Prevalence and outcomes of persistent pulmonary hypertension of the newborn in a neonatal unit, Mankweng Hospital, Limpopo Province, South Africa

Abstract

Background. Persistent pulmonary hypertension of the newborn (PPHN) is a condition of high pulmonary arterial pressures leading to hypoxaemia and continued shunting of blood across fetal channels as a result of failure of circulatory transition at birth. Objective. To determine the prevalence and outcomes of PPHN at Mankweng Hospital, Limpopo Province, South Africa. Methods. A retrospective descriptive review of patients’ files from January 2015 to December 2017 was conducted. PPHN was diagnosed on echocardiogram. Results. During the 3-year period of the study, a total of 6 776 neonates were admitted to the neonatal unit, of whom 0.76% ( n =52) were diagnosed with PPHN. Of these, 98% (n=51) had complete information in their medical records and were further analysed. Slightly more than half (53%) were males, 59% were delivered by caesarean section, 94% had gestational age ≥37 weeks, and 39% and 14% had Apgar scores of <6 at 1 minute and 5 minutes, respectively. Most neonates (72%) had meconium aspiration as the single risk factor or in combination with other conditions. Nearly half (45.1%) of the neonates with PPHN did not survive. Gender, mode of delivery, and Apgar score were each correlated with PPHN mortality and they all showed no statistically significant association. A significantly higher proportion of non-survivors received inotropic support than survivors ( p <0.05). Conclusions. The prevalence of PPHN was found to be lower than in other low- and middle-income countries; nonetheless, the all-cause mortality rate is significantly high. The commonest aetiology of PPHN is meconium aspiration syndrome as a single underlying risk factor, and in combination with other conditions. Most neonates who needed inotropic support died.