title: Diagnosis and management of persistent pulmonary hypertension of the newborn.
abstract: Persistent pulmonary hypertension of new born (PPHN) is associated with mortality and morbidity; it may be idiopathic or secondary to a number of conditions. The mainstay of diagnosis and to exclude structural abnormalities is echocardiography. Brain type natriuretic peptide (BNP) levels are elevated in PPHN, but are insufficiently sensitive to contribute to routine diagnosis. Management includes improving oxygenation by optimising lung volume by ventilatory techniques and/or surfactant and administering pulmonary vasodilator agents. Inhaled nitric oxide (iNO), a selective pulmonary vasodilator, reduces the need for extracorporeal membrane oxygenation in term infants; it does not, however, improve mortality or have any long term positive effects in prematurely born infants or infants with congenital diaphragmatic hernia. Other pulmonary vasodilators have been reported in case series to be efficacious alone or in combination with iNO. Randomised trials with long term follow up are required to identify the optimum therapeutic strategies in PPHN.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London.
authors.forename: Perraju
authors.initials: P
authors.lastname: Bendapudi
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London.
authors.forename: Gopinath Gangadhara
authors.initials: GG
authors.lastname: Rao
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London. Electronic address: anne.greenough@kcl.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D000280:Administration, Inhalation; D004452:Echocardiography / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006612:High-Frequency Ventilation / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010547:Persistent Fetal Circulation Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D013501:Surface-Active Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D013501:Surface-Active Agents; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain
keywords: Congenital diaphragmatic hernia; Meconium aspiration syndrome; Nitric oxide; Pulmonary hypertension; Pulmonary vasodilator