PDF herunterladen
Am J Perinatol 2001; 18(2): 087-092
DOI: 10.1055/s-2001-13638
ORIGINAL ARTICLES

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Neonatal-Perinatal Risk Factors for the Development of Persistent Pulmonary Hypertension of the Newborn in Preterm Newborns

Jonathan K. Muraskas1 , Linda J. Juretschke2 , Marc G. Weiss1 , Monika Bhola1 , Richard E. Besinger3
  • 1Division of Neonatology, Loyola University Medical Center, Maywood, Illinois
  • 2Department of Nursing, Ronald McDonald Children's Hospital, Loyola University Medical Center, Maywood, Illinois
  • 3Division of Maternal-Fetal Medicine, Loyola University Medical Center, Maywood, Illinois
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Dezember 2001 (online)

Auch verfügbar auf
    Lizenzen und Reprints

ABSTRACT

There is a long-held belief that preterm newborns lack sufficient arteriolar musculature to maintain a prolonged elevated pulmonary vascular resistance (PVR) after birth. Net ductal flow is thought to be minimal, with the developing pulmonary circulation incapable of significant vasoconstriction. We identified retrospectively 15 premature newborns over a 10-year period weighing ≤1500 g and with a gestational age of ≤30 weeks with documented persistent pulmonary hypertension of the newborn (PPHN) in the first 24 hours after birth. We matched 36 newborns of similar weight and gestation with no clinical evidence of shunting. The control group weaned to an FiO2 ≤0.50 by 12 hours after birth. Despite similar gestational ages, the PPHN group (n = 15) had significantly higher birth weights than the control group (n = 36). The duration of ruptured membranes, maternal tobacco use, and use of antenatal steroids were significantly higher in the PPHN group. We speculate that these three factors might act in a synergistic relationship with which to accelerate pulmonary vascular smooth muscle development in premature newborns.

KEYWORD

Persistent pulmonary hypertension of the newborn - pulmonary vascular resistance - antenatal steroids - prolonged premature rupture of the membranes - maternal tobacco use

