Mortality rate of persistent pulmonary hypertension of the newborn before and after using KNH one-page care plan for PPHN in King Narai Hospital
Keywords:
PPHN, mortality rate, length of hospital stayAbstract
Background: Persistent Pulmonary Hypertension of the newborn (PPHN) is a severe condition with a high mortality and morbidities due to limitations in medical staff, medications and inhaled nitric oxide (iNO). In 2018, we developed a guideline for the management of PPHN to improve diagnosis and treatment. As a result, the mortality rate decreased. However, deaths from this condition continue to occur, highlighting the challenges and opportunities for improving treatment in resource-limited settings. Therefore, the KNH One-Page Care Plan for PPHN was developed in 2021, a simple, concise tool that fits on a single page for ease of use. This care plan ensures consistent management of all newborns with PPHN, providing clear reporting points for nurses to physicians and establishes uniform steps for physician-led interventions.
Objective: To investigate the mortality rate of neonates with PPHN at King Narai Hospital after the implementation of the KNH one-page care plan for PPHN.
Method: This study is a retrospective study conducted on newborns with a gestational age of 34 weeks or more, diagnosed with PPHN, between October 1, 2018, and September 30, 2024. We evaluated the effectiveness of the KNH One-Page Care Plan for PPHN at King Narai hospital in term of mortality rate, duration of mechanical ventilation, length of hospital stays and complications before and after its implementation. Additionally, we investigated the factors associated with mortality and identified the appropriate OSI (Oxygen Saturation Index) threshold for initiating pulmonary vasodilator therapy in hospitals without iNO.
Result: A total of 59 infants were included, divided into two groups: 40 infants born before the implementation of the PPHN care plan and 19 were in the group treated after its implementation. The baseline characteristics of the two groups and the causes of pulmonary hypertension were not significantly different. The mortality rate in the pre-care plan group was 27.5%, while in the post-care plan group, it was 0% (p value <0.001). The pre-care plan group had a significantly longer duration of mechanical ventilation (10 days vs. 4 days, p value <0.001). The pre-care plan group had a significantly longer hospital stay (16.9 days vs. 9.7 days, p value <0.001). Factors associated with mortality included an OSI before receiving pulmonary vasodilator treatment and administration of high-dose norepinephrine. The optimal OSI range for initiating pulmonary vasodilator therapy was found to be between 8 and 11.
Conclusion: The KNH One-Page Care Plan for PPHN effectively reduced mortality rates, duration of intubation, and hospital stays in newborns with PPHN.
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