Persistent pulmonary hypertension of the newborn

Abstract

Persistent pulmonary hypertension of newborn (PPHN) is a consequence of failed pulmonary vascular transition at birth and leads to pulmonary hypertension (PHT) with shunting of deoxygenated blood across the ductus arteriosus (DA) and foramen ovale (FO), resulting in severe hypoxemia which could lead to life-threatening circulatory instability. PPHN is a serious event affecting both term and preterm infants. It is usually associated with diseases such as congenital diaphragmatic hernia (CDH), meconium aspiration syndrome (MAS), sepsis, neonatal pneumonia, birth asphyxia and respiratory distress syndrome (RDS). Echocardiography is used to confirm diagnosis and monitor treatment. Therapy of PPHN includes treatment of underlying causes, adequate respiratory support, and pharmacologic measures to promote pulmonary vasodilation and decrease pulmonary vascular resistance (PVR). Inhaled nitric oxide (iNO) is the mainstay therapeutic strategy and significantly reduces the need for extracorporeal membrane oxygenation (ECMO). PPHN patients are at increased risk of developing long-term neurological and pulmonary morbidities.