[Pulmonary hypertension in pediatric and neonatal intensive care unit. Part II: diagnosis and treatment]

In pediatric and neonate intensive care units, the most common causes of pulmonary hypertension (PHT) are congenital cardiac malformations, whether operated or not, respiratory diseases leading to acute or chronic hypoxemia, and left heart failure. In children and neonates, ultrasound is now the reference exam to detect and/or diagnose a PHT. Most often, the changes in morphology of the right ventricle and/or septal kinetics provide the diagnosis; the presence of valvular regurgitation (tricuspid, pulmonary) as well as cardiac or extrapulmonary shunts enables quantifying pulmonary arterial pressures with the Doppler flow. Monitoring the factors favoring PHT (hypoxemia, acidosis, hypercapnia, stress, etc.), oxygenation, ventilation, and systemic hemodynamics is crucial before planning specific treatment. Nitric oxide is the first treatment attempted in the ICU; other treatments (prostacyclin, sildenafil, bosentan) can be used in severe PHT, but cautiously because their usefulness in children has only been suggested in small case series.