Persistent Pulmonary Hypertension of the Newborn: Causes, Symptoms, Risks, and Treatment
Persistent pulmonary hypertension of the newborn is not a common newborn illness, but it can cause long-term complications and serious health issues. Babies born with this condition have a circulatory system that has not transitioned normally to normal newborn circulation from fetal circulation. This is due to an increase in the pressure in the lungs. This condition results in inadequate amounts of oxygen being carried throughout the body, which may results in organs being stressed due to a lack of oxygen. This condition is typically seen within 12 hours of the baby being born. The Children’s Hospital states that about one in 700 births is affected by this condition.
Causes
The cause of newborn persistent pulmonary hypertension is typically unknown if the newborn is otherwise healthy. Certain pregnancy complications that may stress the baby in the uterus may cause this condition. These complications may include high blood pressures, giving birth after 40 weeks, maternal diabetes or anemia. Congenital conditions and certain other diseases of the infant that have some type of affect on the lungs may also occur alongside this condition. These may include meconium aspiration syndrome, severe pneumonia, hypoglycemia, anemia, infection and birth asphyxia.
Signs and Symptoms
Persistent pulmonary hypertension of the newborn may present with the following signs and symptoms:
- Rapid breathing
- Respiratory distress (including, grunting and flaring nostrils, as well as other possible signs and symptoms)
- Rapid heart rate
- Bluish coloring of the skin
A heart murmur may also be heard in some newborns. Newborns, while receiving 100 percent oxygen, may also have continuously low blood-oxygen levels.
Risks
There are risks and complications associated with this conditions. Newborns with this condition, even with prompt diagnosis and a good treatment plan, may still experience health issues associated with insufficient oxygen being taken to the body’s tissues. This may cause shock, brain hemorrhage, kidney failure, seizures, multiple organ failure, heart failure and even death in some cases. Other possible risks and complications may include:
- Bronchopulmonary dysplasia
- Seizure disorders
- Neurological deficits
- Breathing difficulties
- Developmental delay
- Feeding problems, sometimes these are long-term
- Hearing problems
Treatment
Newborns with this condition will have their treatment directed by a neonatologist and will receive his or her care in a neonatal intensive care unit. Maximizing how much oxygen the newborn is getting is the first step in treatment. A mechanical ventilator is a machine that will be used to administer this oxygen to the newborn. Other treatments to treat any additional or underlying conditions will be administered simultaneously. Giving the newborn an inhaled form of nitric oxide may help to relax contracted blood vessels, in turn increasing blood flow to the lungs for some newborns. If all other methods fail, a more intensive procedure may be necessary, known as extracorporeal membrane oxygenation. This procedure will require the infant go through major surgery and can be dangerous. This procedure involves a machine that will act as an artificial lung and heart for several days for the newborn to help their lungs recover and heal.
Resources
The Children’s Hospital. (2008). Persistent Pulmonary Hypertension of the Newborn. Retrieved on November 15, 2010 from The Children’s Hospital: https://www.thechildrenshospital.org/wellness/info/parents/20830.aspx
Merck Manuals Online Medical Library. (2009). Persistent Pulmonary Hypertension. Retrieved on November 15, 2010 from Merck Manuals Online Medical Library: https://www.merck.com/mmhe/sec23/ch264/ch264j.html