title: [Pulmonary hypertension of the newborn--recent advances in the management and treatment].
abstract: Pulmonary hypertension of the newborn is a clinical syndrome with diverse etiology in which the transition from fetal circulation with high pulmonary vascular resistance to postnatal circulation with low pulmonary vascular resistance failed. The persistence of high pulmonary vascular pressure leads to right-left shunts and marked cyanosis. Despite of the advances in neonatology, the treatment of some forms of PPHN is often difficult and mortality rate remains high. In infants with PPHN appropriate interventions are critical to reverse hypoxemia, improve pulmonary and systemic perfusion and preserve end-organ function. Our understanding for management of PPHN has evaluated over decades. This review summarizes the current strategies for treatment of pulmonary hypertension of the newborn: general care, cardiovascular support, the advantages and limitations of different ventilatory strategies, oxygen therapy, extracorporal membrane oxygenation, and the evidence-based inhaled nitric oxide therapy. The balance between pulmonary vasoconstrictor and vasodilator mediators plays an important role for pulmonary vascular resistance. Recent studies are designed to develop evidence-based therapies for regulation of pulmonary vascular tone, safe medications for selective pulmonary vasodilatation effective for treatment of PPHN and other forms of pulmonary hypertension in the neonatal intensive care unit.
authors.forename: L
authors.initials: L
authors.lastname: Vakrilova
authors.forename: P
authors.initials: P
authors.lastname: Radulova
authors.forename: St
authors.initials: S
authors.lastname: Hitrova
authors.forename: B
authors.initials: B
authors.lastname: Slancheva
mesh_terms: D000975:Antioxidants / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D008168:Lung / Q000187:drug effects; D009569:Nitric Oxide / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy / Q000379:methods; D014043:Tolazoline / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D001993:Bronchodilator Agents; D014665:Vasodilator Agents; D009569:Nitric Oxide; D014043:Tolazoline