In newborn infants, persistent pulmonary hypertension (PPHN) can occur. It happens when a newborn’s circulation carries on as it did while the baby was still inside. When this occurs, an excessive amount of blood flow skips over the baby’s lungs. Sometimes this is referred to as persistent fetal circulation.
A fetus’s lungs do not exchange oxygen and carbon dioxide while it is pregnant. Thus, the fetus only requires a small amount of blood to maintain the health of the tissues. Most of the blood in a fetus is circulated away from the lungs. Through connections in the heart and large blood vessels, it transmits it.
When infants begin breathing air after birth, this circulation changes. Their lungs’ altered pressure aids in the closure of those fetal (pre birth) connections. By doing this, blood is redirected to pump to their lungs. This makes it easier for carbon dioxide and oxygen to exchange.
These typical changes might not take place in a newborn with low oxygen levels or breathing difficulties. As a result, the baby’s circulation keeps moving blood away from the lungs. The infant’s lungs continue to have a high blood pressure.
Risk factors of the condition can include:
- before birth, they took in their own feces (meconium aspiration)
- oxygen deficiency before or during birth
- infection of their blood or lungs
- abnormal heart or lung development
- being the child of a diabetic mother
- a large-for-gestational-age birth (LGA). Age at conception is the age of the unborn child. More than 90% of all other babies born at the same gestational age are larger than LGA babies.
Signs of pulmonary hypertension in newborns can include:
- Rapid heartbeat and breathing
- Breathing while grunting or groaning
- Retractions: When you breathe quickly and forcefully, the skin between and under your ribs pulls in.
- Cyanosis, a condition where the lips and area around the mouth are blue,
- Even after receiving oxygen, the blood has low oxygen saturation levels
- Compared to the right wrist, the baby’s legs have a lower oxygen saturation level.
- Reduced blood pressure
Understanding the various causes of the pulmonary hypertension condition:
Congenital heart defects, which are present at birth, can cause pulmonary hypertension in children. Additionally, it may run in families or be inherited.
Newborns with persistent pulmonary hypertension frequently have a chronic lung condition. A particularly high risk population for the condition is premature infants with bronchopulmonary dysplasia (underdeveloped lungs and pulmonary blood vessels).
Other conditions that raise a child’s risk of developing pulmonary hypertension include:
- Cardiomyopathy, or a heart muscle condition,
- persistent blood clots
- Congenital lung hypoplasia due to a diaphragmatic hernia, or hole in the diaphragm (abnormally small lungs)
- Dysplastic fibrosis
- Down syndrome Infectious diseases
Diagnostic procedures of the condition can include:
Your baby’s doctor for breathing problems will inquire about your pregnancy history and general health. Then, they will examine your infant. The following tests may be performed by your child’s doctor to identify PPHN:
Echocardiogram (echo):
In this painless examination, the heart and blood vessels are imaged using sound waves. It will demonstrate how blood circulates within the body.
X-rays:
A camera can photograph the lungs and determine whether the heart is too big. Consult a neonatologist in coimbatore to undergo the pulmonary hypertension treatment for the condition.
Blood tests:
These tests will reveal changes in the quantity of blood cells as well as the blood’s levels of other substances like salt, sugar, and acids. They can help determine whether your baby has an infection or how well they use oxygen.
Pulmonary vasodilator testing:
We may administer therapies like extra oxygen or other medications to relax the blood vessels in the lungs during a cardiac catheterization or an echo. These tests enable us to evaluate how different medications affect the blood pressure in the lungs.
Treatment options that are available to treat the condition:
The purpose of pphn treatment in newborn is to raise blood oxygen levels, widen pulmonary blood vessels, and keep blood pressure within normal ranges. This is accomplished using fluids, medications, and oxygen.
Your baby is supplied oxygen through:
Nasal cannula:
In order to connect to oxygen, a small tube with prongs is inserted in the nostrils.
Continuous Positive Air Pressure (CPAP):
Air or oxygen is gently pushed into the lungs by this device.
Ventilator:
Until your baby is able to breathe on their own, this machine will do it for them. A breathing tube will be inserted down their windpipe by the doctor. It is known as intubation. A breathing tube is then attached to the ventilator. Your baby will receive even and regular breaths thanks to the ventilator’s programming.
High frequency oscillation ventilation:
This particular ventilator is a special kind. It is capable of providing quick, brief bursts of air via a breathing tube.
Intravenous catheters are used to administer medications and fluids (IV). One or more of the blood vessels are punctured with a little, flexible tube. Blood samples are also obtained using it. The IV tube is put in one of two places:
An umbilical IV is the umbilical cord.
In medical terminology, peripherally inserted central catheters are called arms or legs (PICC line). A large blood vessel close to the heart is where the PICC line enters from the arm or leg.
How long does it take to recover from persistent pulmonary hypertension in newborns?
Your baby’s lungs will take weeks or even months to fully recover after pulmonary hypertension therapy. It will be crucial to protect your infant from catching the flu or a cold. By washing your hands properly and keeping your child away from sick people and crowded areas, you can contribute to this. Additionally, it will be crucial for your child to regularly visit their pediatrician at a pphn hospital in Coimbatore and other specialists in order to be checked for typical developmental milestones.
Outlook on the condition:
Pneumatic hypertension has no known treatment, and some kids eventually need lung or heart-lung transplants. New research is constantly being conducted in an effort to expand the options available and advance treatments for persistent pulmonary hypertension in newborns are currently being developed to help stop the disease from getting worse.
