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Persistent Pulmonary Hypertension of the Newborn

Pathogenesis, Etiology, and Management

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Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is characterized by severe hypoxemia shortly after birth, absence of cyanotic congenital heart disease, marked pulmonary hypertension, and vasoreactivity with extrapulmonary right-to-left shunting of blood across the ductus arteriosus and/or foramen ovale. In utero, a number of factors determine the normally high vascular resistance in the fetal pulmonary circulation, which results in a higher pulmonary compared with systemic vascular pressure. However, abnormal conditions may arise antenatally, during, or soon after birth resulting in the failure of the pulmonary vascular resistance to normally decrease as the circulation evolves from a fetal to a postnatal state. This results in cyanosis due to right-to-left shunting of blood across normally existing cardiovascular channels (foramen ovale or ductus arteriosus) secondary to high pulmonary versus systemic pressure.

The diagnosis is made by characteristic lability in oxygenation of the infant, echocardiographic evidence of increased pulmonary pressure, with demonstrable shunts across the ductus arteriosus or foramen ovale, and the absence of cyanotic heart disease lesions.

Management of the disease includes treatment of underlying causes, sedation and analgesia, maintenance of adequate systemic blood pressure, and ventilator and pharmacologic measures to increase pulmonary vasodilatation, decrease pulmonary vascular resistance, increase blood and tissue oxygenation, and normalize blood pH. Inhaled nitric oxide has been one of the latest measures to successfully treat PPHN and significantly reduce the need for extracorporeal membrane oxygenation.

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Acknowledgments

This article was supported by grants from the National Institute of Child Health and Human Development (NICHD) [1R01HD039428001A1] and the US Environmental Protection Agency (USEPA) [RFA 2001-STAR-H1] (No. R829395-01-0). The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Wayne State University, Detroit, Michigan, USA

    Enrique M. Ostrea Jr

  2. Hutzel Women’s Hospital and Children’s Hospital of Michigan, Detroit, Michigan, USA

    Enrique M. Ostrea Jr

  3. Philippine General Hospital, Manila, Philippines

    Esterlita T. Villanueva-Uy & Herbert G. Uy

  4. University of the Philippines National Institutes of Health, Manila, Philippines

    Esterlita T. Villanueva-Uy

  5. University of the Philippines College of Medicine, Manila, Philippines

    Esterlita T. Villanueva-Uy & Herbert G. Uy

  6. Wayne State University Neonatology Program, Detroit, Michigan, USA

    Girija Natarajan

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  1. Enrique M. Ostrea Jr
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  2. Esterlita T. Villanueva-Uy
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  3. Girija Natarajan
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  4. Herbert G. Uy
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Correspondence to Enrique M. Ostrea Jr.

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Ostrea, E.M., Villanueva-Uy, E.T., Natarajan, G. et al. Persistent Pulmonary Hypertension of the Newborn. Pediatr-Drugs 8, 179–188 (2006). https://doi.org/10.2165/00148581-200608030-00004

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