American Journal of Pediatrics 2019; 5(3): 142-147 http://www.sciencepublishinggroup.com/j/ajp doi: 10.11648/j.ajp.20190503.20 ISSN: 2472-0887 (Print); ISSN: 2472-0909 (Online) Risk Factors of Persistent Pulmonary Hypertension of Newborn (PPHN) in Different Gestation Nargis Ara Begum 1, * , Sharmin Afroze 2 , Runa Laila 1 , Shahnaz Parvin Siddiqua 1 , Mohammad Toyobur Rahaman 1 1 Department of Neonatology, United Hospital Limited, Dhaka, Bangladesh 2 Department of Neonatology, Dr. M R Khan Shishu (Children) Hospital & Institute of Child Health, Dhaka, Bangladesh Email address: * Corresponding author To cite this article: Nargis Ara Begum, Sharmin Afroze, Runa Laila, Shahnaz Parvin Siddiqua, Mohammad Toyobur Rahaman. Risk Factors of Persistent Pulmonary Hypertension of Newborn (PPHN) in Different Gestation. American Journal of Pediatrics. Vol. 5, No. 3, 2019, pp. 142-147. doi: 10.11648/j.ajp.20190503.20 Received: June 14, 2019; Accepted: July 15, 2019; Published: August 12, 2019 Abstract: Persistent Pulmonary Hypertension of Newborn (PPHN) is a critical neonatal problem resulting from failed circulatory adaptation at birth, associated with substantial perinatal morbidity as well as mortality. Despite significant advancement in management of PPHN across the globe, it still remains a challenge especially in developing countries like Bangladesh. So the study was conducted over five years in United Hospital Limited to determine the risk factors of PPHN in relation to gestational age. All PPHN cases diagnosed by echocardiogram were included in the study and divided into term (≥ 37 wks) and preterm group (<37 wks). Among 157 of PPHN cases, 66% were male, 59% were preterm, mean gestational age and birth weight were 35.6 ± 2.54 wks and 2598.22 ± 760.353 gm respectively. Maternal asthma (p 0.01) and pre-eclamptic toxemia (p 0.010) were significant risk factors for persistent pulmonary hypertension of newborn. PPHN was found high in neonates with Respiratory Distress Syndrome (p 0.000) and Meconium Aspiration Syndrome (p 0.000). Most (96%) of the babies were discharged to home. Keywords: Persistent Pulmonary Hypertension, Risk Factors, Persistent Fetal Circulation 1. Introduction Persistent Pulmonary Hypertension of Newborn (PPHN) is a condition characterized by marked pulmonary hypertension resulting from elevated pulmonary vascular resistance(PVR) and altered pulmonary vaso-reactivity, that leads to right to left extra-pulmonary shunting of blood across the foramen ovale and the ductus arteriosus [1]. Though PPHN is less common causes of respiratory distress in newborns but it has significant impact on morbidity and mortality [2]. PPHN occurs in 1-2 infants/1000 live births [3] and mortality rate ranging from 4–33% [4]. High pulmonary pressure is normal and necessary state for the fetus. In fetal life, most of the right ventricular output crosses the ductus arteriosus to the aorta and only 5-10% of the combined ventricular output is directed to the pulmonary vascular bed. This high pulmonary vascular tone in fetus is due to increased pulmonary vasoconstrictors (low oxygen tension, endothelin-1, leukotriene’s and Rho kinase) and decreased vasodilators (prostacyclin and nitric oxide) [5]. In some newborns, the normal decrease in pulmonary vascular tone does not occur and eventually results in PPHN. Inadequate pulmonary perfusion leads to refractory hypoxemia, respiratory distress and acidosis [6]. There are several maternal risk factors associated with the occurrence of PPHN which includes the following: maternal asthma, maternal diabetes, pre- conception maternal overweight, chorioamnionitis, antenatal exposure to selective serotonin reuptake inhibitors and non- steroidal anti-inflammatory drugs, infection (mainly by Group B Streptococcus) and cesarean section etc. Important