Definition of "PPHN"

Last modified: 6 hours



PPHN (Persistent pulmonary hypertension of the newborn) is where the Pt is unable to breathe properly because of pulmonary hypertension.

Pathophysiology
  • In a fetus, there is high pulmonary vascular resistance, and low pulmonary blood flow, as the fetus doesn't use the lungs for O2 transfer
  • Once the baby is born, the lung vasculature normally relaxes, thereby lowering pulmonary vascular resistance, in response to the first minutes of breathing air, thereby allowing blood to flow through them. The lungs are needed for oxygen transfer, and requires high blood flow. In PPN this does not occur
  • Accordingly, there is conversion from the antenatal circulation pattern, to the normal adult pattern (i.e. systemic and pulmonary circulations)
Classification

Types include:

  • Normal vascular anatomy with functional vasoconstriction, which is reversible, thus has good prognosis. Causes include:
    • Hypoxia
    • Meconium aspiration
    • RDS
  • Decreased diameter of pulmonary vessels with hypertrophy of vessel walls, which is a fixed abnormality, thus has poor prognosis. Causes include:
    • Post-term pregnancy
    • Placental insufficiency
    • Maternal NSAID use
  • Decreased size of pulmonary vascular bed, which is a fixed abnormality, thus has poor prognosis. It is caused by space occupying lesions, such as:
    • Pleural effusions
    • Diaphragmatic hernias
  • Functional obstruction of pulmonary blood flow, which if reversible, has good prognosis. Causes include:
    • Polycythemia
    • Hyperfibrinogenemia
Complications

Can lead to:

  • Hypoxemia
  • Brain damage
Prognosis
  • Some causes treatable and reversible, but others associated with por survival
  • Periods of inadequate oxygenation can cause long-term effects, including BPD (i.e. scarred, stiffened lungs), seizure, developmental delay, and neurological deficits. Hearing problems is also associated

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Definition of PPHN | Autoprac


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