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
Further Information

Publication History

Publication Date:
31 December 2001 (online)

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.

REFERENCES

  • 1 Siassi B, Goldberg S J, Emmanouilides G C. Persistent pulmonary vascular obstruction in newborn infants.  J Pediatr . 1971;  78 610-615
  • 2 Levin D L, Heymann M A, Kitterman J A. Persistent pulmonary hypertension of the newborn infant.  J Pediatr . 1976;  89 626-630
  • 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
  • 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
  • 5 Walsh-Sukys M C. Persistent pulmonary hypertension of the newborn: the black box revisited.  Clin Perinatol . 1993;  20 127-143
  • 6 Wegman M E. Annual summary of vital statistics, 1990.  Pediatrics . 1991;  88 1081-1092
  • 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
  • 8 Chu J, Clements J A, Cotton E. Preliminary report: the pulmonary hypoperfusion syndrome.  Pediatrics . 1965;  35 733-742
  • 9 Stahlman M, Blankenship W J, Shepard F M. Circulatory studies in clinical hyaline membrane disease.  Biol Neonate . 1972;  20 300-320
  • 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
  • 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
  • 12 Reid L M. Structure and function in pulmonary hypertension: new perceptions.  Chest . 1986;  89 279-288
  • 13 Wille L, Ulmer H E, Obladen M. Persistence of fetal circulation in the newborn.  J Perinat Med . 1981;  9 106-109
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 22 Werler M M, Pober B R, Holmes L B. Smoking and pregnancy.  Teratology . 1988;  32 473-481
  • 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
  • 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
  • 25 Merenstein G B, Weisman L E. Premature rupture of the membranes: neonatal consequences.  Semin Perinatol . 1996;  20 375-380
  • 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
  • 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
  • 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
  • 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
  • 30 Bauer C R, Stern L, Colle E. Prolonged ROM associated with a decreased incidence of RDS.  Pediatrics . 1974;  53 7-12
  • 31 Liggins G C. Premature delivery of fetal lambs infused with glucocorticoids.  J Endocr . 1969;  45 515-523
  • 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