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Persistent pulmonary hypertension in the newborn

Bushra Afzal, Praveen Chandrasekharan, Daniel J Tancredi, James Russell, Robin H Steinhorn, Satyan Lakshminrusimha
OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York...
February 2019: Pediatric Critical Care Medicine
Kartikeya Makker, Adeleye J Afolayan, Ru-Jeng Teng, Girija G Konduri
Previous studies in adult pulmonary hypertension reported that increased hypoxia-inducible factor-1α (HIF-1α) signaling contributes to pulmonary vascular remodeling. However, alterations in endothelial HIF-1α signaling and its contribution to impaired angiogenesis in persistent pulmonary hypertension of the newborn (PPHN) remain unclear. We investigated the hypothesis that HIF-1α levels are increased in lung endothelial cells in PPHN and contribute to impaired angiogenesis function. We examined HIF-1α expression and promoter activity in the isolated pulmonary artery endothelial cells (PAEC) from fetal lambs with or without PPHN induced by prenatal ductus arteriosus constriction...
February 2019: Physiological Reports
Warren M Zapol
Inhaled Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn. By Roberts JD, Polaner DM, Lang P, and Zapol WM. Lancet 1992; 340:818-19. Reprinted with permissionNO has vasodilatory effects on the pulmonary vasculature in adults and animals. We examined the effects on systemic oxygenation and blood pressure of inhaling up to 80 parts per million by volume of NO at fraction of inspired oxygen 0.9 for up to 30 min by six infants with persistent pulmonary hypertension of the newborn. In all infants, this treatment rapidly and significantly increased preductal oxygen saturation; in five infants, postductal oxygen saturation and oxygen tensions also increased...
January 15, 2019: Anesthesiology
Reem Amer, Yasser N Elsayed, Marjory Ruth Graham, Anurag S Sikarwar, Martha Hinton, Shyamala Dakshinamurti
BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is due to a failure of pulmonary vascular relaxation. Vasopressin, a systemic vasoconstrictor acting on smooth muscle AVPR1a receptors, is used in treatment of PPHN. We sought to determine acute effects of vasopressin infusion on pulmonary hemodynamics in a large animal model of hypoxic PPHN. METHODS: PPHN was induced in 6 newborn piglets by 72 h normobaric hypoxia (FiO2 = 0.10); controls were 7 age-matched 3-day-old piglets...
January 15, 2019: Pediatric Pulmonology
Leif D Nelin, Jim L Potenziano
BACKGROUND: Substantial numbers of neonates with hypoxic respiratory failure (HRF) do not immediately respond to inhaled nitric oxide (iNO) and are often labeled as non-responders. This retrospective data analysis assessed time to treatment response in the iNO key registration trial. METHODS: Treatment response was defined as a ≥10% increase in partial pressure of arterial oxygen (PaO2 ) or a ≥10% decrease in oxygenation index (OI) after initiation of study gas without the need for extracorporeal membrane oxygenation (ECMO)...
January 12, 2019: BMC Pediatrics
(no author information available yet)
Objective: To analyze clinical characteristics and risk factors of very low birth weight and extremely low birth weight infants with bronchopulmonary dysplasia (BPD). Methods: A retrospective epidemiological study was performed in 768 neonates (376 males) with birth weights<1 500 g and gestational age ≤ 34 weeks who survived ≥28 days. Clinical data were obtained from the multi-center clinical database of neonatal intensive care units (NICU) in 19 hospitals of Jiangsu Province between January 1, 2017 and December 31, 2017...
January 2, 2019: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Li-Fen Ye, Yong Fan, Qiang Shu, Ru Lin
BACKGROUND: To summarize the experience of management of persistent pulmonary hypertension of the newborn (PPHN) with extracorporeal membrane oxygenation (ECMO) support. METHODS: We presented three neonates with PPHN supported by ECMO in our center. Medical records and patient management notes were retrospectively reviewed. RESULTS: For two neonates with congenital diaphragmatic hernia (CDH), diaphragm repair surgery was done under ECMO support...
January 3, 2019: World Journal of Pediatrics: WJP
Frédérique Berger-Caron, Bruno Piedboeuf, Geneviève Morissette, David Simonyan, Philippe Chétaille, Annie Pellerin, Audrey Hébert
BACKGROUND:  Persistent pulmonary hypertension of the newborn (PPHN) occurs in 10% of neonatal respiratory insufficiency. To selectively reduce pulmonary vascular resistance, several treatments have been tried. Inhaled epoprostenol (iPGI2 ) has been used for 12 years in our institution for the management of refractory PPHN despite the gaps in the literature to support this use. OBJECTIVES:  The primary objective was to evaluate the efficacy of iPGI2 for PPHN...
