory conditions. The present study was an attempt to determine whether NLR can predict the occurrence of MAS. The present study included 101 children with meconium-stained amniotic fluid. They comprised 22 patients who developed MAS and 79 neonates who didn't have the condition. All neonates were subjected to careful analysis of maternal and perinatal history in addition to thorough clinical assessment and radiological and laboratory evaluation. Blood samples from the umbilical cord were collected at birth and were used to obtain complete blood counts and C-reactive protein (CRP) assay. Univariate analysis revealed that elevated CRP levels, increased NLR, and 5-minute Apgar score of <7 were significant risk factors for the occurrence of MAS. Multivariate analysis revealed that low 5-minute Apgar score and increased NLR remained as significant risk factors of MAS. Receiver operating characteristic curve analysis showed good performance of NLR in prediction of MAS. NLR is useful in prediction of MAS in term neonates with meconium-stained amniotic fluid.
Collapse
Affiliation(s)
- Suzan Gad
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Syed Raza
- Department of Pediatrics, Sheikh Khalifa Medical City, Ajman, UAE
| | - Mervat Hesham
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Sheta
- Department of Pediatrics, Mansoura General Hospital, Mansoura, Egypt
| |
Collapse
|
7
|
Ozturk Z, Kalayci CC. Pregnancy outcomes in psychiatric patients treated with passiflora incarnata. Complement Ther Med 2017; 36:30-32. [PMID: 29458926 DOI: 10.1016/j.ctim.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/02/2017] [Accepted: 11/13/2017] [Indexed: 11/17/2022] Open
Abstract
Passiflora incarnata is marketed in many countries as anxiolytic herbal supplement. Herbal medicines are natural products, but it doesn't mean they are always safe, especially during pregnancy. Passiflora incarnata extract was not teratogenic in experimental studies. However, there are no data available on possible effects on human pregnancy. Here we report five pregnant women with depression and/or anxiety who used passiflora incarnata in pregnancy. We observed one pregnancy resulting in neonatal death, two pregnancies with premature rupture of membranes, two infants with meconium aspiration syndrome and one infant with persistent pulmonary hypertension. No birth defects and no growth or developmental abnormalities for the live born infants were reported at 6 months of age. This observation is important since there have been no human reports about the use of passiflora incarnata in pregnant women. Pregnant women exposed to passiflora incarnata should be monitored, unless further data are available.
Collapse
Affiliation(s)
- Zeynep Ozturk
- Department of Clinical Pharmacology and Toxicology, Izmir Ataturk Research Hospital, Izmir, Turkey.
| | | |
Collapse
|
8
|
Abstract
Most neonatal deaths worldwide occur in low- and middle-income countries (LMICs). Respiratory distress is an important cause of neonatal morbidity and mortality. The epidemiology of respiratory distress among term neonates who constitute the vast majority of births is under reported. The scarcely available data from LMICs suggest an incidence of 1.2% to 7.2% among term live births and greater morbidity compared to that in high-income countries. Pneumonia and meconium aspiration syndrome are the predominant causes among outborn neonates, but next only to transient tachypnea among inborn neonates. Community management of neonatal sepsis/pneumonia using simplified antibiotic regimens when referral is not feasible, implementation of non-invasive ventilation, and innovative low-cost technologies to deliver respiratory therapy are important advances that have taken place in these settings. There is an urgent need to generate data on respiratory morbidities among term neonates so that the limited resources in these settings can be allocated judiciously.
Collapse
|
9
|
Ryu IK, Tang CL, Chu SY, Shim GH, Chey MJ. Comparison between Patients with Persistent Pulmonary Hypertension of Neonates Concomitant with Parenchymal Lung Disease and Idiopathic Persistent Pulmonary Hypertension of Neonates. NEONATAL MEDICINE 2017. [DOI: 10.5385/nm.2017.24.4.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- In Kyung Ryu
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Chih Lung Tang
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Shou Yu Chu
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Gyu Hong Shim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Myoung Jae Chey
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| |
Collapse
|