What is the focus of clinical history in the evaluation of 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

Persistent pulmonary hypertension of the newborn (PPHN) should be suspected in any newborn with profound and often labile hypoxemia. Infants will have a preductal and postductal oxygen saturation gradient difference of at least 10%, which is dependent on the magnitude of the left-to-right shunting at the foramen ovale (with preductal saturations being higher). These findings are not specific to PPHN and, therefore, it is important to rule out structural heart disease with an echocardiogram.

A thorough history is important to identify causes that may increase the risk for having PPHN such as meconium aspiration syndrome, respiratory distress syndrome, congenital diaphragmatic hernia, pulmonary hypoplasia, pneumonia, and sepsis. Infants of mothers who have diabetes, asthma, or obesity are also reported to be at increased risk for PPHN. [24]

A few genetic risk factors have been identified in patients who have developed PPHN including trisomy 21 (independent of any cardiac lesion), genetic mutations leading to surfactant protein B deficiency, and mutations in the ATP-binding cassette transporter 3 gene. [4]


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