Thiamine responsive Pulmonary Hypertension among exclusively breastfed babies –A Hospital based prospective study from southern India

Abstract

Pulmonary hypertension remains leading cause of mortality despite many advances in its management. Thiamine
deficiency is identified as a reversible cause of pulmonary hypertension in exclusively breastfed infants whose
mothers are thiamine defecient. The present study is planned to find out the reversible pulmonary hypertension
in association with thiamine deficiency.
Objectives: To study the pattern of pulmonary hypertension and its associated factors due to thiamine deficiency.
Methodology: It is hospital based study in a tertiary care hospital of tumkur. Pretested and pre designed
questionnaire was used to collect patients socio demographic data, clinical data and the data regarding
investigations and treatment and prognosis.
Results: Total of 300 babies were included in the present study after taking into consideration of all inclusion
and exclusion criteria. All the babies, 300 (100) belonged to Hindhu community. 234 (79.3%) belonged to class
3 socio economic status according to modified kuppuswamy classification. Majority 212 (70.6%) had only
primary education and 32 (10.6%) were illiterates. 88(29.3%) had come with severe gasping. 287(95.6%) of babies
had hepatomegaly and oliguria was present in 144 (48%) of babies. The majority of the infants were presented
with shock 256 (85.3%), which was managed. Repeat echo was done serially and the difference in reduction of
pulmonary pressure after administration of thiamine was statistically significant (p value <0.005) Conclusion:
Thiamine responsive pulmonary hypertension presents as an acute condition with severe respiratory distress,
vomiting in a previously well and exclusively breast fed baby. Hence clinical suspicion to recognise the symptoms
early and diagnose and mere thiamine administration is life saving and which reverses the fatal condition. Health
education to mothers and family members about food taboos related to use of polished rice to prevent deficiency
of thiamine is also important and supplementation of thiamine as prophylaxis can also be considered in the
programmes related to antenatal and postnatal care.