Journal article
Variation in the Management of Persistent Pulmonary Hypertension of the Newborn: A Survey of Physicians in Canada, Australia, and New Zealand
American journal of perinatology, Vol.29(7), pp.519-525
08/01/2012
DOI: 10.1055/s-0032-1310523
PMID: 22495900
Abstract
Background Despite advances in management of persistent pulmonary hypertension of the newborn (PPHN), the risk of mortality and adverse neurological sequelae remains high. Characterizing variation in practices is a crucial step toward improved patient outcome.
Objective Evaluate intensive care practices in Canada and the Australia-New Zealand region (AUS-NZ).
Methods A prospective cross-sectional online survey of neonatologists was conducted. A 35-item questionnaire was developed, validated, and piloted to collect information on diagnosis, inhaled nitric oxide (iNO) practices, alternative vasodilators or cardiotropes, and echocardiography. Variation among survey respondents as well as intergroup comparison was performed.
Results Data were collected from 217 respondents. Echocardiography and arterial blood gas were the most common diagnostic tests to assess the severity of PPHN. iNO administration is more frequently scrutinized in Canada (36% versus 10% [AUS-NZ], p < 0.001). Canadian physicians reported higher use of intravenous milrinone (p < 0.001), vasopressin (p = 0.02), and inhaled prostacyclin (p = 0.02), but lower use of sildenafil (p = 0.01) for refractory pulmonary hypertension. A greater proportion of neonatologists in AUS-NZ were trained to perform echocardiography (p < 0.001) to optimize treatment decisions.
Conclusion Wide variation exists in the management of PPHN. There is a need to providemore guidance regarding principles of management in PPHN, while recognizing the dynamic nature of cardiopulmonary physiology in individual patients.
Details
- Title: Subtitle
- Variation in the Management of Persistent Pulmonary Hypertension of the Newborn: A Survey of Physicians in Canada, Australia, and New Zealand
- Creators
- Sandesh Shivananda - McMaster UniversityLucia Ahliwahlia - University of TorontoMartin Kluckow - Royal North Shore HospitalJenny Luc - University of TorontoRobert Jankov - University of TorontoPatrick McNamara - University of Toronto
- Resource Type
- Journal article
- Publication Details
- American journal of perinatology, Vol.29(7), pp.519-525
- Publisher
- Thieme Medical Publishers
- DOI
- 10.1055/s-0032-1310523
- PMID
- 22495900
- ISSN
- 0735-1631
- eISSN
- 1098-8785
- Number of pages
- 7
- Language
- English
- Date published
- 08/01/2012
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984354005802771
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