What is persistent pulmonary hypertension of the newborn?

Persistent pulmonary hypertension of the newborn, or PPHN, is a serious breathing problem that happens when a baby has trouble breathing their first few breaths. In the womb, babies get their oxygen from their mother and the placenta (an organ that gives the baby nutrients). The blood vessels in the baby's lungs are closed until they try to take a first breath after delivery. The blood vessels in their lungs might not open up enough. The baby may be unable to get enough oxygen. When oxygen can't get to their brain or other organs, it can sometimes be fatal.

Causes of persistent pulmonary hypertension of the newborn

The exact cause of PPHN is unknown. One thing that can contribute to getting PPHN is if the baby breathes in its own sticky feces. This is known as meconium aspiration. Babies with infections or who don't get enough oxygen before or during birth may also develop this condition.

Risk factors for persistent pulmonary hypertension

Although the cause is unknown, certain factors increase the infant’s risk of developing PPHN. These factors include:

  • Babies who are full-term—born at 34 weeks or more
  • Meconium aspiration—this happens when the baby breathes in its own sticky poop (meconium) Infection
  • Respiratory distress syndrome (RDS)—this breathing difficulty happens in infants who do not have fully developed lungs
  • Lack of oxygen before or during birth

Symptoms of persistent pulmonary hypertension of the newborn

Symptoms usually show up within 72 hours of birth. The symptoms of PPHN also show the seriousness of this condition. There's a great possibility of death, starting with the baby's inability to breathe normally.

Other symptoms of PPHN may include:

  • Reduced urination
  • Low blood pressure
  • Blue color to the skin
  • Low blood oxygen levels
  • Hands and feet that feel cool
  • Breathing problems, including slow or rapid breathing or grunting

Diagnosis of persistent pulmonary hypertension of the newborn

The following tests may be used to diagnose PPHN:

  • Arterial blood gas analysis
  • Pulse oximetry—a noninvasive way to measure oxygen levels in the blood
  • Chest X-ray or an echocardiogram
  • Echocardiogram—a detailed ultrasound of the baby’s heart

Treatments for persistent pulmonary hypertension of the newborn

Treatment starts with keeping the baby warm. Doctors can give them oxygen through a mask, incubator, hood or tubes inserted in the baby's mouth or nostrils. Babies with PPHN can also benefit from a machine that gives them oxygen and breathe for them.

Other treatments for PPHN may include:

  • Medications that increase blood pressure in the baby's body
  • Nitric oxide gas therapy along with oxygen to open the blood vessels in the lungs
  • A process that bypasses the lungs and directly delivers oxygen to the brain and through the baby's body

Once the baby can breathe on their own, it's extremely important that doctors and nurses continue to monitor the infant. There's a high rate of death with this very serious condition. It can sometimes take weeks or even months for the baby's lungs to recover all the way.

Recovery from persistent pulmonary hypertension of the newborn

While the baby is recovering from treatment, it's critical that you help them avoid catching colds or the flu. Keep the child away from sick people and large crowds. Wash your hands often. During the recovery period, have frequent appointments with your pediatrician. This helps you ensure your baby is developing normally and growing into a healthy child.

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