Persistent pulmonary hypertension of the neonate in a developing country--does extracorporeal membrane oxygenation have a role to play?

A retrospective study was undertaken of survival after conventional management of 35 infants suffering from persistent pulmonary hypertension of the neonate (PPHN). The outcome of infants weighing more than 2,000 g and who also qualified for extracorporeal membrane oxygenation (ECMO) therapy on the grounds of published criteria was assessed. The admission incidence of patients with PPHN was 1.1%. Secondary PPHN was more common than primary. The overall survival rate of 69% in this study reflects the trend in recently reported improved survival rates of infants with PPHN, treated with conventional techniques. Sixteen of 28 infants weighing more than 2,000 g qualified for ECMO therapy; 4 of them died. Had ECMO been available as an alternative mode of therapy, only 2 of the 4 might have been saved. The other 2 were considered to have conditions incompatible with a normal quality of life. We therefore assessed the requirement for ECMO in our population to be approximately 0.6/1,000 live births. Although ECMO may be promising, the introduction of this technique in developing countries should rather be delayed until more substantial data refute this. Because PPHN could be related to a potential preventable cause in almost 80% of cases, we propose the support of more cost-effective strategies such as continuing obstetric and perinatal education programmes.