J Pediatr. 2019 Aug 6. pii: S0022-3476(19)30817-0. doi: 10.1016/j.jpeds.2019.06.053. [Epub ahead of print]
https://www.ncbi.nlm.nih.gov/pubmed/31399244
Morbidity of Persistent Pulmonary Hypertension of the Newborn in the First Year of Life.
Steurer MA1, Baer RJ2, Oltman S3, Ryckman KK4, Feuer SK5, Rogers E6, Keller RL7, Jelliffe-Pawlowski LL3.
Author information
1Department of Pediatrics, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA. Electronic address: martina.steurermuller@ucsf.edu.2California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA.3Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.4Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.5California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.6Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.7Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Abstract
OBJECTIVE:
To assess postdischarge mortality and morbidity in infants diagnosed with different etiologies and severities of persistent pulmonary hypertension of the newborn (PPHN), and to identify risk factors for these adverse clinical outcomes.
STUDY DESIGN:
This was a population-based study using an administrative dataset linking birth and death certificates, hospital discharge and readmissions records from 2005 to 2012 in California. Cases were infants ≥34 weeks’ gestational age with International Classification of Diseases,9th edition, codes consistent with PPHN. The primary outcome was defined as postdischarge mortality or hospital readmission during the first year of life. Crude and adjusted risk ratio (aRR) with 95% CIs were calculated to quantify the risk for the primary outcome and to identify risk factors.
RESULTS:
Infants with PPHN (n = 7847) had an aRR of 3.5 (95% CI, 3.3-3.7) for the primary outcome compared with infants without PPHN (n = 3 974 536), and infants with only mild PPHN (n = 2477) had an aRR of 2.2 (95% CI, 2.0-2.5). Infants with congenital diaphragmatic hernia as etiology for PPHN had an aRR of 8.6 (95% CI, 7.0-10.6) and infants with meconium aspiration syndrome had an aRR of 4.0 (95% CI, 3.6-4.4) compared with infants without PPHN. Hispanic ethnicity, small for gestational age, severe PPHN, and etiology of PPHN were risk factors for the primary outcome.
CONCLUSIONS:
The postdischarge morbidity burden of infants with PPHN is large. These findings extend to infants with mild PPHN and etiologies with pulmonary vascular changes that are thought to be short term and recoverable. These data could inform counseling of parents.
Copyright © 2019 Elsevier Inc. All rights reserved.PMID: 31399244 DOI: 10.1016/j.jpeds.2019.06.05
