15 February 2020 by Gabriel Diaz

Persistent pulmonary hypertension of the newborn (Pphn) in altitude. Importance of early detection

INTRODUCTION: Hypobaric Hypoxia influences pulmonary hypertension in: frequency, pathogenesis, diagnostic approach and treatment; however, there is very few information on PPHN in altitude.

OBJECTIVE: To analize patients with PPHN in three maternities of Bogota, (2640 MOSL) in last two years, emphazising the evolution of patients with early diagnosis.

MATERIAL AND METHODS: Data were obtained from medical records and echocardiography reports of three institutions. Patients with PPHN were filtered. Demographic data, BNP, treatments and clinical evolution were analized. The data were analyzed with statistical packages.

RESULTS: Majority of patients (42 from 46) without early diagnosis, needed mechanical ventilation, HFOV, Sildenafil, NO plus Sildenafil-HFOV, and one patient needed ECMO (2%). 4 patients (8,6%), with early diagnosis based in clinical findings: mild polypnea, heart hyperactivity and loud second heart sound, supported with BNP value, needed only hiperoxia, with resolution of severe PPHN in 24-48 hours.

DISCUSION: Previous studies have demostrated in newborn rats exposed to hipoxia, that muscle cells are developed in distal portions of arterioles from pericites and intermediate cells. These studies confirm the importance of early detection of PPHN. Analizing our newborn patients with severe PPHN in last 2 years in altitude, we can see that the early diagnosis (clinical findings plus echocardiogram) is very important. In these cases, the answer to hiperoxia was very fast, compared with all other patients that needed other therapies and long hopitalization.

Other considerations are: high frequency of PPHN in altitude and the good correlation of BNP values with the clinical evolution of the patients.

CONCLUSION: Early detection of PPHN impact positively the patient evolution. (Clinical findings are very important).
Altitude by hypobaric hipoxia, influences frequency and maybe severity of PPHN.
BNP is a good marker for diagnosis and follow in PPHN.

Key Contributors

Gabriel F. Díaz G, Alicia Márquez, Carlos Sánchez, Luis Ponce, Sergio Torres, Cristian Vargas, Óscar Arévalo, Alberto Olivella Universidad Nacional de Colombia; Fundación Santa Fe De Bogota; Cllínica De La Mujer; CPO; Valle de Lili; Clínica Palermo; HOMI


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