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2015 ; 1
(ä): 14
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Persistent pulmonary hypertension of the newborn
#MMPMID27057331
Sharma V
; Berkelhamer S
; Lakshminrusimha S
Matern Health Neonatol Perinatol
2015[]; 1
(ä): 14
PMID27057331
show ga
Persistent pulmonary hypertension of the newborn (PPHN) is characterized by
elevated pulmonary vascular resistance resulting in right-to-left shunting of
blood and hypoxemia. PPHN is often secondary to parenchymal lung disease (such as
meconium aspiration syndrome, pneumonia or respiratory distress syndrome) or lung
hypoplasia (with congenital diaphragmatic hernia or oligohydramnios) but can also
be idiopathic. The diagnosis of PPHN is based on clinical evidence of labile
hypoxemia often associated with differential cyanosis. The diagnosis is confirmed
by the echocardiographic demonstration of - (a) right-to-left or bidirectional
shunt at the ductus or foramen ovale and/or, (b) flattening or leftward deviation
of the interventricular septum and/or, (c) tricuspid regurgitation, and finally
(d) absence of structural heart disease. Management strategies include optimal
oxygenation, avoiding respiratory and metabolic acidosis, blood pressure
stabilization, sedation and pulmonary vasodilator therapy. Failure of these
measures would lead to consideration of extracorporeal membrane oxygenation
(ECMO); however decreased need for this rescue therapy has been documented with
advances in medical management. While trends also note improved survival,
long-term neurodevelopmental disabilities such as deafness and learning
disabilities remain a concern in many infants with severe PPHN. Funded by:
1R01HD072929-0 (SL).