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Persistent Pulmonary Hypertension:10 Years Experience in Neonatal ICU

Persistent Pulmonary Hypertension:10 Years Experience in Neonatal ICU. Fawaz Kashlan MD Consultant Neonatologist Riyadh Military Hospital. Pulmonary conditions presenting in early life with severe respiratory failure and that may result in pulmonary hypertension mimicking idiopathic PPHN.

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Persistent Pulmonary Hypertension:10 Years Experience in Neonatal ICU

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  1. Persistent Pulmonary Hypertension:10 Years Experience in Neonatal ICU Fawaz Kashlan MD Consultant Neonatologist Riyadh Military Hospital

  2. Pulmonary conditions presenting in early life with severe respiratory failure and that may result in pulmonary hypertension mimicking idiopathic PPHN. • Hyaline membrane disease (HMD) • Pneumonia • Other aspiration pneumonias • Meconium aspiration syndrome (MAS) • Congenital diaphragmatic hernia • Congenital lung cyst • Congenital cystic adenomatoid malformation • Pulmonary sequestration • Congenital lobar emphysema • Pulmonary hypoplasia • Congenital pulmonary alveolar proteinosis (SP-B deficiency) • Congenital misalignment of pulmonary vessels • Congenital pulmonary lymphangiectasis • Capillary haemangiomatosis Semin Neonato11997; 2:25-35

  3. Neonatal Services, Riyadh Military Hospital, Riyadh, Saudi Arabia • The NICU was established in 1978 and was expanded in 1982 to become 17 bed unit • In 1989, the unit was expanded again to a 27 bed • The third and last expansion was completed in 1998 to become 53 beds unit • It is considered a level 3+ unit that is fully equipped with all the necessary modern and sophisticated equipment such as high frequency oscillatory ventilators, nitric oxide…

  4. Data Collection and Analysis NICU Data Sheet is filled at time of discharge for all infants admitted to NICU by junior and sometimes senior staff. Head of NICU reviews all data sheets soon after collection before being entered into the computer Epiinfo program is used for data entry and analysis http://wwwn.cdc.gov/epiinfo/ Annual report is produced every year

  5. Number of Live Birth at Riyadh Military Hospital from 1998-2007

  6. Admissions to NICU N

  7. Total Population N

  8. PPHN Before and After 34 Weeks of Gestation N

  9. PPHN and inhaled Nitric Oxide Use in infants Born at More Than 34 Weeks of Gestation N

  10. PPHN and inhaled Nitric Oxide Use in infants Born at 34 Weeks of Gestation or less N

  11. PPHN: Patients Characteristics

  12. Clinical Outcome CoNS:

  13. Clinical Outcome

  14. Other Outcome Measures

  15. Other Outcome Measures

  16. Drug Therapy

  17. Congenital Pulmonary Disease

  18. DIAPHRAGMATIC HERNIA

  19. Congenital CNS Abnormalities

  20. Congenital SyndromesN=13/167

  21. Chromosmal SyndromesN = 10/167

  22. Congenital Renal Abnormalities

  23. Use of Inhaled Nitric Oxide

  24. Use of Inhaled Nitric Oxide in Infants born with Birth Weight of Less Than 1000 Grams

  25. Potential Benefits of iNO in the Preterm Lung • Short Term ● Pulmonary vasodilatation ● Improved V/Q matching ● Reduction in neutrophil accumulation and/or activation • Long Term ● Reduction of oxidant stress ● Improved surfactant function ● Improved alveolarization ● Reduced vascular remodeling and improved vascular growth Kinsella et al NeoReviews 2007;8;e247-e253

  26. Neonatal Cardiopulmonary failure: Meconium Aspiration Primary Pulmonary Hypertension Respiratory Distress Syndrome Pneumonia Massive Air Leak Congenital Diaphragmatic Hernia Sepsis INDICATIONS FOR ECMO Survival > 90% Survival 60 %

  27. Cost effectiveness analysis of neonatal extracorporeal membrane oxygenation based on four year results from the UK Collaborative ECMO Trial • Design: Cost effectiveness analysis based on a randomised controlled trial in which infants were individually allocated to ECMO (intervention) or conventional management (control) and then followed up to 4 years of age. • Results: Over four years, the policy of neonatal ECMO was effective at reducing known death or severe disability (relative risk = 0.64; 95% confidence interval 0.47 to 0.86; p = 0.004). • The mean additional health service cost of neonatal ECMO was £17 367 (95% confidence interval £12 072 to £22 224) per infant (£UK, 2001 prices). • Conclusions: The study provides rigorous evidence of the cost effectiveness of ECMO at four years for mature infants with severe respiratory failure.

  28. Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK • Patients and interventions: 718 neonates received ECMO for respiratory failure between 1993 and 2005. • The overall survival rate of 79.7% compared favourably with the worldwide Arch Dis Child Fetal Neonatal Ed 2009;94:F129

  29. PPHN remains a significant cause of morbidity and mortality at RMH In our NICU, PPHN is associated with high rate of congenital abnormalities. Use of Nitric Oxide is increasing in premature babies Survival and good long term outcome can improve if ECMO is available locally. Conclusion

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