Persistent pulmonary hypertension of the newborn: causes, effects, diagnosis and treatments.

Persistent hypertension of the newborn, or PPHN, is a serious and life-threatening condition that can cause a newborn not to receive enough oxygen post-birth. 

In their mother’s womb, babies get all the oxygen from the pregnant women through the placenta. Until birth, the blood vessels going to the baby’s lungs (pulmonary vessels) are shut down and only open when the baby takes their first breath. After birth, the blood should be transported through the baby’s lungs and pick up oxygen. 

In PPHN, the blood vessels to the baby’s lungs do not open completely.

Effects of PPHN 

Closed blood vessels after birth causes:

• When too much blood bypasses the lungs, there is insufficient oxygen to the brain and body.
• High pressure in blood vessels to the lungs. This high blood pressure is called pulmonary hypertension and may hurt the baby’s lungs and heart.

Signs and symptoms 

Below are the signs and symptoms at birth or within the first hours after birth;

• Fast heart rate and fast breathing 
• Moaning or grunting when taking breaths
• Retractions: the skin under and between the ribs gets pulled during quick and hard breathing 
• Cyanosis, the blue colour of the lips and around the mouth
• A low amount of oxygen carried in the blood 
• Low blood pressure 
• Lower oxygen saturation in the infant’s baby legs than in the right legs.

Causes

The causes of PPHN are unknown. “Back pressure” can be caused as a result of the failure of lung vessels to open enough. Hence, the heart is forced to keep using the fetal or pre-birth circulation pathways. 

Diagnosis 

The following tests are done to diagnose PPHN 

• X-rays 
• Echocardiogram 
• Blood tests 
• Pulse oximeter 

Treatment 

Treatment for PPHN aims to increase oxygen levels in the baby’s blood, open blood vessels in the lungs and maintain normal blood pressure. The following treatments are done to achieve these goals.

Your baby might be given oxygen by:

• Nasal Cannula: A small tube with medical prongs inserted in the nostrils for oxygen supply.
• Continuous positive air pressure for CPAP: this device pushes oxygen or air into the baby’s lungs. 
• Ventilator: This machine breathes for your infant until the newborn can breathe independently. 
• High-frequency oscillation ventilation: a particular type of ventilator that delivers fast, short bursts of oxygen through a breathing tube.

Fluids and medicines are given through an IV, which could be placed in either 

• The umbilical cord called an umbilical IV
• An arm or leg 

Types of medicines given are:

• Blood pressure medicine 
• Antibiotics 
• Sedatives 
• Surfactant 

Risk factors for persistent pulmonary hypertension in newborns

Although the cause of persistent pulmonary hypertension in the newborn is unknown, certain factors may increase the infant’s risk of developing this condition. 

• Meconium aspiration: When the newborn/infant breathes its sticky poop (meconium) 
• Infection 
• Lack of oxygen before or during birth
• Respiratory distress syndrome (RDS): Infants with fully developed lungs may experience difficulty breathing.
• Diaphragmatic hernia: the diaphragm is a muscle separating the chest from the abdomen. In this condition, a hole is formed in the diaphragm, and organs from one side push through the hole. In a diaphragmatic hernia, the organs from the abdomen push through the chest.
• Mother having diabetes mellitus 
• Babies with PPHN may be large for gestational age (LGA). Gestational age marks the age of the baby in the mother's body. LGA babies are bigger than 90% of normal-size babies. 

Persistent Pulmonary hypertension in newborns is a condition that makes it difficult for a newborn to get enough oxygen after birth. Although the condition is incurable, it is manageable with treatments, medications, and regular follow-ups. 

Request an appointment at Apollo Cradle, DELHI-NCR - Moti Nagar. Call 1860-500-1066 to book an appointment.