Abstract
Persistent pulmonary hypertension often occurs in infants with meconium aspiration syndrome or asphyxia. There is a subgroup of infants with PPHN in whom myocardiopathy predominates. We reviewed the course of 7 infants treated for PPHN who had increased heart size on chest x-ray, and/or an EKG with right ventricular hypertrophy. All patients had documented right-to-left shunting by echocardiogram either through PDA or foramen ovale. Mean B.W. was 3.13 ± .49 kg SD (range 2.32 to 3.74), G.A. was 38.85 ± 2.38 weeks SD, Apgars mean of 4.71 ± 2.49 SD at one minute and 6.57 ± 2.43 SD at five minutes. All patients required >90% inspired oxygen concentration, with 6 patients on 100% requiring mechanical ventilation. The following were mean ventilator settings on day one: FiO2 98.57% ± 3.77 SD, rate 87 ± 34.95 SD bpm, IP 38.66 ± 12.35 SD cmH2O, PEEP 5.5 ± 1.64 SD cmH2O. The mean critical PCO2 on day I was 23.85 ± 8.7 SD mmHg, with a mean PO2 of 128.85 ± 109.02 mmHg SD. Six of 7 infants were treated with intravascular volume replacement and dopamine (mean maximum dose 18.58 ± 18.05 SD mcg/kg/min). In 4 surviving infants on dopamine and intravascular volume, the maximum dose of dopamine was associated with a reduction in inspired oxygen within a range of 25-40% within 48 hours followed by entrance into the transitional phase (decrease of 30% inspired O2). The mean day of entry into the transitional phase was 6.4 ± 3.30 SD days of life. These infants represent a subgroup of neonates with PPHN. Cardiomyopathy in these infants appears to benefit most from intravascular volume replacement and dopamine therapy. (Supported in part by NIH grant RR-00240).
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Stefano, J., Spitzer, A., McNeils, W. et al. 1531 CARDIOMYOPATHY ASSOCIATED PERSISTENT PULMONARY HYPERTENSION (PPHN). Pediatr Res 19, 366 (1985). https://doi.org/10.1203/00006450-198504000-01555
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DOI: https://doi.org/10.1203/00006450-198504000-01555