Comprehensive management for the improved outcome of persistent pulmonary hypertension of the newborn in a one-day-old baby girl: a case report
Main Article Content
Keywords
cyanosis, newborn, pulmonary arterial hypertension
Abstract
Introduction: Persistent pulmonary hypertension of the newborn (PPHN) is characterized by an increase in pulmonary vascular resistance (PVR), caused by failure of circulatory adaptation within minutes after delivery. Persistent pulmonary hypertension of the newborn (PPHN) can lead to severe respiratory distress and hypoxemia. Newborns with PPHN are at high risk of severe asphyxia and its complications. This study aims to present a comprehensive assessment and treatment of newborn PPHN that might be applicable in any hospital setting.
Case description: A one-day-old baby girl came to the emergency room with the chief complaint of cyanosis since birth. The baby was born with oxygen, with pre-ductal and post-ductal differentiation of 5%. The baby showed weak crying movements and inadequate spontaneous breathing, indicating persistent respiratory distress and a chest x-ray revealed pneumonia. The echocardiogram showed a bidirectional secundum, an atrial septal defect, moderate patent ductus arteriosus, and severe pulmonary hypertension. Sputum culture showed Klebsiella pneumoniae (ESBL). Comprehensive management was given to the patient. After several days of hospitalization, the patient was discharged in good condition.
Conclusion: PPHN is associated with high morbidity and mortality in newborns. Comprehensive evaluation and management of PPHN and control of any comorbid conditions must be performed to improve patient outcomes.
References
2. Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, Partridge JC, Rogers EE, Keller RL. Persistent Pulmonary Hypertension of the Newborn in Late Preterm and Term Infants in California. Pediatrics. 2017;139(1). Available from: http://dx.doi.org/10.1542/peds.2016-1165
3. Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn. New England Journal of Medicine. 2006;354(6):579–87. Available from: http://dx.doi.org/10.1056/nejmoa052744
4. Hilgendorff A, Apitz C, Bonnet D, Hansmann G. Pulmonary hypertension associated with acute or chronic lung diseases in the preterm and term neonate and infant. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart. 2016;102(Suppl 2):ii49–56. Available from: http://dx.doi.org/10.1136/heartjnl-2015-308591
5. Steinhorn RH. Neonatal pulmonary hypertension. Pediatr Crit Care Med. 2010;11(2 Suppl):S79–84. Available from: https://pubmed.ncbi.nlm.nih.gov/20216169
6. Konduri GG, Vohr B, Robertson C, Sokol GM, Solimano A, Singer J, et al. Early Inhaled Nitric Oxide Therapy for Term and Near-Term Newborn Infants with Hypoxic Respiratory Failure: Neurodevelopmental Follow-Up. J Pediatr. 2007;150(3):235-240.e1. Available from: http://dx.doi.org/10.1016/j.jpeds.2006.11.065
7. Manja V, Mathew B, Carrion V, Lakshminrusimha S. Critical congenital heart disease screening by pulse oximetry in a neonatal intensive care unit. J Perinatol. 2014/07/24. 2015;35(1):67–71. Available from: https://pubmed.ncbi.nlm.nih.gov/25058746
8. Shivanna B, Gowda S, Welty SE, Barrington KJ, Pammi M. Prostanoids and their analogues for the treatment of pulmonary hypertension in neonates. Cochrane Database Syst Rev. 2019;10(10):CD012963–CD012963. Available from: https://pubmed.ncbi.nlm.nih.gov/31573068
9. Konduri GG, Sokol GM, Van Meurs KP, Singer J, Ambalavanan N, Lee T, et al. Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure. J Perinatol. 2013/07/18. 2013;33(12):944–9. Available from: https://pubmed.ncbi.nlm.nih.gov/23867958
10. Steinhorn RH, Fineman J, Kusic-Pajic A, Cornelisse P, Gehin M, Nowbakht P, et al. Bosentan as Adjunctive Therapy for Persistent Pulmonary Hypertension of the Newborn: Results of the Randomized Multicenter Placebo-Controlled Exploratory Trial. J Pediatr. 2016;177:90-96.e3. Available from: http://dx.doi.org/10.1016/j.jpeds.2016.06.078
11. Kahveci H, Yilmaz O, Avsar UZ, Ciftel M, Kilic O, Laloglu F, et al. Oral sildenafil and inhaled iloprost in the treatment of pulmonary hypertension of the newborn. Pediatr Pulmonol. 2014;49(12):1205–13. Available from: http://dx.doi.org/10.1002/ppul.22985
12. Mourani PM, Abman SH. Pulmonary vascular disease in bronchopulmonary dysplasia. Curr Opin Pediatr. 2013;25(3):329–37. Available from: http://dx.doi.org/10.1097/mop.0b013e328360a3f6
13. Abman SH, Kinsella JP, Rosenzweig EB, Krishnan U, Kulik T, Mullen M, et al. Implications of the U.S. Food and Drug Administration Warning against the Use of Sildenafil for the Treatment of Pediatric Pulmonary Hypertension. Am J Respir Crit Care Med. 2013;187(6):572–5. Available from: http://dx.doi.org/10.1164/rccm.201210-1928pp
14. Kelly LE, Ohlsson A, Shah PS. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev. 2017;8(8):CD005494–CD005494. Available from: https://pubmed.ncbi.nlm.nih.gov/28777888
15. Nair J, Lakshminrusimha S. Update on PPHN: mechanisms and treatment. Semin Perinatol. 2014;38(2):78–91. Available from: https://pubmed.ncbi.nlm.nih.gov/24580763