Morbidity of Persistent Pulmonary Hypertension of the Newborn in the First Year of Life

Martina A Steurer; Rebecca J Baer; Scott Oltman; Kelli K Ryckman; Sky K Feuer; Elizabeth Rogers; Roberta L Keller; Laura L Jelliffe-Pawlowski

doi:10.1016/j.jpeds.2019.06.053

Morbidity of Persistent Pulmonary Hypertension of the Newborn in the First Year of Life

J Pediatr. 2019 Oct:213:58-65.e4. doi: 10.1016/j.jpeds.2019.06.053. Epub 2019 Aug 6.

Authors

Martina A Steurer¹, Rebecca J Baer², Scott Oltman³, Kelli K Ryckman⁴, Sky K Feuer⁵, Elizabeth Rogers⁶, Roberta L Keller⁷, Laura L Jelliffe-Pawlowski³

Affiliations

¹ Department of Pediatrics, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA. Electronic address: martina.steurermuller@ucsf.edu.
² California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA.
³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
⁴ Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
⁵ California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
⁶ Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
⁷ Department of Pediatrics, University of California San Francisco, San Francisco, CA.

PMID: 31399244
DOI: 10.1016/j.jpeds.2019.06.053

Abstract

Objective: To assess postdischarge mortality and morbidity in infants diagnosed with different etiologies and severities of persistent pulmonary hypertension of the newborn (PPHN), and to identify risk factors for these adverse clinical outcomes.

Study design: This was a population-based study using an administrative dataset linking birth and death certificates, hospital discharge and readmissions records from 2005 to 2012 in California. Cases were infants ≥34 weeks' gestational age with International Classification of Diseases,9th edition, codes consistent with PPHN. The primary outcome was defined as postdischarge mortality or hospital readmission during the first year of life. Crude and adjusted risk ratio (aRR) with 95% CIs were calculated to quantify the risk for the primary outcome and to identify risk factors.

Results: Infants with PPHN (n = 7847) had an aRR of 3.5 (95% CI, 3.3-3.7) for the primary outcome compared with infants without PPHN (n = 3 974 536), and infants with only mild PPHN (n = 2477) had an aRR of 2.2 (95% CI, 2.0-2.5). Infants with congenital diaphragmatic hernia as the etiology for PPHN had an aRR of 8.2 (95% CI, 6.7-10.2) and infants with meconium aspiration syndrome had an aRR of 4.2 (95% CI, 3.7-4.6) compared with infants without PPHN. Hispanic ethnicity, small for gestational age, severe PPHN, and etiology of PPHN were risk factors for the primary outcome.

Conclusions: The postdischarge morbidity burden of infants with PPHN is large. These findings extend to infants with mild PPHN and etiologies with pulmonary vascular changes that are thought to be short term and recoverable. These data could inform counseling of parents.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
California
Female
Humans
Infant
Infant, Newborn
Male
Patient Readmission
Persistent Fetal Circulation Syndrome / complications*
Persistent Fetal Circulation Syndrome / diagnosis
Persistent Fetal Circulation Syndrome / mortality*
Retrospective Studies
Risk Factors
Socioeconomic Factors