Abstract 1796

Persistent pulmonary hypertension of the newborn (PPHN) is one of the most challenging situations in the neonatal intensive care nursery and it is associated with high morbidity and mortality. We report an eight years experience of 29 neonates with PPHN in a children's hospital in Taiwan where inhaled Nitric Oxide (INO) and Extracopreal Membrane Oxygenation (ECMO) were not readily available. There were 18 male and 11 female newborns. 72% of the babies were referred from outside hospitals. Mean birth weight was 2707±693 gm and mean gestational age was 37.1±3.1 weeks. The diagnosis of PPHN was confirmed by Echocardiography. Underlying clinical conditions were meconium aspiration syndrome (n=8), perinatal asphyix (7), respiratory distress syndrome (5), sepsis and/or pneumonia (4), congenital diaphragmatic hernia (3), and cyanosis (2). Treatment modalities included supportive medical management, vasodilator therapy (Tolazoline), mechanical ventilation, and correction of underlying conditions. Most of the patients received nonhyperventilation respirator therapy. The goals of this therapy were to maintain preductal arterial blood gas with pH levels between 7.40 and 7.50, PaO2 levels between 60 and 90 Torr, and PaCO2 levels between 30 and 50 Torr. High peak inflating pressure (>35 cmH2O) and high ventilator rate (>60/min) were avoided. Five patients received high frequency oscillatory ventilation therapy. Alveolar-arterial oxygen tension difference was greater than 610 Torr in 24 patients. The mean durations on mechanical ventilation were 8.1 days. The mortality rate was 31% (9/29). Eight patients had pulmonary barotrauma including pneumothorax in 5 and pulmonary interstitial emphysema in 3. Two patients developed chronic lung disease. Three patients had neurological handicap. In conclusion, although the average mortality rate of PPHN reported is about 40%, we could achieve a survival rate of nearly 70% among neonates with PPHN treated in a developing country where INO and ECMO were not readily available.