December 14, 2018: American Journal of Perinatology
Hiroki Nakamura, Julia Zimmer, Florian Friedmacher, Prem Puri
INTRODUCTION:  Persistent pulmonary hypertension (PPH) is a major cause of morbidity and mortality in newborns with congenital diaphragmatic hernia (CDH). PPH is characterized by increased vascular resistance and smooth muscle cell (SMC) proliferation, leading to obstructive changes in the pulmonary vasculature. Nitric oxide (NO), generated by endothelial NO synthase (eNOS), is an important regulator of vascular tone and plays a key role in pulmonary vasodilatation. NO synthase interacting protein (NOSIP), which is strongly expressed by pulmonary SMCs, has recently been identified to reduce the endogenous NO production by interacting with eNOS...
December 10, 2018: European Journal of Pediatric Surgery
Fernanda Blasina, Lucía Vaamonde, Fernando Silvera, Gonzalo Solla, Juan Andrés Abin-Carriquiry, Carmen Gutiérrez, Pilar Beltramo, Irene García, Miguel Martell
Persistent pulmonary hypertension of the newborn (PPHN) is a complex pathology resulting from a failure of the post-natal reduction in pulmonary vascular resistance leading to hypoxemia. The standard therapy is inhaled Nitric Oxide (NO) improving oxygenation but its availability is limited, especially in hospitals with restricted financial resources. We evaluated the efficacy and safety of a new device generating NO (TAS + PLUS), in an experimental piglet models of pulmonary hypertension (PH), and we later tested its application in a pilot study of newborn patients suffering from PPHN...
December 7, 2018: Pulmonary Pharmacology & Therapeutics
Afif El-Khuffash, Patrick J McNamara, Colm Breatnach, Neidin Bussmann, Aisling Smith, Oliver Feeney, Elizabeth Tully, Joanna Griffin, Willem P de Boode, Brian Cleary, Orla Franklin, Eugene Dempsey
Persistent pulmonary hypertension of the newborn (PPHN) is a relatively common condition which results in a mortality of up to 33%. Up to 40% of infants treated with nitric oxide (iNO) either have a transient response or fail to demonstrate an improvement in oxygenation. Milrinone, a selective phosphodiesterase 3 (PDE3) inhibitor with inotropic and lusitropic properties may have potential benefit in PPHN. This pilot study was developed to assess the impact of milrinone administration on time spent on iNO in infants with PPHN...
2018: Maternal Health, Neonatology and Perinatology
Jun Shiraishi, Satoshi Kusuda, Kazutoshi Cho, Atsushi Nakao, Takehiko Hiroma, Hiroshi Sugiura, Satoshi Suzuki, Makoto Oshiro, Seiji Yoshimoto, Shinichi Watabe
BACKGROUND: In perinatal medicine, inhaled nitric oxide (iNO) has been an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn (PPHN) and hypoxemic respiratory failure (HRF). However, its use in more premature infants is controversial. To evaluate the current clinical practices regarding use of acute inhaled nitric oxide (iNO) therapy in extremely preterm infants, a nationwide survey was conducted in Japan. METHODS: A questionnaire survey was conducted from May to September, 2015...
December 6, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
G F Yan, X D Cai, C B Zhou, X Y Hong, Y Wang, C M Zhang, Z H Yang, Y C Zhang, Y Cui, Y Q Cui, Y B Cheng, S Y Qian, P F Zhang, Y P Jin, X D Zhu, H Gao, Z P Li, X L Lu, H J Miao, Q Y Zhang, Y M Li, W G Yang, C Y Liu, B Li, Y Li, Z J Bo, J P Chu, X Wang, G P Lu
Objective: To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland. Methods: In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy. Results: By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children's hospitals and 7 were general hospitals...
December 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Nazia Fatima, Sohail Arshad, Ahmed Iqbal Quddusi, Abdur Rehman, Aashee Nadeem, Imran Iqbal
BACKGROUND: Persistent pulmonary hypertension is a serious disease among new-borns. Inhaled nitric oxide is first line of therapy along with extracorporeal membrane oxygenation. Pulmonary vasodilators such as sildenafil, bosentan and milrinone are also used to treat persistent pulmonary hypertension especially in resource limited centres where inhaled nitric oxide is not available. The objective of this study was to compare the effect of sildenafil alone and sildenafil with bosentan on severity of tricuspid regurgitation and duration of hospitalization in new-borns with persistent pulmonary hypertension...
July 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Keze Ma, Mingyu Xie, Xiaoguang He, Guojun Liu, Xiaomei Lu, Qi Peng, Baimao Zhong, Ning Li
BACKGROUND: Genetic defects in the mitochondrial aminoacyl-tRNA synthetase are important causes of mitochondrial disorders. VARS2 is one of the genes encoding aminoacyl-tRNA synthetases. Recently, an increasing number of pathogenic variants of VARS2 have been reported. CASE PRESENTATION: We report the novel compound heterozygous pathogenic VARS2 mutations c.643 C > T (p. His215Tyr) and c.1354 A > G (p. Met452Val) in a female infant who presented with poor sucking at birth, poor activity, hyporeflexia, hypertonia, persistent pulmonary hypertension of newborn (PPHN), metabolic acidosis, severe lactic acidosis, expansion and hypertrophic cardiomyopathy...
