Good Morning and Welcome Applicants!

January 27, 2011

Pulmonary HTN• Pulmonary Artery Pressure =

L atrial pressure + (pulm flow x pulm vascular resis)

• Any increase can lead to pulm HTN

Pulmonary HTN

• Progressive• Pulmonary artery pressure

• >25 mm Hg• Untreated

• RV unable to support circulation• Prognosis determined by

reversibility of underlying process

PPHN

• Most common cause of PHTN in the newborn• 0.2% of newborns

• Usually associated with respiratory conditions• Elevated pulm vasc resistance• Right to left shunting

• Foramen ovale• Ductus arteriosis

• Significant hypoxemia

• Idiopathic

PPHN• Presentation

• Profound and labile hypoxemia• Out of proportion to parenchymal disease

• Birth or gradual changes• Cyanosis• Grunting• Flaring• Retractions• Tachypnea• Tachycardia• Shock

PPHN

• Wide variety of severity• Normal perfusion to shock

• Hypoxemia and acidosis• Further constricts the pulmonary

vessels increasing the PH and creating a cycle

PPHN

• Shunting• PDA

• Pre and post ductal

• PaO2 gradient of >20 mmHg

• O2 saturation gradient of >5%

PPHN

• X-rays• Underlying illness• Clear

• Diminished vascular markings

• Slightly dilated heart

• Idiopathic

PPHN

• Echo• Must exclude cyanotic heart disease• R to L shunting across foramen ovale

or ductus arteriosis• Deviation of the atrial septum

• Ventricular septum• Right atrial enlargement• Tricuspid regurgitation

PPHN

• Treatment• Underlying disturbances

• Hypoglycemia• Hypocalcemia • Polycythemia• Hypothermia

• Minimal Stimulation

PPHN

• Treatment• Increase systemic resistance

• Volume• Inotropic • Decrease R to L shunt

• Decrease pulmonary vascular resistance• Oxygen• iNO

PPHN

• Treatment• Mechanical ventilation• High-frequency ventilation• Sedation• Surfactant • ECMO

PPHN• Outcomes

• 95% Meconium aspiration• 50% Congenital diaphragmatic hernia

• Neurodevelopmental impairment• Neurosensory hearing loss• Behavioral problems• Respiratory difficulties• Most likely due to the underlying

condition and severity