Management of neonatal pulmonary hypertension-a survey of neonatal intensive care units in India

BMC Pediatrics

Table 3 Management strategies

Characteristic	Responses N	Percentage %
Pre-ductal oxygen saturation targets (n = 118)
90–94%	48	40.7
> 95%	29	24.6
92–96%	24	20.3
88–94%	17	14.4
Target PaO2 in the acute phase (n = 118)
30–50 mmHg	03	2.5
50–70 mmHg	85	72
70–100 mmHg	28	23.7
100–120 mmHg	02	1.8
Commonly used management strategies (n = 118)
Pulmonary vasodilators	104	88.1
Inotropes/ cardiotropes	101	85.6
Conventional ventilation	81	68.6
High frequency ventilation	70	59.3
Surfactant therapy	69	58.5
ECMO	0	0
Indication for usage of pulmonary vasodilator therapy (n = 118)
Echocardiographic features of PPHN	54	45.8
High FiO2 requirement	46	39
High oxygenation index	18	15.2
Most preferred indication for starting iNO therapy (n = 29)^a
OI > 20 ppm	13	44.8
OI > 25 ppm	5	17.2
OI > 15 ppm	4	13.8
Failure of high frequency ventilation	5	17.2
Functional echocardiography	1	3.5
Arterial blood gas	1	3.5
Starting dose of iNO (n = 29)^a
20 ppm	20	69
5–20 ppm	8	27.6
> 20 ppm	1	3.4
Maximum dose of iNO (n = 29)^a
20 ppm	16	55.2
20–40 ppm	12	41.4
> 40 ppm	1	3.4
Average duration of iNO (n = 29)^a
< 12 h	02	6.9
12–24 h	08	27.6
24–48 h	12	41.4
> 48 h	07	24.1
Criteria for weaning off iNO (n = 29)^a
Rule of 60^b	17	58.7
After FiO2 requirements decrease to half of initial	07	24.1
After TnEcho shows resolution of pulmonary hypertension	04	13.8
After pre-post ductal saturation difference disappears	01	3.4
Percentage of non-responders to iNO (n = 29)^a
< 10%	10	34.5
10–20%	08	27.6
20–40%	07	24.1
40–50%	04	13.8

Abbreviations: PaO2 arterial oxygen pressure, ECMO extracorporeal membrane oxygenation, PPHN persistent pulmonary hypertension of newborn, FiO2 fraction of inspired oxygen, iNO inhaled nitric oxide, OI oxygenation index, ppm parts per million, TnECHO targeted neonatal echocardiography
^aNumber of responses received for that question
^bInspired oxygen below 60%, Pa O2≥60 mmHg for 60 min

ISSN: 1471-2431