Persistent Pulmonary Hypertension

ppi_hypertensionWhen the arteries to the lung remain constricted and narrow at the time of delivery, a newborn is suffering from a serious medical condition known as persistent pulmonary hypertension. This medical disorder decreases the normal blood flow to the infant’s lungs and limits the amount of oxygen present in the bloodstream. Persistent pulmonary hypertension usually occurs when there is extreme breathing distress during pregnancy or immediately after delivery. It can also be caused by particular drugs the mother may take just before giving birth and in high doses during pregnancy. Doctors will use an echocardiogram to determine if the infant has this condition.

Symptoms
Medical professionals are trained to look for and identify symptoms of persistent pulmonary hypertension, which include rapid breathing and bluish colored skin. These are signs that the infant is not getting enough oxygen. Symptoms may present themselves at the time of birth, but in some cases, symptoms are not evident until a day or two later. If the infant’s blood pressure is low, additional symptoms like a weak pulse and pale or grayish colored skin can be present.

Causes
Persistent pulmonary hypertension happens more commonly in newborns who have reached full term or are overdue (post-term). Sometimes, other lung conditions and problems can be an underlying cause of persistent pulmonary hypertension but, it can occur in infants with no prior lung conditions or problems. During pregnancy, the infant’s lungs do not require a lot of blood flow. This is because the placenta functions to remove carbon dioxide and to deliver oxygen to the baby. It is normal for a fetus’ blood vessels to be constricted tightly since they do not need a lot of blood flow prior to birth. However, as soon as the fetus is delivered and the umbilical cord is severed, the baby’s lungs need to function properly and now do the job the placenta did in womb. The lungs begin oxygenating the blood and eliminating carbon dioxide. In order to do so, the infant needs to breath in air and the pulmonary arteries need to dilate, causing blood to flow to the lungs. Distress, including respiratory, at the time of delivery, as well as particular drugs ingested by the mother during pregnancy can prevent this process from occurring properly. This is why high doses of aspirin should be avoided during pregnancy, especially around the time of delivery.

Treatment
Most infants can be treated by giving them oxygen. In more severe cases infants are placed on a ventilator while being given oxygen. Large amounts of oxygen helps to dilate the arteries to the lung. If the condition is very severe, small doses of nitric oxide may be included with the oxygen. Although rare, there are times when other treatments are not working and extracorporeal membrane oxygenation is a life saving alternative. The infant’s blood is extracted and then processed through a machine that increases oxygen while eliminating carbon dioxide. The blood is then recirculated into the newborn’s blood stream.

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