Persistent pulmonary hypertension in the newborn: pathophysiology, diagnosis and treatment
Authors:
Z. Straňák 1,2; T. Brožová 1; J. Širc 1,2; P. Korček 1,2
Authors‘ workplace:
Ústav pro péči o matku a dítě, Praha
1; 3. lékařská fakulta Univerzity Karlovy, Praha
2
Published in:
Čes-slov Neonat 2022; 28 (1): 12-17.
Category:
Reviews
Overview
Persistent pulmonary hypertension of the newborn (PPHN) is characterized by sustained elevation of pulmonary vascular resistence and decreased pulmonary blood flow leading to severe hypoxia and adverse outcome (neurological impairment, multiorgan dysfunction syndrome, death). Targeted echocardiography helps in establishing definitive diagnosis, monitoring circulation and response to therapeutic intervention. The aim of this review is to present theoretical background (basic principles of pulmonary vascular resistence), clinical manifestation, current diagnostic tools (especially echocardiographic findings) and therapy of PPHN (including newly branded vasoactive substances).
Keywords:
diagnosis – Nitric oxide – persistent pulmonary hypertension of the newborn – pulmonary vasodilation – pulmonary perfusion
Sources
1. Bendapudi P, Rao GG, Greenough A. Diagnosis and management of persistent pulmonary hypertension of the newborn. Paediatr Respir Rev 2015; 16: 157–161. doi: 10.1016/j.prrv.2015.02.001.
2. Cosa N, Costa E Jr. Inhaled pulmonary vasodilators for persistent pulmonary hypertension of the newborn: Safety issues relating to drug administration and delivery devices. Med Devices 2016; 12(9): 45–51. doi: 10.2147/MDER.S99601.
3. Dillard J, Pavlek LR, Korada S, Chen B. Worsened short-term clinical outcomes in a cohort of patients with iNO-unresponsive PPHN: A case for improving iNO responsiveness. J Perinatol 2022; 42(1): 37–44. doi: 10.1038/s41372-021-01228-x.
4. Foglia EE, te Pas AB. Effective ventilation: The most critical intervention for successful delivery room resuscitation. Semin Fetal Neonatal Med 2018; 23: 340–346. doi: 10.1016/j.siny.2018.04.001
5. Fortas F, Di Nardo M, Yousef N, et al. Life-threatening PPHN refractory to nitric oxide: Proposal for a rational therapeutic algorithm. Eur J Pediatr 2021; 180(8): 2379–2387. doi: 10.1007/ s00431-021-04138-4.
6. Gomella TL, et al. Gomella’s Neonatology 8th Edition 2021, Persistent pulmonary hypertension of the newborn.
7. Hooper SB, Te Pas AB, Lang J, van Vonderen JJ, et al. Cardiovascular transition at birth: A physiological sequence. Pediatr Res 2015; 77: 608–614. doi: 10.1038/pr.2015.21
8. Huybrechts KF, Bateman BT, Palmsten K, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA 2015; 313: 2142–2151. doi: 10.1001/ jama.2015.5605
9. James AT, Bee C, Corcoran JD, McNamara PJ, et al. Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: A case series. J Perinatol 2015; 35: 268–273. doi: 10.1038/jp.2014.208
10. Lakshminrusimha S, Mathew B, Leach CL. Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide. Semin Perinatol 2016; 40: 160–173. doi: 10.1053/j.semperi. 2015.12.004
11. Lang JAR, Pearson JT, Binder-Heschl C, et al. Increase in pulmonary blood flow at birth: Role of oxygen and lung aeration. J Physiol 2016; 594: 1389–1398. doi: 10.1113/JP270926
12. Maneenil G, Thatrimontrichai A, Janjindamai W, Dissaneevate S. Effect of bosentan therapy in persistent pulmonary hypertension of the newborn. Pediatr Neonatol 2018; 59: 58–64. doi: 10.1016/j.pedneo.2017.02.003
13. Nair J, Lakshminrusimha S. Update on PPHN: Mechanisms and treatment. Semin Perinatol 2014; 38(2): 78–91. doi: 10.1053/j. semperi.2013.11.004.
14. Rosenzweig EB, Abman SH, Adatia I, et al. Paediatric pulmonary arterial hypertension: Updates on definition, classification, diagnostics and management. Eur Respir J 2019; 53: 1801–1916. doi: 10.1183/13993003.01916-2018
15. Sharma M, Callan E, Konduri GG. Pulmonary vasodilator therapy in persistent pulmonary hypertension of the newborn. Clin Perinatol 2022; 49(1): 103–125. doi: 10.1016/j.clp.2021.11.010.
16. Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, et al. Persistent pulmonary hypertension of the newborn in late preterm and term infants in California. Pediatrics 2017; 139: e20161165. doi: 10.1542/peds.2016-1165
17. Van Marter LJ, Hernandez-Diaz S, Werler MM, et al. Nonsteroidal antiinflammatory drugs in latepregnancy and persistentpulmonary hypertension of the newborn. Pediatrics 2013; 131: 79–87. doi: 10.1542/peds.2012-0496
Labels
NeonatologyArticle was published in
Czech and Slovak Neonatology
2022 Issue 1
Most read in this issue
- Persistent pulmonary hypertension in the newborn: pathophysiology, diagnosis and treatment
- Recent methods of perfusion measurement in newborn
- Treatment of neonatal hemodynamic compromise
- Neonatal myocardial hypertrophy