Skip to main content Accessibility help
×
Home

Doppler echocardiographic predictors of outcome in newborns with persistent pulmonary hypertension

  • Alain Fraisse (a1), Tal Geva (a1), Jean Gaudart (a2) and David L. Wessel (a1)

Abstract

Patients: We studied retrospectively the echocardiographic features of newborns with persistent pulmonary hypertension who had been randomised to receive inhaled nitric oxide or conventional therapy. We sought to identify the predictors of extracorporeal membrane oxygenation therapy, death, and response to inhaled nitric oxide. Results: Among 85 neonates studied, an extrapulmonary right-to-left shunt through either an oval foramen and/or an arterial duct was present in 80 (94%) cases. In the 64 patients (75%) with adequate images for measurements, left ventricular ejection fraction was normal or mildly depressed in 87%, but there was a decreased index of left ventricular output, inferior to 2 l/min/m2, in 61% of the cases. Using multivariate analysis, an exclusive right-to-left ductal shunt was found to be an independent predictor of death, with odds ratio of 7.8, and 95% confidence intervals from 1.2 to 52.8, with a p value of 0.04. There was also a non-significant trend toward greater use of extracorporeal membrane oxygenation in patients with a predominant left-to-right ductal shunt, the odds ratio being 0.13, with 95% confidence intervals from 0.01 to 1.22, and a p value of 0.07. In the 40 patients randomised to receive inhaled nitric oxide, 28 had a positive response as defined by a 20% reduction in the index of oxygenation as measured from the post-ductal arterial blood gas sample. A left-to-right atrial shunt increased the risk of failing to respond to inhaled nitric oxide, with an odds ratio of 7.46, 95% confidence intervals from 1.23 to 45.1, and a p value of 0.028. Conclusion: Detailed Doppler echocardiographic screening of patients with suspected persistent pulmonary hypertension of the newborn may refine the selection of groups for specific treatment, and identify risk factors.

Copyright

Corresponding author

Correspondence to: Alain Fraisse MD, Cardiologie Pédiatrique, Département de Cardiologie, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France. Tel: +33 491 386750; Fax: +33 491 385638; E-mail: alain.fraisse@ap-hm.fr

References

Hide All

References

Christou H, Van Marter LJ, Wessel DL, et al. Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn. Crit Care Med 2000; 28: 37223727.
Clark RH, Kueser TJ, Walker MW, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. New Engl J Med 2000; 342: 469474.
Day RW. Right ventricular size is acutely decreased by inhaled nitric oxide in newborns with pulmonary hypertension. Am J Perinat 1998; 15: 445451.
Day RW, Lynch JM, White KS, Ward RM. Acute response to inhaled nitric oxide in newborns with respiratory failure and pulmonary hypertension. Pediatrics 1996; 98: 698705.
Ochikubo CG, Waffarn F, Turbow R, Kanakriyeh M. Echocardiographic evidence of improved hemodynamics during inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn. Pediatr Cardiol 1997; 18: 282287.
The Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in full-term and nearly full-term new infants with hypoxic respiratory failure. New Engl J Med 1997; 336: 597604.
Wessel DL, Adiata I, Van Marter LJ, Thompson JE, Stark AR, Kourembanas S. Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent hypertension of the newborn. Pediatrics 1997; 100: 17.
Evans N, Kluckow M, Currie A. Range of echocardiographic findings in term neonates with high oxygen requirements. Arch Dis Child 1998; 78: F105F111.
Musewe NN, Poppe D, Smallhorn JF, et al. Doppler echocardiographic measurement of pulmonary artery pressure from ductal Doppler velocities in the newborn. J Am Coll Cardiol 1990; 15: 446456.
Rozé JC, Storme L, Zupan V, Morville P, Dinh-Xuan AT, Mercier JC. Echocardiographic investigation of inhaled nitric oxide in newborn babies with severe hypoxemia. Lancet 1994; 344: 303305.
Skinner JR, Hunter S, Hey EN. Haemodynamic features at presentation in persistent pulmonary hypertension of the newborn and outcome. Arch Dis Child 1996; 74: F26F32.
Gournay V, Cambonie G, Rozé JC. Doppler echocardiographic assessment of pulmonary blood flow in healthy newborns. Acta Paediatr 1998; 87: 419423.
St John Sutton MG, Meyer RA. Left ventricular function in persistent pulmonary hypertension of the newborn. Computer analysis of the echocardiogram. Br Heart J 1983; 50: 540549.
Henrichsen T, Goldman A, Macrae D. Inhaled nitric oxide can cause severe systemic hypotension. J Pediatr 1996; 129: 183.
Day RW. Evaluation of neonatal pulmonary hypertension by Doppler echocardiography. Pediatr Cardiol 1998; 19: 439.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed