Mohammed Nasir, Mihiretu Ahmed
Hawassa University. Bushulo Mother to Child Center.
Ethiopia
BioMedical Central Pediatrics
BMC Pediatr 2026;
DOI: 10.1186/s12887-026-06904-5
Abstract
Introduction: Persistent pulmonary hypertension of the newborn (PPHN) is a failure of normal fetal-to-neonatal circulatory transition. Evidence from low-resource settings remains limited. This study evaluated clinical characteristics, treatment outcomes, mortality predictors, and time to clinical and echocardiographic resolution among neonates with PPHN at a tertiary hospital in Hawassa, Ethiopia.
Methodology: A retrospective follow-up study was conducted from July 1 to September 30, 2025, among 115 neonates admitted to the NICU of Hawassa University Comprehensive Specialized Hospital with PPHN diagnosed between June 2022 and June 2025. Clinical profiles were described using frequencies and percentages. Kaplan–Meier survival analysis and log-rank tests compared
survival between severe and non-severe PPHN. Cox proportional hazards modeling identified predictors of mortality. Mann–Whitney U tests assessed differences in time to clinical and echocardiographic resolution.
Results: Of 115 neonates, 26.1% were delivered by cesarean section, 55.7% were term, and 51.3% had normal birth weight. Common etiologies included early onset neonatal sepsis (74.8%), meconium aspiration syndrome (55.7%), and respiratory distress syndrome (30.4%). Severe PPHN, initially managed with sildenafil, was present in 89.6% of neonates; 20.9% required a saline bolus, and 20% required inotropic support. Over a median follow-up of 38 days (IQR: 8–45), mortality was 28.7%. Predictors of mortality included perinatal asphyxia (AHR: 2.4; 95% CI: 1.4–3.3), acute kidney injury (AHR: 1.9; 95% CI: 1.3–2.9), and need for inotropic support (AHR: 1.8; 95% CI: 1.3–2.5). Survival at 7, 30, and 60 days was lower in severe PPHN (78.8%, 60%, 60%) than in non-severe cases (100%, 97.1%, 97.1%; p < 0.001). Clinical resolution occurred earlier than echocardiographic resolution, with medians of 28 vs. 33 days overall; non-severe cases resolved faster clinically (8 vs. 28 days) and echocardiographically (9 vs. 33 days; p < 0.001).
Conclusion: Within the study cohort, PPHN was most prevalent among term neonates, those with normal birth weight, and those delivered by cesarean section. Sepsis, meconium aspiration, and respiratory distress syndrome were common causes. Mortality was 28.7%, with perinatal asphyxia, acute kidney injury, and inotropic support identified as independent predictors. Early management and echocardiographic follow-up are essential, as echocardiographic resolution occurs later than clinical improvement.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes