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National survey of diagnosis and management of persistent pulmonary hypertension of the newborn.

The diagnosis and management of persistent pulmonary hypertension of the newborn remains controversial. A national survey was performed to analyze recent trends in the incidence, diagnosis, management, and survival of patients with persistent pulmonary hypertension of the neonate. Sixty-six institutions from all geographical regions responded. The overall admission incidence was 3.9% +/- 2.6%. Secondary persistent pulmonary hypertension of the neonate was more common than primary. Unexplained hypoxemia, ductal level right-to-left shunting, echocardiography, and a positive response to hyperventilation were all used frequently (in at least 79% of institutions) to diagnose persistent pulmonary hypertension of the neonate. The majority of institutions considered a positive response to hyperventilation to be determined by an increase of PaO2 by 30 mm Hg with a concomitant decrease in PaCO2 to 25 mm Hg. Approximately 70% of institutions use varying ventilator techniques (ie, with or without hyperventilation), but the majority use hyperventilation predominantly. Almost all (greater than 90%) institutions used muscle paralytic agents and pulmonary vasodilators. Tolazoline was the first choice of pulmonary vasodilator therapy. The overall survival rate of persistent pulmonary hypertension of the newborn was 77.4% +/- 13.4%. Survival rate did not differ between different geographic areas of the country. There was a trend noted for improved survival with less use of muscle paralyzing agents. Yet despite varying treatment protocols, survival rates are improving.