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Persistent Pulmonary Hypertension of the Newborn (PPHN)

Persistent Pulmonary Hypertension of the Newborn (PPHN). Fred Hill, MA, RRT. Introduction. PPHN is also known as persistent fetal circulation (PFC) Most common in term and postterm infants

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Persistent Pulmonary Hypertension of the Newborn (PPHN)

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  1. Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT

  2. 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 ductusarteriosus, pneumonia, and RDS

  3. 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

  4. 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

  5. Fetal Circulation

  6. 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

  7. Treatment • Hyperventilation • Pharmacologic agents • Tolazoline • Nitroprusside • Dopamine • Isoproterenol • Prostaglandins E1 and I2 • NO • Extracorporeal Membrane Oxygenation (ECMO)

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