Persistent Pulmonary Hypertension Of The Newborn

Öz

Persistent pulmonary hypertension PPHT of the newborn which can be secondary or idiopathic in many cases is associated with morbidity and mortality. Inadequate of pulmonary relaxation after birth results in PPHT, and oxygen-free blood shunts from pulmonary to systemic circulation. Term and near term babies are affected more frequently. Regardless of etiology, short- and long-term morbidite-related hypoxemia should be avoided, and thus, after diagnosis, available treatment should promptly be started. Echocardiography is the main diagnostic method for the exclusion of structural heart diseases in diagnosis. The main treatments includes oxygen supplementation, mechanical ventilation, nitric oxide, phosphodiesterase inhibitors, prostaglandin analogues, endothelin receptor antagonists, and extracorporeal membrane oxygenation, as well as treatment of underlying disease. Optimal treatment approach is still controversial. Treatments applied in newborns with PPHT should guarantee chronic health problems after discharge and long term results, that will not cause neurodevelopmental deficit.

Anahtar Kelimeler

• Persistant pulmonary hypertension,newborn,pulmonary vasodilator,nitric oxide,extracorporeal membrane oxygenation

Yenidoğanın Persistan Pulmoner Hipertansiyonu

Öz

Yenidoğanda persistan pulmoner hipertansiyon PPHT birçok duruma ikincil ya da idiyopatik olabilen morbidite ve mortaliteler ile ilişkili bir durumdur. PPHT doğumdan sonra pulmoner relaksasyonun yetersizliği ve oksijensiz kanın pulmonerden sistemik dolaşıma şantı ile sonuçlanır. Term ve terme yakım bebekleri daha sık etkiler. Etiyolojiye bakılmaksızın kısa ve uzun dönem morbiditelerle ilişkili hipoksemiden kaçınır kaçırmaz, tanı konup tedavi edilmelidir. Tanıda yapısal kalp hastalıklarının dışlanması için ekokardiyografi EKO başlıca tanı yöntemidir. Başlıca tedavi, altta yatan hatsalığın tedavisi ile birlikte oksijen desteği, mekanik ventilasyon, nitrik oksit, fosfodiesteraz inhibitörleri, prostaglandin analogları, endotelin reseptör antagonistleri ve ekstrakorporyal membran oksijenizasyonu gibi umut verici tedaviler vardır. Optimal tedavi yaklaşımı tartışmalıdır. PPHT olan yenidoğanlarda uygulanan tedaviler, taburculuk sonrası kronik sağlık problemleri ve nörogelişimsel defisite yol açmayacak uzun dönem sonuçlarını garanti etmelidir.

Anahtar Kelimeler

• Persistan pulmoner hipertansiyon,yenidoğan,pulmoner vazodilatör,nitrik oksit,ekstrakorporyal membran oksijenizasyonu

Kaynakça

1. Puthiyachirakkal M, Mhanna MJ. Pathophysiology, management, and outcome of persistent pulmonary hypertension of the newborn: a clinical review. Front Pediatr. 2013;1:23.
2. Walsh-Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics. 2000;105(1 Pt 1):14-20.
3. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev. 2007;(3):CD005494.
4. Gao Y, Raj JU. Regulation of the pulmonary circulation in the fetus and newborn.Physiol Rev. 2010;90(4):1291-335.
5. Jain A, McNamara PJ. Persistent pulmonary hypertension of the newborn: Advances in diagnosis and treatment. Semin Fetal Neonatal Med. 2015;20(4):262-71.
6. Avery’s neonatology: pathophysiology and management of the newborn, 7th ed (in press), Chapter 29.
7. Pandya KA, Puligandla PS. Pulmonary hypertension management in neonates.Semin Pediatr Surg. 2015;24(1):12-6.
8. Lipkin PH, Davidson D, Spivak L, Straube R, Rhines J, Chang CT. Neurodevelopmental and medical outcomes of persistent pulmonary hypertension in term newborns treated with nitric oxide. J Pediatr. 2002;140(3):306-10.

