Predictors of persistent pulmonary hypertension of the newborn among patients with meconium aspiration syndrome; a tertiary care hospital based cross-sectional study from eastern India

Meconium aspiration syndrome(MAS) is a common cause of respiratory distress in neonates. One third of such cases develop persistent pulmonary hypertension of the newborn(PPHN), which is also a major cause of mortality.

To evaluate characteristics in neonates with MAS associated with increased risk of development of PPHN.

This cross-sectional observational study was conducted in the neonatal unit of a tertiary level paediatric hospital of Eastern India.

Data was collected from June 2012 to June 2014. Clinical, radiological and echocardiographic parameters of patients with Meconium Aspiration Syndrome(MAS) were recorded. Patients having congenital heart diseases were excluded.

Statistical software R and MS Excel were used for statistical analysis. Comparisons between categorical variables were performed using Fischer's exact test for count data and 2-sample test for equality of proportions. In these tests, a p value less than 0.05 was considered significant.

Out of 103 MAS, 18(17.4%)had PPHN. Among MAS patients, gestational age of 38 weeks or above, presence of moderate to severe hypoxic ischemic encephalopathy, prolonged oxygen requirements, hyperexpansion in chest xray, Tricuspid Regurgitation, Patent Ductus Arteriosus, right ventricular dilatation and/or hypertrophy were significantly associated with patients with development of PPHN among MAS patients(p<0.05). Combination of characteristics like age of 38 weeks or above, with hypoxia and hyperexpansion have high sensitivity, specificity in predicting PPHN.

Combined characteristics like age of 38 weeks or above, with prolonged oxygen requirements and hyperexpansion may be used at even at centres where echocardiography facilities are not available for prediction of PPHN.