What is included in medical therapy for persistent pulmonary hypertension of the newborn (PPHN)?

Updated: Sep 03, 2019
  • Author: Kate A Tauber, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Answer

Answer

PPHN treatment may consist of the following:

  • Inotropic support (eg, dopamine [first line in the absence of cardiac dysfunction], dobutamine, milrinone)

  • Surfactant administration: For premature and full-tem newborns with parenchymal lung disease

  • Endotracheal intubation and mechanical ventilation: To maintain normal functional residual capacity by recruiting areas of atelectasis; to avoid overexpansion

  • High-frequency ventilation: Used in newborns with underlying parenchymal lung disease and low lung volumes; therapy is best in centers with clinicians experienced in achieving/maintaining optimal lung distention

  • Correction of hypoglycemia, hypocalcemia, acidosis, and alkalosis

  • Induced paralysis: Controversial; paralytic agents are typically reserved for newborns who cannot be treated with sedatives alone (Note: paralysis, especially with pancuronium, may promote atelectasis of dependent lung regions and promote ventilation-perfusion mismatch.)

  • ECMO: Used when optimal ventilatory support fails to maintain acceptable oxygenation and perfusion [2, 3]


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