Satyan Lakshminrusimha1, Seetha Shankaran2, Abbot Laptook3, Scott McDonald4, Martin Keszler3, Krisa Van Meurs5, Ronnie Guillet6, Sanjay Chawla2, Beena G Sood2, Sonia Bonifacio5, Abhik Das7, Rosemary D Higgins8. 1. Department of Pediatrics, University of California at Davis, Sacramento, CA. Electronic address: slakshmi@ucdavis.edu. 2. Department of Pediatrics, Wayne State University, Detroit, MI. 3. Department of Pediatrics, Brown University, Providence, RI. 4. RTI International, Research Triangle Park, NC. 5. Department of Pediatrics, Stanford University, Palo Alto, CA. 6. Department of Pediatrics, University of Rochester, Rochester, NY. 7. RTI International, Rockville, MD. 8. NICHD, Bethesda, MD.
Abstract
OBJECTIVE: To determine the characteristics of term infants with persistent pulmonary hypertension of the newborn (PPHN) associated with moderate or severe hypoxic ischemic encephalopathy (HIE). METHODS: We compared infants with and without PPHN enrolled in 2 randomized trials of therapeutic hypothermia: the induced hypothermia trial of cooling to 33.5°C for 72 hours vs normothermia, and the "usual-care" arm (33.5°C for 72 hours) of the optimizing cooling trial. RESULTS: Among 303 infants with HIE from these 2 studies, 67 (22%) had PPHN and 236 (78%) did not. We compared infants with PPHN with those without PPHN. The proportion of patients treated with therapeutic hypothermia was similar in PPHN and no-PPHN groups (66% vs 65%). Medication use during resuscitation (58% vs 44%), acidosis after birth (pH: 7.0 ± 0.2 vs 7.1 ± 0.2), severe HIE (43% vs 28%), meconium aspiration syndrome (39% vs 7%), pulmonary hemorrhage (12% vs 3%), culture-positive sepsis (12% vs 3%), systemic hypotension (65% vs 28%), inhaled nitric oxide therapy (64% vs 3%), and extracorporeal membrane oxygenation (12% vs 0%) were more common in the PPHN group. Length of stay (26 ± 21 vs 16 ± 14 days) and mortality (27% vs 16%) were higher in the PPHN group. CONCLUSIONS: PPHN is common among infants with moderate/severe HIE and is associated with severe encephalopathy, lung disease, sepsis, systemic hypotension, and increased mortality. The prevalence of PPHN was not different between those infants receiving therapeutic hypothermia at 33.5°C in these 2 trials (44/197 = 22%) compared with infants receiving normothermia in the induced hypothermia trial (23/106 = 22%).
RCT Entities:
OBJECTIVE: To determine the characteristics of term infants with persistent pulmonary hypertension of the newborn (PPHN) associated with moderate or severe hypoxic ischemicencephalopathy (HIE). METHODS: We compared infants with and without PPHN enrolled in 2 randomized trials of therapeutic hypothermia: the induced hypothermia trial of cooling to 33.5°C for 72 hours vs normothermia, and the "usual-care" arm (33.5°C for 72 hours) of the optimizing cooling trial. RESULTS: Among 303 infants with HIE from these 2 studies, 67 (22%) had PPHN and 236 (78%) did not. We compared infants with PPHN with those without PPHN. The proportion of patients treated with therapeutic hypothermia was similar in PPHN and no-PPHN groups (66% vs 65%). Medication use during resuscitation (58% vs 44%), acidosis after birth (pH: 7.0 ± 0.2 vs 7.1 ± 0.2), severe HIE (43% vs 28%), meconium aspiration syndrome (39% vs 7%), pulmonary hemorrhage (12% vs 3%), culture-positive sepsis (12% vs 3%), systemic hypotension (65% vs 28%), inhaled nitric oxide therapy (64% vs 3%), and extracorporeal membrane oxygenation (12% vs 0%) were more common in the PPHN group. Length of stay (26 ± 21 vs 16 ± 14 days) and mortality (27% vs 16%) were higher in the PPHN group. CONCLUSIONS: PPHN is common among infants with moderate/severe HIE and is associated with severe encephalopathy, lung disease, sepsis, systemic hypotension, and increased mortality. The prevalence of PPHN was not different between those infants receiving therapeutic hypothermia at 33.5°C in these 2 trials (44/197 = 22%) compared with infants receiving normothermia in the induced hypothermia trial (23/106 = 22%).
Authors: M C Walsh-Sukys; J E Tyson; L L Wright; C R Bauer; S B Korones; D K Stevenson; J Verter; B J Stoll; J A Lemons; L A Papile; S Shankaran; E F Donovan; W Oh; R A Ehrenkranz; A A Fanaroff Journal: Pediatrics Date: 2000-01 Impact factor: 7.124
Authors: Myra H Wyckoff; Khalid Aziz; Marilyn B Escobedo; Vishal S Kapadia; John Kattwinkel; Jeffrey M Perlman; Wendy M Simon; Gary M Weiner; Jeanette G Zaichkin Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: Seetha Shankaran; Abbot R Laptook; Richard A Ehrenkranz; Jon E Tyson; Scott A McDonald; Edward F Donovan; Avroy A Fanaroff; W Kenneth Poole; Linda L Wright; Rosemary D Higgins; Neil N Finer; Waldemar A Carlo; Shahnaz Duara; William Oh; C Michael Cotten; David K Stevenson; Barbara J Stoll; James A Lemons; Ronnie Guillet; Alan H Jobe Journal: N Engl J Med Date: 2005-10-13 Impact factor: 91.245
Authors: Linda J Van Marter; Sonia Hernandez-Diaz; Martha M Werler; Carol Louik; Allen A Mitchell Journal: Pediatrics Date: 2012-12-03 Impact factor: 7.124
Authors: Bushra Afzal; Praveen Chandrasekharan; Daniel J Tancredi; James Russell; Robin H Steinhorn; Satyan Lakshminrusimha Journal: Pediatr Crit Care Med Date: 2019-02 Impact factor: 3.624
Authors: Regan E Giesinger; Philip T Levy; J Lauren Ruoss; Mohamed El Dib; Khorshid Mohammad; Pia Wintermark; Patrick J McNamara Journal: Pediatr Res Date: 2020-10-18 Impact factor: 3.756