Update on PPHN: Mechanisms and treatment

Research output: Contribution to journalReview article

53 Citations (Scopus)

Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of failed circulatory adaptation at birth, seen in about 2/1000 live born infants. While it is mostly seen in term and near-term infants, it can be recognized in some premature infants with respiratory distress or bronchopulmonary dysplasia. Most commonly, PPHN is secondary to delayed or impaired relaxation of the pulmonary vasculature associated with diverse neonatal pulmonary pathologies, such as meconium aspiration syndrome, congenital diaphragmatic hernia, and respiratory distress syndrome. Gentle ventilation strategies, lung recruitment, inhaled nitric oxide, and surfactant therapy have improved outcome and reduced the need for extracorporeal membrane oxygenation (ECMO) in PPHN. Newer modalities of treatment discussed in this article include systemic and inhaled vasodilators like sildenafil, prostaglandin E1, prostacyclin, and endothelin antagonists. With prompt recognition/treatment and early referral to ECMO centers, the mortality rate for PPHN has significantly decreased. However, the risk of potential neurodevelopmental impairment warrants close follow-up after discharge for infants with PPHN.

Original languageEnglish (US)
Pages (from-to)78-91
Number of pages14
JournalSeminars in Perinatology
Volume38
Issue number2
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

Fingerprint

Persistent Fetal Circulation Syndrome
Extracorporeal Membrane Oxygenation
Lung
Meconium Aspiration Syndrome
Therapeutics
Bronchopulmonary Dysplasia
Alprostadil
Epoprostenol
Vasodilator Agents
Premature Infants
Surface-Active Agents
Ventilation
Nitric Oxide
Referral and Consultation
Parturition
Pathology
Mortality

Keywords

  • Hypoxic respiratory failure
  • Nitric oxide
  • Persistent fetal circulation
  • Pulmonary vascular resistance
  • Systemic vasodilators

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Update on PPHN : Mechanisms and treatment. / Nair, Jayasree; Lakshminrusimha, Satyanarayana.

In: Seminars in Perinatology, Vol. 38, No. 2, 01.03.2014, p. 78-91.

Research output: Contribution to journalReview article

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