Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-05T21:14:37.593Z Has data issue: false hasContentIssue false
  • English
  • Français

Doppler echocardiographic predictors of outcome in newborns with persistent pulmonary hypertension

Published online by Cambridge University Press:  21 January 2005

Alain Fraisse ,
Tal Geva ,
Jean Gaudart  and
David L. Wessel
Alain Fraisse
Affiliation:
Department of Cardiology, Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Tal Geva
Affiliation:
Department of Cardiology, Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Jean Gaudart
Affiliation:
Département de Biomathématique, Faculté de Médecine, Université de la Méditerranée, Marseille, France
David L. Wessel
Affiliation:
Department of Cardiology, Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Patients: We studied retrospectively the echocardiographic features of newborns with persistent pulmonary hypertension who had been randomised to receive inhaled nitric oxide or conventional therapy. We sought to identify the predictors of extracorporeal membrane oxygenation therapy, death, and response to inhaled nitric oxide. Results: Among 85 neonates studied, an extrapulmonary right-to-left shunt through either an oval foramen and/or an arterial duct was present in 80 (94%) cases. In the 64 patients (75%) with adequate images for measurements, left ventricular ejection fraction was normal or mildly depressed in 87%, but there was a decreased index of left ventricular output, inferior to 2 l/min/m2, in 61% of the cases. Using multivariate analysis, an exclusive right-to-left ductal shunt was found to be an independent predictor of death, with odds ratio of 7.8, and 95% confidence intervals from 1.2 to 52.8, with a p value of 0.04. There was also a non-significant trend toward greater use of extracorporeal membrane oxygenation in patients with a predominant left-to-right ductal shunt, the odds ratio being 0.13, with 95% confidence intervals from 0.01 to 1.22, and a p value of 0.07. In the 40 patients randomised to receive inhaled nitric oxide, 28 had a positive response as defined by a 20% reduction in the index of oxygenation as measured from the post-ductal arterial blood gas sample. A left-to-right atrial shunt increased the risk of failing to respond to inhaled nitric oxide, with an odds ratio of 7.46, 95% confidence intervals from 1.23 to 45.1, and a p value of 0.028. Conclusion: Detailed Doppler echocardiographic screening of patients with suspected persistent pulmonary hypertension of the newborn may refine the selection of groups for specific treatment, and identify risk factors.

Keywords

Neonatesarterial ductvasodilation therapynitric oxide
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 3 , June 2004 , pp. 277 - 283
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Christou H, Van Marter LJ, Wessel DL, et al. Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn. Crit Care Med 2000; 28: 3722–3727.Google Scholar
Clark RH, Kueser TJ, Walker MW, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. New Engl J Med 2000; 342: 469–474.Google Scholar
Day RW. Right ventricular size is acutely decreased by inhaled nitric oxide in newborns with pulmonary hypertension. Am J Perinat 1998; 15: 445–451.Google Scholar
Day RW, Lynch JM, White KS, Ward RM. Acute response to inhaled nitric oxide in newborns with respiratory failure and pulmonary hypertension. Pediatrics 1996; 98: 698–705.Google Scholar
Ochikubo CG, Waffarn F, Turbow R, Kanakriyeh M. Echocardiographic evidence of improved hemodynamics during inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn. Pediatr Cardiol 1997; 18: 282–287.Google Scholar
The Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in full-term and nearly full-term new infants with hypoxic respiratory failure. New Engl J Med 1997; 336: 597–604.
Wessel DL, Adiata I, Van Marter LJ, Thompson JE, Stark AR, Kourembanas S. Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent hypertension of the newborn. Pediatrics 1997; 100: 1–7.Google Scholar
Evans N, Kluckow M, Currie A. Range of echocardiographic findings in term neonates with high oxygen requirements. Arch Dis Child 1998; 78: F105–F111.Google Scholar
Musewe NN, Poppe D, Smallhorn JF, et al. Doppler echocardiographic measurement of pulmonary artery pressure from ductal Doppler velocities in the newborn. J Am Coll Cardiol 1990; 15: 446–456.Google Scholar
Rozé JC, Storme L, Zupan V, Morville P, Dinh-Xuan AT, Mercier JC. Echocardiographic investigation of inhaled nitric oxide in newborn babies with severe hypoxemia. Lancet 1994; 344: 303–305.Google Scholar
Skinner JR, Hunter S, Hey EN. Haemodynamic features at presentation in persistent pulmonary hypertension of the newborn and outcome. Arch Dis Child 1996; 74: F26–F32.Google Scholar
Gournay V, Cambonie G, Rozé JC. Doppler echocardiographic assessment of pulmonary blood flow in healthy newborns. Acta Paediatr 1998; 87: 419–423.Google Scholar
St John Sutton MG, Meyer RA. Left ventricular function in persistent pulmonary hypertension of the newborn. Computer analysis of the echocardiogram. Br Heart J 1983; 50: 540–549.Google Scholar
Henrichsen T, Goldman A, Macrae D. Inhaled nitric oxide can cause severe systemic hypotension. J Pediatr 1996; 129: 183.Google Scholar
Day RW. Evaluation of neonatal pulmonary hypertension by Doppler echocardiography. Pediatr Cardiol 1998; 19: 439.Google Scholar