Neonatal and Postneonatal Pulmonary Hypertension

During transition at birth with ventilation of the lungs, pulmonary vascular resistance (PVR) decreases from high fetal values, leading to an 8 to 10-fold increase in pulmonary blood flow (Qp). In some infants, this transition does not occur, resulting in pulmonary hypertension (PH). In infants, PH can present as: (a) primary PH in term neonates (idiopathic), (b) PH secondary to lung disease or hypoplasia in term infants, (c) acute PH in preterm infants with respiratory distress syndrome (RDS), (d) chronic PH with bronchopulmonary dysplasia (BPD) in preterm infants and (e) post-neonatal PH. A hemodynamically significant patent ductus arteriosus (PDA) can exacerbate PH in preterm infants due to increased Qp. Pulmonary vein stenosis (PVS) can complicate BPD with PH. Diagnosis of PH is based on clinical features, echocardiography and, in some intractable cases, cardiac catheterization. Therapy of PH includes oxygen, invasive or non-invasive ventilation, correction of acidosis, surfactant and selective and non-selective pulmonary vasodilators such as inhaled nitric oxide and sildenafil, respectively. Early closure of a hemodynamically significant PDA has the potential to limit pulmonary vascular remodeling associated with BPD and PH. The role of thiamine in pathogenesis of PH is also discussed with the recent increase in thiamine-responsive acute pulmonary hypertension in early infancy. Recognition and prompt therapy of PH can prevent right ventricular dysfunction, uncoupling and failure

Acidosis · Anesthesia · Bronchopulmonary dysplasia · Cardiology · Dilator · Ductus arteriosus · Gestational age · Hemodynamics · Nitric oxide · Pregnancy · Pulmonary hypertension · Respiratory distress · Sildenafil · Vascular resistance · Congenital Diaphragmatic Hernia Studies · Congenital Heart Disease Studies · Medicine · Neonatal Respiratory Health Research · Internal Medicine

• Inhaled Nitric Oxide at Birth Reduces Pulmonary Vascular Resistance and Improves Oxygenation in Preterm Lambs

  Open Access•Satyan Lakshminrusimha, Sylvia F Gugino et al.•Children•2021

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• The Impact of Antenatal and Postnatal Factors on the Development of the Pulmonary Microvasculature in Preterm Infants

  Open Access•Raluca Chirculescu, Ruxandra Stănculescu et al.•Children•2025

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• Targeted Therapy for Pulmonary Hypertension in Premature Infants

  Open Access•Shannon N Nees, Erika B Rosenzweig et al.•Children•2020

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• Bidirectional Ductal Shunting and Preductal to Postductal Oxygenation Gradient in Persistent Pulmonary Hypertension of the Newborn

  Open Access•Amy Lesneski, Morgan Hardie et al.•Children•2020

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• Nicu Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change

  Open Access•Erika M Edwards, Satyan Lakshminrusimha et al.•Children•2019

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