Predicting survival in infants with persistent pulmonary hypertension of the newborn.

Since persistent pulmonary hypertension of the newborn (PPHN) often occurs as a life-threatening illness, it would be advantageous to identify the highest-risk infants within the first 24 hours of life so that transfer to centers with extracorporeal membrane oxygenation (ECMO) or high-frequency ventilation can be facilitated. Fifty-three infants with PPHN were evaluated retrospectively. A multivariate discriminant analysis of risk factors determined that lowest pH, critical PaCO2, highest inspiratory pressure (PI), maximum ventilator rate, and 5-minute Apgar score were significantly different between the 35 survivors (66%) and the 18 infants (34%) who had died when examined within the first 24 hours of life. A clinical scoring system was designed based on these five criteria, which predicted outcome accurately in 93% of infants. A logistic regression analysis was performed as a check on these results and found that lowest pH, critical PaCO2, and PI predicted outcome with great accuracy. These results suggest that the use of these scoring systems within the first 24 hours of age may help predict outcome in infants with PPHN.