November 20, 2018: BMC Medical Genetics
Qin Xiang Ng, Nandini Venkatanarayanan, Collin Yih Xian Ho, Wen Shan Sim, Donovan Yutong Lim, Wee-Song Yeo
BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition associated with substantial mortality and morbidity. Previous studies have suggested a possible link between maternal selective serotonin reuptake inhibitor (SSRI) use and the risk of PPHN. This study aimed to provide an up-to-date review and meta-analysis of the topic. METHODS: Using the search terms [SSRI OR SSRIs OR selective serotonin reuptake inhibitors OR antidepressant OR Prozac OR fluoxetine OR Lexapro OR escitalopram] AND [pregnancy OR maternal OR newborn OR persistent pulmonary hypertension OR PPHN OR neonat* OR fet*], a preliminary search on the PubMed, Medline, EMBASE, Web of Science, and Google Scholar database yielded 7327 articles published in English between January 1, 1960 and October 1, 2017...
November 8, 2018: Journal of Women's Health
Narongsak Nakwan, Suksham Jain, Kishore Kumar, Shigeharu Hosono, Majeda Hammoud, Yasser Yahia Elsayed, Shabina Ariff, Babar Hasan, Waqar Khowaja, Poom Woei Bing
OBJECTIVES: To explore the incidence, etiologies, diagnostic methods, treatment options and outcomes in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to identify mortality risk factors in a study from six Asian countries. METHODS: A retrospective chart review of patients with documented PPHN from seven centers in six Asian countries (Japan, Kuwait, India, Pakistan, Singapore, and Thailand) between 1 January, 2014 and 31 December, 2016, was performed...
October 14, 2018: Journal of Maternal-fetal & Neonatal Medicine
Manon Gijtenbeek, Enrico Lopriore, Sylke J Steggerda, Arjan B Te Pas, Dick Oepkes, Monique C Haak
BACKGROUND: Newborns with anemia are at increased risk of persistent pulmonary hypertension of the newborn (PPHN), yet reports on the association between fetomaternal hemorrhage (FMH) and PPHN are rare. To optimize care for pregnancies complicated by FMH, clinicians should be aware of the risks of FMH and the possible diagnostic and therapeutic options. To increase the current knowledge, the incidence of PPHN and short-term neurologic injury in FMH cases were studied. STUDY DESIGN AND METHODS: We included all FMH cases (≥30 mL fetal blood transfused into the maternal circulation) admitted to our neonatal unit between 2006 and 2018...
December 2018: Transfusion
Shinsuke Hoshino, Junpei Somura, Ouki Furukawa, Takahide Yanagi, Yoshihiro Maruo
The combination of persistent pulmonary hypertension of the newborn (PPHN) and transposition of the great arteries (TGA) has serious impacts on treatment and prognosis, often with adverse outcomes. We report the case of a male full-term newborn with TGA with intact ventricular septum and severe PPHN who died 2 h after birth; further, we examined his vascular histology. On autopsy, lung histology showed mild fibrous hypertrophy in the intima and moderate medial hypertrophy of the minimal pulmonary artery. Hypoplasia of the pulmonary artery was not detected...
May 2018: Journal of Cardiology Cases
Anurag Singh Sikarwar, Martha Hinton, Kallivalappil Thomas Santhosh, Premnath Dhanaraj, Mariel Talabis, Prashen Chelikani, Shyamala Dakshinamurti
OBJECTIVE: Persistent pulmonary hypertension of the newborn (PPHN) features hypoxemia, pulmonary vasoconstriction and impaired cardiac inotropy. We reported low basal and stimulated cAMP in hypoxic pulmonary artery smooth muscle cells (PASMC). We now examine pulmonary arterial adenylyl cyclase (AC) activity and regulation in hypoxic PPHN. APPROACH: PPHN was induced in newborn swine by normobaric hypoxia (FiO2 0.10) for 72hr; age-matched normoxic controls. We studied relaxation of pulmonary arterial rings to AC activator forskolin and sGC activator sodium nitroprusside (SNP) by isometric myography; ATP content, phosphodiesterase activity, AC content, isoform expression and catalytic activity in presence or absence of Gαs-coupled receptor agonists, forskolin, or trans-nitrosylating agents, in human and neonatal porcine PASMC, and HEK293T stably expressing AC isoform 6, after 72 hour hypoxia (10% O2) or normoxia (21% O2)...
September 20, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
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