1. Persistent Pulmonary Hypertension of the Newborn (PPHN) Fred Hill, MA, RRT

2. Introduction PPHN is also known as persistent fetal circulation (PFC) PPHN is also known as persistent fetal circulation (PFC) Most common in term and postterm infants Most common in term and postterm infants Associated with asphyxia, meconium aspirations syndrome, sepsis, congenital diaphragmatic hernia, pulmonary hypoplasia, congenital heart disease, premature closure of ductus arteriosus, pneumonia, and RDS Associated with asphyxia, meconium aspirations syndrome, sepsis, congenital diaphragmatic hernia, pulmonary hypoplasia, congenital heart disease, premature closure of ductus arteriosus, pneumonia, and RDS

3. Diagnosis Hyperoxia test Hyperoxia test –Administer high FiO 2 (usually 1.0) –Check PaO 2 If <100, R →L shunt (PPHN or cyanotic heart disease) If <100, R →L shunt (PPHN or cyanotic heart disease) If >100, pulmonary pathophysiology most likely If >100, pulmonary pathophysiology most likely

4. Diagnosis Pre- and post-ductal sampling Pre- and post-ductal sampling –Obtain an umbilical artery sample (post) at same time as drawing a right radial (pre) –Check PaO 2 s If difference > 15-20 mm Hg indicates R →L shunt through PDA If difference > 15-20 mm Hg indicates R →L shunt through PDA

5. Fetal Circulation

6. Diagnosis Hyperoxia-hyperventilation test Hyperoxia-hyperventilation test –Demonstrate PaO 2 < 50 mm Hg with FiO 2 of 1.0 –Hyperventilate to PaCO 2 of 20 to 25 mm Hg –If PaO 2 ↑ >100 mm Hg = PPHN Echocardiogram Echocardiogram

7. Treatment Hyperventilation Hyperventilation Pharmacologic agents Pharmacologic agents –Tolazoline –Nitroprusside –Dopamine –Isoproterenol –Prostaglandins E 1 and I 2 –NO Extracorporeal Membrane Oxygenation (ECMO) Extracorporeal Membrane Oxygenation (ECMO)