9. Finer NN, Barrington KJ. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev. 2006;(4):CD000399.
10. Hosono S, Ohno T, Kimoto H, Shimizu M, Takahashi S, Harada K.Developmental outcomes in persistent pulmonary hypertension treated with nitric oxide therapy. Pediatr Int. 2009;51(1):79-83.
11. Bourbon J, Boucherat O, Chailley-Heu B, Delacourt C.Control mechanisms of lung alveolar development and their disorders in bronchopulmonary dysplasia. Pediatr Res. 2005;57(5 Pt 2):38R-46R.
12. Thébaud B, Abman SH. Bronchopulmonary dysplasia: where have all the vessels gone? Roles of angiogenic growth factors in chronic lung disease. Am J Respir Crit Care Med. 2007;175(10):978-85.
13. Bendapudi P, Rao GG, Greenough A. Diagnosis and management of persistent pulmonary hypertension of the newborn. Paediatr Respir Rev. 2015;16(3):157-61.
14. Keller RL. Pulmonary Hypertension and Pulmonary Vasodilators. Clin Perinatol. 2016;43(1):187-202.
15. Lotze A, Mitchell BR, Bulas DI, Zola EM, Shalwitz RA, Gunkel JH. Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure. Survanta in Term Infants Study Group. J Pediatr. 1998;132(1):40-7.
16. González A, Fabres J, D’Apremont I, Urcelay G, Avaca M, Gandolfi C et al. Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with a moderate respiratory failure and pulmonary hypertension. J Perinatol. 2010;30(6):420-4.
17. Davidson D, Barefield ES, Kattwinkel J, Dudell G, Damask M, Straube R et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group. Pediatrics. 1998;101(3 Pt 1):325-34.
18. Roberts JD Jr, Fineman JR, Morin FC 3rd, Shaul PW, Rimar S, Schreiber MD et al. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. The Inhaled Nitric Oxide Study Group. N Engl J Med. 1997;336(9):605-10.
19. Clark RH, Kueser TJ, Walker MW, Southgate WM, Huckaby JL, Perez JA et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group. N Engl J Med. 2000;342(7):469-74.
20. Cole FS, Alleyne C, Barks JD, Boyle RJ, Carroll JL, Dokken D et al. NIH Consensus Development Conference statement: inhaled nitric-oxide therapy for premature infants. Pediatrics. 2011;127(2):363-9.
21. Shah PS, Ohlsson A.Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev. 2011;(8):CD005494.
22. Namachivayam P, Theilen U, Butt WW, Cooper SM, Penny DJ, Shekerdemian LS. Sildenafil prevents rebound pulmonary hypertension after withdrawal of nitric oxide in children. Am J Respir Crit Care Med. 2006;174(9):1042-7.
23. FDA Drug Safety Communication: FDA recommends against use of Revatio in children with pulmonary hypertension. http://www.fda.gov/ Drugs/DrugSafety/ucm317123.htm (Accessed on August 31, 2012).
24. Radicioni M, Bruni A, Camerini P. Combination therapy for life-threatening pulmonary hypertension in a premature infant: first report on bosentan use. Eur J Pediatr. 2011;170(8):1075-8.
25. Bindl L, Fahnenstich H, Peukert U.Aerosolised prostacyclin for pulmonary hypertension in neonates. Arch Dis Child Fetal Neonatal Ed. 1994;71(3):F214-6.
26. Soditt V, Aring C, Groneck P. Improvement of oxygenation induced by aerosolized prostacyclin in a preterm infant with persistent pulmonary hypertension of the newborn. Intensive Care Med. 1997;23(12):1275-8.
27. Rao S, Bartle D, Patole S.Current and future therapeutic options for persistent pulmonary hypertension in the newborn. Expert Rev Cardiovasc Ther. 2010;8(6):845-62.
28. The Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in term and near-term infants: neurodevelopmental follow-up of the neonatal inhaled nitric oxide study group (NINOS). J Pediatr. 2000 May;136(5):611-7.
29. Ellington M Jr, O’Reilly D, Allred EN, McCormick MC, Wessel DL, Kourembanas S. Child health status, neurodevelopmental outcome, and parental satisfaction in a randomized, controlled trial of nitric oxide for persistent pulmonary hypertension of the newborn. Pediatrics. 2001;107(6):1351-6.