Management of neonatal pulmonary hypertension-a survey of neonatal intensive care units in India.
Indian survey
Inhaled nitric oxide
Inotropes
Persistent pulmonary hypertension of newborn
Pulmonary vasodilators
Targeted neonatal echocardiography
Journal
BMC pediatrics
ISSN: 1471-2431
Titre abrégé: BMC Pediatr
Pays: England
ID NLM: 100967804
Informations de publication
Date de publication:
31 03 2023
31 03 2023
Historique:
received:
25
01
2023
accepted:
22
03
2023
medline:
4
4
2023
entrez:
2
4
2023
pubmed:
3
4
2023
Statut:
epublish
Résumé
Persistent pulmonary hypertension of the newborn (PPHN) is a common neonatal condition associated with significant morbidity and mortality. First-line diagnostic and treatment options such as echocardiography and inhaled nitric oxide (iNO) are not routinely available in resource limited settings and alternative treatment modalities need to be utilized. This study was conducted to assess current diagnostic and management strategies used for PPHN in Indian neonatal intensive care units (NICUs). A questionnaire in multiple choice question format was sent to practising neonatologists in India via an online survey tool between July to August 2021. Information pertaining to demographic data, diagnostic criteria and management strategies of PPHN was requested. The responses were collated and information processed. There were 118 respondent NICUs (response rate 74%). The majority of neonatal units (65%) admitted an average of 1-3 patients of PPHN per month. Targeted neonatal echocardiography (TnECHO) was practised in 80% of the units. Most common management strategies being followed were pulmonary vasodilators (88.1%), inotropes (85.6%), conventional ventilation (68.6%) and high frequency ventilation (59.3%). The most preferred pulmonary vasodilator was sildenafil (79%) and inotropic agent was milrinone (32%). Only 25% of respondents reported use of iNO. None of the participating units used extracorporeal membrane oxygenation. We found wide variability in management practices of PPHN across Indian NICUs. Non-selective pulmonary vasodilators are more widely used than iNO. There is an urgent need for structured TnECHO training programs and evidence based national guidelines for standardized management of PPHN as per availability of resources in India. Additional research on low cost alternative therapies to iNO in Indian settings might be helpful.
Sections du résumé
BACKGROUND
Persistent pulmonary hypertension of the newborn (PPHN) is a common neonatal condition associated with significant morbidity and mortality. First-line diagnostic and treatment options such as echocardiography and inhaled nitric oxide (iNO) are not routinely available in resource limited settings and alternative treatment modalities need to be utilized. This study was conducted to assess current diagnostic and management strategies used for PPHN in Indian neonatal intensive care units (NICUs).
METHODS
A questionnaire in multiple choice question format was sent to practising neonatologists in India via an online survey tool between July to August 2021. Information pertaining to demographic data, diagnostic criteria and management strategies of PPHN was requested. The responses were collated and information processed.
RESULTS
There were 118 respondent NICUs (response rate 74%). The majority of neonatal units (65%) admitted an average of 1-3 patients of PPHN per month. Targeted neonatal echocardiography (TnECHO) was practised in 80% of the units. Most common management strategies being followed were pulmonary vasodilators (88.1%), inotropes (85.6%), conventional ventilation (68.6%) and high frequency ventilation (59.3%). The most preferred pulmonary vasodilator was sildenafil (79%) and inotropic agent was milrinone (32%). Only 25% of respondents reported use of iNO. None of the participating units used extracorporeal membrane oxygenation.
CONCLUSION
We found wide variability in management practices of PPHN across Indian NICUs. Non-selective pulmonary vasodilators are more widely used than iNO. There is an urgent need for structured TnECHO training programs and evidence based national guidelines for standardized management of PPHN as per availability of resources in India. Additional research on low cost alternative therapies to iNO in Indian settings might be helpful.
Identifiants
pubmed: 37004003
doi: 10.1186/s12887-023-03964-9
pii: 10.1186/s12887-023-03964-9
pmc: PMC10064718
doi:
Substances chimiques
Sildenafil Citrate
BW9B0ZE037
Nitric Oxide
31C4KY9ESH
Vasodilator Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
149Informations de copyright
© 2023. The Author(s).
Références
BMC Pediatr. 2022 May 27;22(1):311
pubmed: 35624452
Semin Perinatol. 2014 Mar;38(2):78-91
pubmed: 24580763
J Neonatal Perinatal Med. 2016 Sep 16;9(3):243-50
pubmed: 27589551
J Pediatr. 2002 Mar;140(3):373-5
pubmed: 11953739
Cochrane Database Syst Rev. 2017 Jan 03;1:CD000509
pubmed: 28045472
Pediatrics. 2000 Jan;105(1 Pt 1):14-20
pubmed: 10617698
Am J Perinatol. 2012 Aug;29(7):519-26
pubmed: 22495900
Pediatr Pulmonol. 2003 Dec;36(6):529-35
pubmed: 14618646
Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):344-350
pubmed: 32929311
J Pediatr. 2019 Oct;213:58-65.e4
pubmed: 31399244
Clin Perinatol. 2001 Sep;28(3):609-27, vii
pubmed: 11570157
J Perinatol. 2021 Apr;41(4):786-793
pubmed: 33589728
Eur J Pediatr. 2021 Aug;180(8):2379-2387
pubmed: 34091748
J Matern Fetal Neonatal Med. 2020 Jun;33(12):2032-2037
pubmed: 30318951
Am J Perinatol. 2017 Feb;34(3):276-282
pubmed: 27490772
Pak J Med Sci. 2021 Sep-Oct;37(5):1387-1391
pubmed: 34475917
J Perinat Med. 2011 May;39(3):311-5
pubmed: 21488808
Front Pediatr. 2020 Jul 24;8:342
pubmed: 32850518