Persistent Pulmonary Hypertension of the Newborn (PPHN)

Overview

• Definition: PPHN is a serious breathing issue in newborns where the pulmonary arteries don’t open enough, limiting oxygen to the brain and organs.
• Life-Threatening: Can occur shortly after birth, requiring immediate medical attention.
• Occurrence: 2 out of every 1,000 live births, more common in full-term and late-term babies.

Symptoms

• Breathing problems: rapid/slow breathing, grunting, retracting.
• Rapid heart rate.
• Cyanosis (bluish skin color).
• Low blood pressure (hypotension).
• Low blood oxygen levels.
• Abnormal heart sounds (heart murmur).

Causes and Risk Factors

• Unknown Exact Cause: Could be due to underdeveloped lung blood vessels or failure to adapt after birth.
• Risk Factors Include:
  • Meconium aspiration.
  • Infections like pneumonia.
  • Respiratory distress syndrome.
  • Birth asphyxia.
  • Diaphragmatic hernia.
  • Congenital heart and lung abnormalities.
  • Certain medications during pregnancy (NSAIDs, SSRIs).

Long-term Effects

• Up to 25% may experience:
  • Developmental delays.
  • Hearing issues (e.g., deafness).
  • Learning disabilities.
  • Reduced physical activity ability.

Diagnosis

• Tests Include:
  • Complete blood count (CBC).
  • Pulse oximetry.
  • Arterial blood gas (ABG).
  • Chest X-ray.
  • Echocardiogram.
  • Head ultrasound.
  • Serum electrolyte tests.
  • Lumbar puncture.

Management and Treatment

• Objectives: Increase oxygen to prevent complications.
• Treatment Options:
  • Oxygen therapy.
  • Mechanical ventilation.
  • Blood pressure support.
  • Nitric oxide to dilate lung blood vessels.
  • High-frequency oscillatory ventilation.
  • ECMO for severe cases.

Prevention

• Not Preventable: Exact cause unknown.
• Risk Reduction: Avoid certain medications during pregnancy.

Prognosis

• Recovery Time: Usually resolves in 1-2 weeks, but some cases take longer.
• Survival Rate: 7-10% mortality; 25% may face lasting effects.
• Living With:
  • Follow-up appointments are crucial.
  • Immediate medical attention if symptoms arise (fever, poor feeding, breathing issues).

Advice from Cleveland Clinic

• Emotional support and education about PPHN are vital for parents.
• Cleveland Clinic provides quick diagnosis and treatment.