(867) Persistent Pulmonary Hypertension of the Newborn and Extracorporeal Membrane Oxygenation in the U.S.

Introduction: Persistent pulmonary hypertension of the newborn (PPHN) is associated with significant morbidity. The objectives of our study were to describe the prevalence and mortality trends and risk factors associated with mortality in neonates with PPHN who were supported with extracorporeal membrane oxygenation (ECMO).

Methods: We examined the Kids’ Inpatient Database to identify neonates with PPHN who were supported with ECMO from 2000 through 2019. All data were weighted to estimate national prevalence. Prevalence is reported per 1,000 discharges. We used extended Mantel Haenszel chi-square for linear trend to analyze prevalence and mortality trends and binary logistic regression to analyze mortality risk factors. Regression analysis was performed on those neonates with PPHN who were supported with ECMO. All reported mortality occurred in the hospital. Inferential statistics are reported as odd ratio with 95% confidence interval and or p-value.

Results: Among a total of 24,322,418 neonates discharged in the U.S. between 2000-2019, 73,354 neonates had PPHN (3/1,000) and 3,048 with PPHN required ECMO (42/1,000). On univariate analysis, the mortality rate was higher in those who required ECMO support (30.4% vs 9.5%; 4.63: 4.17-5.13; p< 0.001). On regression analysis, the mortality was higher in neonates with PPHN who were placed on ECMO on or after hospital day 3 (1.64: 1.24-2.17) and those treated at a children’s hospital (1.52: 1.15-2.02) and lower in those who were transferred into a treating facility (0.51: 0.38-0.68). The prevalence (2/1000 to 3/1000 discharges, p< 0.001) and mortality (7.8% to 9.9%, p< 0.001) trends of PPHN increased significantly from 2000 to 2019; however, both prevalence (45/1,000 to 42/1,000; p=0.873) and mortality (30/1,000 to 25/1,000; P=0.425) trends for those who were supported with ECMO showed no significant change.

Conclusions: Although both prevalence and mortality trends for PPHN increased between 2000-2019, those same trends for neonates with PPHN who were supported with ECMO did not change. Neonates with PPHN who are supported with ECMO have significantly higher mortality than those with PPHN alone. The risk of mortality is higher in those who are placed on ECMO on or after hospital day 3.