ĐẶC ĐIỂM ĐIỀU TRỊ CAO ÁP PHỔI TỒN TẠI Ở TRẺ SƠ SINH TẠI KHOA HỒI SỨC SƠ SINH BỆNH VIỆN NHI ĐỒNG 2

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN) is a rare condition but has high mortality and morbidity rates. Inhaled NO is the recommended first-line method for treating PPHN. However, due to the high cost of NO, many treatment facilities in low-and middle-income countries, like Vietnam, do not have access to it. Objectives: To investigate the treatment characteristics of persistent pulmonary hypertension (PPHN), the rate of different pulmonary vasodilators used, the efficacy of initial pulmonary vasodilators, and the survival and death rates in the treatment of PPHN. Method: This is a prospective follow-up study of newborns with PPHN treated at the Neonatal Intensive Care Unit (NICU) of Children's Hospital 2 from July 1, 2022 to June 30, 2023.Results: The study screened 395 children with respiratory failure admitted to the hospital within 72 hours of life. Among them, echocardiography showed 57 cases of PPHN. Excluding 15 cases with congenital heart disease and severe congenital anomalies, 42 cases met the inclusion criteria. Meconium aspiration syndrome was the most common cause, accounting for one-third of the cases (35.7%). The usage rates of different pulmonary vasodilators were as follows: sildenafil (90.5%), milrinone (78.6%), magnesium sulfate (19%), bosentan (19%), and iNO (14.3%). Sildenafil was used as the initial treatment in 67.5% of cases and milrinone in 32.5% of cases. After 24 hours of treatment, 12 out of 27 infants (44.4%) in the sildenafil group and 8 out of 13 infants (61.5%) in the milrinone group showed a positive response. Overall, 71.4% of the infants were successfully weaned off mechanical ventilation and discharged from the NICU. The overall mortality rate was 28.6%, with PPHN-associated mortality at 21.4%.Conclusion: PPHN can be caused by various causes and has a high mortality rate.  Sildenafil and milrinone are the most used non-iNO pulmonary vasodilators. The efficacy of non-iNO pulmonary ranges from 44% to 62%. Further research is needed to evaluate the efficacy and safety of these non-iNO pulmonary vasodilators.