PPHD (1708)

(PPHN)

How does a normal heart work?

The right side of the heart pumps blood to the lungs where the blood gets oxygen.  The left side of the heart gets this oxygen rich blood from the lungs and pumps it out to the rest of the body. 

• Before a baby is born very little blood flows to the lungs. The baby gets oxygen from the placenta.
• After a baby is born, more blood flows to the lungs.  When the baby breathes air, their blood is filled with oxygen.  The heart then pumps the oxygen filled blood to the body.

What is Persistent Pulmonary Hypertension of the Newborn (PPHN)?

PPHN is a serious breathing problem in newborns.  Babies with PPHN have high blood pressure in the blood vessels that carry blood to the lungs.  It is hard for the blood to flow through the lungs.  The pressure in these vessels is too high (hypertension).  With less blood going to the lungs, there is less oxygen for the rest of the body.

What causes it?

Some causes are health problems in the baby.

• Infections.
• Meconium aspiration. This is when a baby breathes in their poop around the time of birth.
• Other lung problems.
• Some causes are from health problems in the mother.
• Diabetes. 
• Certain medicines.

What are the symptoms?

Symptoms of PPHN are from low oxygen levels in the body. Babies with PPHN may:

• work hard to breathe.
• breathe fast (tachypnea).
• grunt or moan.
• have sharp pulling in of the chest muscles during breathing (retractions).
• have a bluish skin color around the mouth or on the hands and feet (cyanosis).

What tests might need to be done? 

An ultrasound of the baby’s heart may be done (echocardiogram).  This looks at the heart and the flow of the blood in and out of the heart.

How is PPHN treated?

Most babies with PPHN will need extra oxygen. This will help increase the amount of oxygen that goes to the body.  This will increase the blood flow to the lungs. 
Other treatments depend on the cause of PPHN (if known) and how bad the problem is. Medicines and breathing support may be needed.

• Medicines 

– Extra oxygen.
– Inhaled nitric oxide. This helps get more blood flow into the lungs.
– Surfactant.  This helps make breathing easier.
– Antibiotics.  They help treat infections.
– Antihypertensives.  Medicines to help keep a good blood pressure.

• Breathing machines to help your baby breathe.  The level of breathing support your baby gets depends on how they are doing.

– Continuous positive airway pressure (CPAP).  This helps keep your baby’s airway open.
– Ventilators (also called mechanical ventilation.)  This does the breathing for your baby.
– ECMO (stands for extracorporeal membrane oxygenation).  A machine that does the work of the baby’s lungs and heart for a short time. 

How will I know how my baby is doing?

Your healthcare team will give you updates on your baby. They will watch and measure how the heart and lungs are doing. They will:

• check your baby’s heart rate, blood pressure and oxygen saturations often.
• watch the level of breathing support needed.

What will happen as my baby grows?

Many babies do well with treatment for PPHN. Each baby is different. Talk to the healthcare team. They can answer any questions you have about your baby.

Adapted from information provided by Mallinckrodt Pharmaceuticals and NICU Parent Education Resources (NICU-PET.com).