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Down's Syndrome Newborns Show Higher Incidence of Idiopathic Persistent Pulmonary Hypertension: Presented at AAP

By Bruce Sylvester

ATLANTA, GA -- October 10, 2006 -- There is a higher incidence of idiopathic persistent pulmonary hypertension of the newborn (PPHN) among newborns with Down's syndrome (DS) compared with other newborns.

The findings were reported here on October 7^th at the annual meeting of the American Academy of Pediatrics (AAP).

"The most important finding of this study is that children who have Down's syndrome have an increased risk for idiopathic persistent pulmonary hypertension compared to non-Down's Syndrome children," said lead investigator Clifford Cua, MD, pediatrician at Columbus Children's Hospital in Columbus, Ohio. "The clinical implication is that when Down's syndrome child comes into the neonatal nursery, the staff should be aware that the risk of idiopathic persistent pulmonary hypertension is higher compared to the other population."

The investigators conducted a retrospective chart review of DS patients admitted to the neonatal intensive care unit at Columbus Children's hospital over a 3-year period. They defined PPHN as a right-to-left shunt at the ductal level. They classified PPHN by treatment used: mild (supplemental oxygen), moderate (mechanical ventilation), or severe (inhaled nitric oxide).

They excluded DS patients with meconium aspiration syndrome or pulmonary space occupying lesions.

They included 58 DS subjects in the study. Twenty-four showed no PPHN, 17 were diagnosed with mild PPHN, 10 with moderate PPHN and 7 with severe PPHN.

The study showed no difference for PPHN between the 4 groups in terms of gender (males: 10, 5, 5, and 5, respectively), gestational age (in weeks: 36.4, 38.2, 36.4, and 36.4, respectively), weight (in kilograms: 2.8, 3.0, 2.4, and 3.0, respectively), or presence of congenital heart defects: 17, 10, 6, and 1, respectively.

Comparing their findings to data from the general population of neonates, they found a significantly higher rate of PPHN in DS neonates.

"Hospital staff should be aware that if the hospital course for a Down's syndrome S neonate doesn't progress as expected, they may need to be more aggressive in identifying and treating pulmonary hypertensive condition in the child," Dr. Cua added.

"Further studies are required to determine if DS patients have a possible genetic predisposition to PPHN," the authors conclude.


[Presentation title: Increased Incidence of Idiopathic Pulmonary Hypertension in Down Syndrome Neonates. Poster 2]

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