13 terms

Persistent Pulmonary Hypertension of the Newborn (PPHN)

STUDY
PLAY

Terms in this set (...)

What is another name for persistent pulmonary hypertension?
Persistent fetal circulation
What is the etiology of PPHN?
Secondary to other diseases
Structurally abnormal pulmonary blood vessels (chronic fetal stress)
Underdeveloped pulmonary vasculature
Hypoxia associated with lung disease
Full or post term infants
History of perinatal or intrauterine hypoxia problems
Known birth defect effecting pulmonary vascular development
What is treatment for PPHN?
Improve alveolar oxygenation
Decrease PVR
EMCO (extra corporeal membrane oxygenation)
Sedation and paralysis
Very little stimulation
What are some reasons for underdeveloped pulmonary vasculature?
CDH, pulmonary hypoplasia
What diseases are associated with hypoxia lung disease?
RDS, MAS, and pneumonia
What is the pathophysiology of PPHN?
Severe pulmonary HTN
Big increase PVR
The PA pressure will exceed aortic pressure resulting in a right to left shunt
This also cause the ductus arteriosis to remain open
The foramen ovale remains open
Severe hypoxemia that does not respond to Oxygen
What are signs/symptoms for PPHN?
Usually within 12-24 hrs of birth
Increased respiratory distress
Tachypnea with minimal retractions
Cyanosis
Poor perfusion
Refractory hypoxemia
How is PPHN diagnosed?
Symptoms and history
Echocardiogram
Pre and post ductal 02 sats
Measure pre from right hand and post from left foot
How do you improve alveolar oxygenation?
High Fi02s (100% to start)
Mechanical ventilator
How do you decrease PVR?
Vasodilators
Inhaled nitric oxide
What are some drugs used in vasodilation?
Sildenafil (IV or oral)
Flolan (IV or inhaled)
When do you use ECMO?
Rescue and purely supportive
Failure to respond to all other treatments
What is the prognosis and outcomes for PPHN?
Depends on the length and severity of hypoxia and underlying disease
Prior to ECMO-50% mortality
Now about 80% survival rate
Long term disabilities possible
Heart failure