Department of Paediatrics
PERSISTENT PULMONARY HYPERTENSION
OF THE NEWBORN
Mechanism
Pressures in pulmonary circulation remain supra-systemic causing right to left shunting
through the ductus arteriosus and the foramen ovale leading to hypoxia, often with
relatively normal carbon dioxide levels.
Primary
Often associated with term or post term infant with a degree of hypoxic ischaemic insult.
Secondary
To lung disease:
IRDS
Meconium aspiration
Pneumonia, especially group B strep
Structural, eg diaphragmatic hernia
Investigation
CXR, ABG preferably pre-ductal, Echo
FBC, PCV, U&E, glucose, blood cultures
Differential Diagnosis
Congenital cyanotic cardiac disease
Management

Minimal handling

Ventilation
-
Aim for
PaO2 >10 kPa
PaCO2 - 4.5-5.5 kPa
pH >7.4
-
Consider use of high frequency oscillation

Paralysis often required

Support BP with volume and Dopamine if necessary

Correct any polycythaemia (arterial PCV >65%) with dilutional exchange

Commence Benzylpenicillin and Gentamicin

Consider Prostacyclin infusion 4-40 ng/kg/min (watch for hypotension and
haemorrhage)
If no benefit from any of above treatments and hypoxia is severe in 100% oxygen,
consider transfer to Leicester for ECMO or Nitric Oxide. Calculate oxygenation index needs referral if persistently >35 (see ECMO protocol).
FJT/LAW September 2008
Review 2 years
Gosset guidelines/persistent pulmonary hypertension of the newborn