PERSISTENT PULMONARY-HYPERTENSION OF THE NEONATE AND ASYMMETRIC GROWTH RESTRICTION

Objective: To evaluate the possible associations between persistent pu lmonary hypertension oi: the neonate, need for extra-corporeal membran ous oxygenation, small for gestational age (SGA), and low ponderal ind ex for gestational age in infants with persistent pulmonary hypertensi on of the neonate and in matched controls. Methods: Eighty-six infants with persistent pulmonary hypertension of the neonate delivered from 1991 to 1994 at our hospital were matched with 430 contemporaneous con trol singleton neonates. Birth weight and ponderal indices (100 x weig ht/length(3)) less than the tenth percentile for gestational age and g ender were defined as SGA and low ponderal index, respectively We asse ssed associations between these markers, the presence of persistent pu lmonary hypertension of the neonate, and rite need for extracorporeal membranous oxygenation. Results: Low ponderal index was associated wit h persistent pulmonary hypertension of the neonate (odds ratio [OR] 5. 4), whereas SGA was not. Low Ponderal index (OR 4.0) was an independen t correlate of persistent pulmonary hypertension of the neonate after adjustment with logistic regression for 5-minute Apgar scores less tha n 7, umbilical arterial pH less than 7.10, and presence of meconium. L ow ponderal index was associated with need for extracorporeal membrano us oxygenation in neonates with persistent pulmonary hypertension (P < .001). Conclusion: Fetal developmental events may significantly affec t neonatal pulmonary status. Diminished neonatal nutritional status, a s measured by low ponderal index for gestational age, is associated wi th increased risk of persistent pulmonary hypertension of the neonate and severity of the disease process. (C) 1998 by The American College of Obstetricians and Gynecologists.