Persistent pulmonary hypertension of the newborn (PPHN) is a condition in which a baby's circulatory system does not work properly after birth. The baby's body continues to get oxygen the same way it did in the womb, rather than beginning to use the lungs. This issue can be caused by stress in the womb during pregnancy complications or disorders from which the baby suffers during the pregnancy. Though most hospitals have treatment plans in place for affected babies, some newborns cannot recover from the condition and either have long-term health effects or die.
While a baby is in the uterus, he does not need to use his lungs because the placenta and umbilical cord bring him oxygen. This means the pulmonary artery works differently than it will after birth, simply sending the baby's blood back to his heart via the ductus arteriosus. This is a fetal blood vessel that should close once the baby is born, since his lungs will work instead; when persistent pulmonary hypertension of the newborn occurs, this vessel continues working rather than closing. Thus, the blood never reaches the lungs but goes back to the heart through the ductus arteriosus without gathering sufficient oxygen. The result is often that other organs in the body do not thrive as they should because of lack of oxygen.
In many cases of persistent pulmonary hypertension of the newborn, the cause is not obvious, especially when the baby is healthy. One hypothesis is that some pregnancy complications, such as diabetes or hypertension in the mother, can increase the chances of a baby getting this condition. In some cases, the cause is more apparent, such as when the baby inhales his own feces, or meconium. Additionally, when a baby develops anemia, hypoglycemia or pneumonia, there is an increased chance of persistent pulmonary hypertension of the newborn.
Typical symptoms include fast breathing, a rapid heart rate and a blue tint to the baby's skin. Most doctors perform several tests before diagnosing the condition, though the baby is usually given oxygen while the screening is done. For example, doctors often get an ultrasound of the head and heart to check for brain bleeds and proper blood flow, in addition to X-rays of the chest to look for lung disease. Additional testing in a laboratory can enhance the accuracy of the diagnosis, so some doctors also perform a lumbar puncture, blood count and pulse oximetry to get a closer look at the blood.
The treatment for persistent pulmonary hypertension of the newborn is typically oxygen from a ventilator, which requires a tube to be inserted into the baby's windpipe. During this time, the baby usually has to stay in the neonatal intensive care unit (NICU). Underlying conditions that may have caused the issue, such as anemia, are treated at this time. Some babies can survive persistent pulmonary hypertension of the newborn with no lasting signs of the issue, while others suffer from neurological and developmental problems their whole life. Still other babies die from this condition, typically the result of irreversible damage to the lungs, heart or other organs.
