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Update on PPHN: mechanisms and treatment
Jayasree Nair1, Satyan Lakshminrusimha2
1Center for Developmental Biology of the Lung, State University of New York, Buffalo, NY.
Seminars in Perinatology
|March 4, 2014
Summary
Persistent pulmonary hypertension of the newborn (PPHN) is a circulatory adaptation failure at birth. Improved treatments like vasodilators and ECMO have decreased mortality, but neurodevelopmental risks require follow-up.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pulmonology
Background:
- Persistent pulmonary hypertension of the newborn (PPHN) affects approximately 2 in 1000 live births.
- It involves failed circulatory adaptation at birth, often secondary to neonatal pulmonary conditions.
- While common in term infants, PPHN can occur in premature infants with respiratory issues.
Purpose of the Study:
- To review current understanding and management of PPHN.
- To discuss advancements in treatment strategies and their impact on outcomes.
- To highlight the importance of neurodevelopmental follow-up for affected infants.
Main Methods:
- Review of existing literature on PPHN.
- Discussion of established and novel therapeutic interventions.
- Analysis of treatment outcomes and long-term follow-up data.
Main Results:
- Gentle ventilation, lung recruitment, inhaled nitric oxide, and surfactant therapy have improved outcomes.
- Newer treatments include systemic and inhaled vasodilators (sildenafil, prostaglandin E1, prostacyclin, endothelin antagonists).
- Prompt recognition, treatment, and ECMO referral have significantly reduced PPHN mortality.
Conclusions:
- Mortality rates for PPHN have decreased due to improved management strategies.
- The risk of neurodevelopmental impairment necessitates ongoing monitoring post-discharge.
- Integrated care approaches are crucial for optimizing outcomes in infants with PPHN.
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