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 ma nagement of 35 infants suffering from persistent pulmonary hypertensio n of the neonate (PPHN). The outcome of infants weighing more than 2 0 00 g and who also qualified for extracorporeal membrane oxygenation (E CMO) therapy on the grounds of published criteria was assessed. The ad mission incidence of patients with PPHN was 1,1%. Secondary PPHN was m ore common than primary. The overall survival rate of 69% in this stud y reflects the trend in recently reported improved survival rates of i nfants with PPHN, treated with conventional techniques. Sixteen of 28 infants weighing more than 2 000 g qualified for ECMO therapy; 4 of th em died. Had ECMO been available as an alternative mode of therapy, on ly 2 of the 4 might have been saved. The other 2 were considered to ha ve conditions incompatible with a normal quality of life. We therefore assessed the requirement for ECMO in our population to be approximate ly 0,6/1 000 live births. Although ECMO may be promising, the introduc tion of this technique in developing countries should rather be delaye d until more substantial data refute this. Because PPHN could be relat ed to a potential preventable cause in almost 80% of cases, we propose the support of more cost-effective strategies such as continuing obst etric and perinatal education programmes.