Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.
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Transcript of Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.
![Page 1: Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.](https://reader036.fdocuments.net/reader036/viewer/2022062314/56649ee45503460f94bf2a21/html5/thumbnails/1.jpg)
Persistent Pulmonary Hypertension of the Newborn
(PPHN)
Fred Hill, MA, RRT
![Page 2: Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.](https://reader036.fdocuments.net/reader036/viewer/2022062314/56649ee45503460f94bf2a21/html5/thumbnails/2.jpg)
Introduction
• PPHN is also known as persistent fetal circulation (PFC)
• Most common in term and postterm infants
• Associated with asphyxia, meconium aspirations syndrome, sepsis, congenital diaphragmatic hernia, pulmonary hypoplasia, congenital heart disease, premature closure of ductus arteriosus, pneumonia, and RDS
![Page 3: Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.](https://reader036.fdocuments.net/reader036/viewer/2022062314/56649ee45503460f94bf2a21/html5/thumbnails/3.jpg)
Diagnosis
• Hyperoxia test– Administer high FiO2 (usually 1.0)
– Check PaO2
• If <100, R→L shunt (PPHN or cyanotic heart disease)
• If >100, pulmonary pathophysiology most likely
![Page 4: Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.](https://reader036.fdocuments.net/reader036/viewer/2022062314/56649ee45503460f94bf2a21/html5/thumbnails/4.jpg)
Diagnosis
• Pre- and post-ductal sampling– Obtain an umbilical artery sample (post) at
same time as drawing a right radial (pre)– Check PaO2s
• If difference > 15-20 mm Hg indicates R→L shunt through PDA
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Fetal Circulation
![Page 6: Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.](https://reader036.fdocuments.net/reader036/viewer/2022062314/56649ee45503460f94bf2a21/html5/thumbnails/6.jpg)
Diagnosis
• Hyperoxia-hyperventilation test– Demonstrate PaO2 < 50 mm Hg
with FiO2 of 1.0
– Hyperventilate to PaCO2 of 20 to 25 mm Hg
– If PaO2 ↑ >100 mm Hg = PPHN
• Echocardiogram
![Page 7: Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT.](https://reader036.fdocuments.net/reader036/viewer/2022062314/56649ee45503460f94bf2a21/html5/thumbnails/7.jpg)
Treatment
• Hyperventilation• Pharmacologic agents
– Tolazoline– Nitroprusside– Dopamine– Isoproterenol– Prostaglandins E1 and I2
– NO• Extracorporeal Membrane Oxygenation
(ECMO)