Persistent Pulmonary Hypertension Of The Newborn

Persistent Pulmonary Hypertension of the Newborn (PPHN) is a condition in which infants cannot get enough oxygen to breathe.

An infant doesn't breathe like adults until after birth since they do not have oxygen and carbon dioxide circulation while still in the womb. After being born, the fetus only needs a small amount of blood, and the blood should ideally circulate away from the lungs. However, when PPHN occurs, the system present from in-the-womb doesn’t change, and the lungs bypass a large amount of blood, causing the blood pressure inside the lungs to remain high.  

What are the Symptoms of Persistent Pulmonary Hypertension in the Newborn?

The baby will have the following characteristics at birth or within the first few hours after birth:

• An increased heart rate and rapid breathing
• During hard and fast breathing, the skin between the ribs retracts- it goes up and down
• Blood pressure is low
• The sound of moaning or grunting when breathing
• Blue lips and mouth
• Oxygen saturation is low even after getting oxygen

Some or all of these symptoms may be present. There may be similarities between the symptoms of PPHN and those of other diseases. 

What Can Cause Persistent Pulmonary Hypertension of the Newborn?

Blood vessel problems in the lungs can cause PPHN. There are cases in which they are underdeveloped, while there are others in which they are abnormally developed.  There is also a possibility that the vessels have difficulty using the outside air. It is often difficult to determine which of these causes the problem right away.

PPHN can occur when the blood vessels in the infant's lungs are not fully opened. Causes include:

• The lungs cannot handle the amount of blood. 
• The brain and body are not getting enough oxygen.
• The blood vessels in the lungs are under too much pressure. A baby's heart and lungs can be damaged by high blood pressure (pulmonary hypertension).

Risk factors associated with Persistent Pulmonary Hypertension of the Newborn

There is no known cause of persistent pulmonary hypertension in newborns. The following factors increase the risk for babies:

• Before or during birth, there may be a lack of oxygen- which can increase the risk of getting PPHN in a baby.
• PPHN affects infants with infections, especially infants whose infections are in their lungs or blood, e.g. pneumonia.
• Infants whose mothers took certain medicines late in pregnancy are more inclined to develop PPHN. 
• Abnormal development of the heart or lungs in a baby can also lead to PPHN.
• If Diabetes Mellitus was present in the mother at birth, PPHN may occur.  

Treatment for Persistent Pulmonary Hypertension of the Newborn 

During treatment, oxygen levels need to be increased in the blood, blood vessels in the infant's lungs should be opened, and blood pressure should remain normal. The process involves the use of oxygen, medicine, and fluids.

Oxygen is often provided with: 

• A nasal cannula attaches oxygen to the nostrils via a small tube.
• Air or oxygen is gently pushed into the lungs with Continuous Positive Air Pressure (CPAP).
• High-frequency Oscillation Ventilation is a special type of ventilator that delivers rapid and small bursts of oxygen through a tube.
• When a child cannot breathe independently, ventilation is necessary. They have a tube placed in their throat, pushing the air into the lungs. 

Infusions of fluids and medications are administered via intravenous catheters (IV). The IV tube is placed in either the umbilical cord or in one of the limbs. The types of medicines given are Blood pressure medicine, antibiotics, sedatives, and surfactants (to help the lungs work better). 

Very severe PPHN may need to be treated with either Nitric oxide, which helps blow up the vessels in the lungs, or by using Extracorporeal membrane oxygenation (ECMO), an external machine that passes air through the child's lung manually.

Persistent pulmonary hypertension in the newborn affects one out of every 1,250 infants. The most common cases occur in infants born at full-term or infants born after their due dates. If you see any of the symptoms (mentioned above) in your child, take them to your healthcare provider.

Request an appointment at Apollo Cradle, Amritsar - Abadi Court Road. Call 1860-500-4424 to book an appointment.