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Persistent Pulmonary Hypertension of the Newborn (PPHN)

Persistent Pulmonary Hypertension of the Newborn (PPHN) is a defect of the lungs.

What it is

Persistent Pulmonary Hypertension of the Newborn (PPHN) occurs when a baby’s circulation system doesn’t adapt properly after birth. While in the uterus, the baby’s lungs are not a part of the circulation system because the placenta supplies the baby with oxygen through the umbilical cord. In this process, the pulmonary artery (which will carry blood from the heart to the lungs after birth) just returns the blood to the heart via a blood vessel called the ductus arteriosus.

After birth, the baby’s system should adapt to breathing air and, as the lungs expand, the ductus ateriosus should close. For babies with PPHN, the ductus arteriosus does not close, and the baby’s blood flow continues to bypass the lungs. This prevents the blood from reaching the lungs and being reoxygenated. The condition created by this defect is called persistent fetal circulation, and it causes the baby’s organs to be distressed from lack of oxygen. If left untreated, this can prove fatal.

Symptoms

  • Rapid breathing and heart rate
  • Respiratory distress, including signs such as flaring nostrils and grunting
  • Cyanosis (bluish skin tone)
  • Possibility of a heart murmur sound

Causes

Anti-depressants: Babies whose mothers take SSRI anti-depressants while pregnant are at a 6x increased risk of developing PPHN, according to research published by the New England Journal of Medicine.

Treatment

Treatment will vary depending on the extent of the PPHN and if there are other conditions present. First, the doctor will insert a tube into the baby’s windpipe to deliver oxygen to the baby’s lungs via a mechanical ventilator. This “breathes” for the baby. There are a few possible treatments, including high-frequency oscillatory ventilation, a drug called sodium bicarbonate or the administration of nitric oxide. An extracorporeal membrane oxygenation (ECMO) machine may be used for babies who are having serious heart or lung failure.

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