Pulmonary Hypertension

DEFINITION

Pulmonary hypertension is a condition where blood vessels in the lungs constrict newborn and cause a reduction in the amount of blood flowing to the lungs so that blood oxygen levels become very low and can be fatal.

CAUSE

The fetus does not breathe, so that blood does not have to flow through the lungs so much oxygen. Many fetal blood that flows directly from the right side of the heart to the left side of the heart through a hole between the two atria of the heart (foramen ovale).

Blood on the right side of the heart, of the pulmonary arteries mostly flow into the aorta through a blood vessel that connects two major vessels, namely the ductus arteriosus. Only a small portion of blood to the lungs.

At birth, the foramen ovale and ductus arteriosis close and blood flows from the right side of the heart to the lungs. But in some babies, the blood vessels in the lungs constrict so foramen ovale remains open; ductus arteriosus may also remain open. If this is the case, then the blood to the lungs only slightly so that the baby's blood oxygen levels are very low.

Pulmonary hypertension is more common in post-mature infants or infants whose mothers had taken aspirin or indomethacin. This situation is more common in infants suffering from lung diseases, such as meconium aspiration syndrome or pneumonia, but it can also occur in infants whose lungs normal.

SYMPTOMS

Sometimes persistent pulmonary hypertension occurs at birth, but can also appear after the first day or two after birth. The symptoms can be found:

·         Baby's breathing is usually rapid. Difficulty breathing may occur terrific if the newborn had lung problems underlying.

·         Blue or pale skin due to low oxygen levels in the blood

·         Weak pulse and rapid heartbeat

DIAGNOSIS

Allegations of persistent pulmonary hypertension based on existing symptoms and results of a physical examination, which is supported by the history of the use of aspirin or indomethacin by a mother for a long time during pregnancy or difficulties in childbirth.

Examination Chest x-rays may be normal if there is no underlying lung disorder. A definitive diagnosis requires echocardiography to assess the pressure in the pulmonary artery.

TREATMENT

Infants are usually placed in the room which has a 100% oxygen levels, or in severe cases, given the ventilator with 100% oxygen. High oxygen levels in the blood to help open the pulmonary artery.

In the case of very heavy, gas nitric oxide in very small concentrations can be added to the baby's oxygen inhaled. Nitric oxide opens the arteries in the lungs of infants and reduces pulmonary hypertension. This therapy may be needed for a few days.

In rare cases, if all therapy is not successful or if the baby's condition is very critical, then rotated the baby's blood through a heart-lung machine (membrane oxygenator) which functions to add oxygen to the blood and remove carbon dioxide from the blood; then the blood is returned to the baby's body.

REFERENCE

- K, Arthur E. Persistent Pulmonary Hypertension. Merck Manual Handbook. 2009.

- NYU Langone Medical Centre. Persistent Pulmonary Hypertension of the Newborn. 2013.