Aim To evaluate prospectively the echocardiographic predictors of outcome in persistent pulmonary hypertension of the newborn (PPHN).
Patients and methods We realised a prospective, monocentric study from April 2012 to April 2013 in a paediatric intensive care unit. Were enrolled newborns who were less of 28 days of life, born at term or preterm, with clinical and echocardiographic signs of pulmonary hypertension. Were excluded patients with congenital heart disease.
Two echocardiographies were performed by a trained intensivist, first at the diagnostic of PPHN, second after therapeutic optimisation. Were measured : sense of the septal curve, evaluation of systolic pulmonary pressure on tricuspid regurgitation, presence and direction of ductal and atrial shunts, right and left ventricular function (with maximal aortic and pulmonary velocity and visual aspect of dilatation of right atrium and ventricle).
Results 27 newborns (median age 0 day: 0–15 days of life) were enrolled. Six died (22%). At the first echocardiography, we find that the newborn who died presented more frequently a right to left ductal shunt (83% vs. 28%,p = 0.043), a dilated right atrium (83% vs. 33%, p = 0,043) and a smallest maximal velocity in pulmonary artery (0,53 m/s vs. 0,64 m/s, non significative) than those who survived. The direction of the atrial shunt were not in correlation with death. Second echocardiography showed that the diminution of the measured pulmonary pressures isn’t a good sign of predictive good outcome.
Conclusion We have to confirm in largest studies that echocardiography can be used to estimate prognosis in PPHN.