REFERENCES

  • 1 Siassi B, Goldberg S J, Emmanouilides G C. Persistent pulmonary vascular obstruction in newborn infants.  J Pediatr . 1971;  78 610-615
    PubMedGoogle Scholar
  • 2 Levin D L, Heymann M A, Kitterman J A. Persistent pulmonary hypertension of the newborn infant.  J Pediatr . 1976;  89 626-630
    PubMedGoogle Scholar
  • 3 Gersony W M, Duc C V, Sinclair J D. ``PFC'' syndrome (Persistence of the Fetal Circulation). Abstract of the 42nd Scientific Sessions.  Circulation . 1969;  40(suppl) 87
    PubMedGoogle Scholar
  • 4 Hageman J R, Adams M A, Gardner T H. Persistent pulmonary hypertension of the newborn: trends in incidence, diagnosis and management.  Am J Dis Child . 1984;  138 592-595
    PubMedGoogle Scholar
  • 5 Walsh-Sukys M C. Persistent pulmonary hypertension of the newborn: the black box revisited.  Clin Perinatol . 1993;  20 127-143
    PubMedGoogle Scholar
  • 6 Wegman M E. Annual summary of vital statistics, 1990.  Pediatrics . 1991;  88 1081-1092
    PubMedGoogle Scholar
  • 7 Walther F J, Benders M J, Leighton J O. Persistent pulmonary hypertension in premature neonates with severe respiratory distress syndrome.  Pediatrics . 1992;  90 899-904
    PubMedGoogle Scholar
  • 8 Chu J, Clements J A, Cotton E. Preliminary report: the pulmonary hypoperfusion syndrome.  Pediatrics . 1965;  35 733-742
    PubMedGoogle Scholar
  • 9 Stahlman M, Blankenship W J, Shepard F M. Circulatory studies in clinical hyaline membrane disease.  Biol Neonate . 1972;  20 300-320
    CrossrefPubMedGoogle Scholar
  • 10 Hansen T N, Corbet A J, Kenny J D, Courtney J D, Rudolph A J. Effects of oxygen and constant positive pressure breathing on aADCO2 in hyaline membrane disease.  Pediatr Res . 1979;  13 1167-1171
    PubMedGoogle Scholar
  • 11 Kinsella J P, Abman S H. Recent developments in the pathophysiology and treatment of persistent pulmonary hypertension of the newborn.  J Pediatr . 1995;  126 853-864
    PubMedGoogle Scholar
  • 12 Reid L M. Structure and function in pulmonary hypertension: new perceptions.  Chest . 1986;  89 279-288
    PubMedGoogle Scholar
  • 13 Wille L, Ulmer H E, Obladen M. Persistence of fetal circulation in the newborn.  J Perinat Med . 1981;  9 106-109
    PubMedGoogle Scholar
  • 14 Johnson G L, Cunningham M D, Desai N S, Cottrill C M, Noonan J A. Echocardiography in hypoxemic neonatal pulmonary disease.  J Pediatr . 1980;  96 716-720
    CrossrefPubMedGoogle Scholar
  • 15 Randala M, Eronen M, Andersson S, Pohjavuori M, Pesonen E. Pulmonary artery pressure in term and preterm neonates.  Acta Paediatr . 1996;  85 1344-1347
    CrossrefPubMedGoogle Scholar
  • 16 Wu T J, Teng R J, Tsou K I. Persistent pulmonary hypertension treated with magnesium sulfate in premature neonates.  Pediatrics . 1995;  96 472-474
    PubMedGoogle Scholar
  • 17 DeJaegere A P, van den Anker N J. Endotracheal instillation of prostacyclin in preterm infants with persistent pulmonary hypertension.  Eur Respir J . 1998;  12 932-934
    CrossrefPubMedGoogle Scholar
  • 18 Soditt V, Aring C, Groneck P. Improvement of oxygenation induced by aerosolized prostacyclin in a preterm infant with persistent pulmonary hypertension of the newborn.  Intensive Care Med . 1997;  23 1275-1278
    CrossrefPubMedGoogle Scholar
  • 19 Parida S K, Baker S, Kuhn R, Desai N, Pauly T H. Endotracheal tolazoline administration in neonates with persistent pulmonary hypertension.  J Perinatol . 1997;  17 461-464
    PubMedGoogle Scholar
  • 20 Abman S H, Kinsella J P, Schaffer M S, Wilkening R B. Inhaled nitric oxide in the management of a premature newborn with severe respiratory distress and pulmonary hypertension.  Pediatrics . 1993;  92 606-609
    PubMedGoogle Scholar
  • 21 Klesges L M, Murray D M, Brown J E, Cliver S P, Goldenberg R L. Relations of cigarette smoking and dietary antioxidants with placental calcification.  Am J Epidemiol . 1998;  147 127-135
    PubMedGoogle Scholar
  • 22 Werler M M, Pober B R, Holmes L B. Smoking and pregnancy.  Teratology . 1988;  32 473-481
    PubMedGoogle Scholar
  • 23 Bearer C, Emerson R K, O'Riordan M A, Roitman E, Shackleton C. Maternal tobacco smoke exposure and persistent pulmonary hypertension of the newborn.  Environ Health Perspect . 1997;  105 202-206
    PubMedGoogle Scholar
  • 24 Vitoratos N, Botsis D, Grigoriou O, Bettas P, Papoulias I, Zourlas P A. Smoking and preterm labor.  Clin Exp Obstet Gynecol . 1997;  24 220-222
    PubMedGoogle Scholar
  • 25 Merenstein G B, Weisman L E. Premature rupture of the membranes: neonatal consequences.  Semin Perinatol . 1996;  20 375-380
    CrossrefPubMedGoogle Scholar
  • 26 Blackman L R, Alges L S, Crenshaw C. Fetal and neonatal outcomes associated with premature rupture of the membranes.  Clin Obstet Gynecol . 1986;  29 279-815
    PubMedGoogle Scholar
  • 27 Thibeault D W, Kilbride H K. Increased acinar arterial wall muscle in preterm infants with PROM and pulmonary hypoplasia.  Am J Perinatol . 1997;  14 457-460
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 28 Alden E R, Mandelkan T, Woodram B S. Morbidity and mortality of infants weighing less than 1000 g in an intensive care nursery.  Pediatrics . 1972;  50 40-49
    PubMedGoogle Scholar
  • 29 Yoon J T, Harper R G. Observation on the relationship between premature ROM and the development of idiopathic RDS.  Pediatrics . 1973;  52 161-168
    PubMedGoogle Scholar
  • 30 Bauer C R, Stern L, Colle E. Prolonged ROM associated with a decreased incidence of RDS.  Pediatrics . 1974;  53 7-12
    PubMedGoogle Scholar
  • 31 Liggins G C. Premature delivery of fetal lambs infused with glucocorticoids.  J Endocr . 1969;  45 515-523
    CrossrefPubMedGoogle Scholar
  • 32 Ballard P L, Ballard R A. Scientific basis of therapeutic reasons for use of antenatal glucocorticoids.  Am J Obstet Gynecol . 1995;  173 254-262
    CrossrefPubMedGoogle Scholar