What Is Persistent Pulmonary Hypertension of the Newborn?
Learn more about PPHN, and your options for moving forward
Persistent Pulmonary Hypertension of the Newborn (PPHN) disrupts the normal expected flow of blood to the lungs of the infant immediately after birth. During the process of birth, the blood pressure in the lungs of the infant normally drops to a level that coincides with typical blood flow circulation when the baby is breathing on its own. When PPHN is present, the condition of fetal blood flow circulation returns which bypasses the lungs, leaving the baby unable to breathe, leading to potentially serious birth injuries if not diagnosed and treated promptly.
Persistent pulmonary hypertension often affects babies born at 34 weeks or greater. Babies born at full-term may experience a type of breathing issue other than PPHN. About 1 in 500 infants are born with PPHN.
Causes of PPHN
A range of factors and existing conditions can precipitate persistent pulmonary hypertension of the newborn (PPHN). These include:
- Low blood sugar
- Fetal respiratory distress syndrome
- Birth asphyxia (deprivation of oxygen during delivery)
- Maternal infection passed to the unborn child
- Underdeveloped lungs or abnormal lung growth
- Meconium aspiration
- Antidepressant medications in the mothers’ system during pregnancy (specifically, selective serotonin reuptake inhibitors, including Prozac, Zoloft, and Paxil)
Symptoms of PPHN
Neonatal pulmonary hypertension often leads to the condition of hypoxemia, in which blood flow in the child’s body is reduced resulting in an unusually low level of oxygen. If the condition is not treated, the child can experience serious respiratory distress with the skin turning bluish in color. Most cases of PPHN manifest within the initial 12 hours post-delivery. A number of the most common symptoms indicating the presence of PPHN include:
- Arduous breathing
- Respiratory distress (including tachypnea)
- Rapid breathing (tachycardia)
- Rapid heart rate
- Blue tinted skin (cyanosis)
- Harsh systolic heart murmur with tricuspid regurgitation
- Low oxygen levels in blood
- Abnormally low blood pressure (systemic hypotension)
- Meconium staining mixed with amniotic fluid before the baby’s birth
Doctors and medical professionals must diagnose PPHN as quickly as possible in order to help avoid devastating birth injury results for the infant. Failure to do so may serve as grounds for a birth injury lawsuit. Some of the diagnostic tests and medical procedures commonly used to determine the presence of PPHN include:
- Chest x-ray
- Arterial blood gas levels test
- Complete blood count
Complications of PPHN
Leaving PPHN untreated or delaying treatment of the condition, can introduce severe complications for the newborn – some of which may be permanent in nature. Some of these complications include:
- Brain hemorrhage
- Brain damage
- Heart failure
- Cognitive impairment
- Kidney damage or failure
- Hearing loss
- Developmental delays
- Cerebral palsy
- Anoxic or hypoxic brain injury
Any failure of medical professionals to diagnose the symptoms of PPHN, administer necessary tests, and provide prompt treatment, may subject the baby to one or more of the above-mentioned complications. The worst-case scenarios related to PPH and involve the failure of multiple organs or even the infant’s death.
Persistent pulmonary hypertension is often easy to detect at birth. However, sometimes the condition develops within 24 to 48 hours after delivery. Rapid breathing or respiratory distress in the infant may indicate the condition of PPHN. In other instances, the newborn’s skin will appear bluish in color due to extremely low oxygen levels in the bloodstream. Low blood pressure (hypertension) may accompany skin that has a gray, blue hue to it.
If the mother went through a strenuous delivery and also received high dosages of aspirin or indomethacin for an extended period of time during pregnancy, the obstetrician may have some doubts that the child is suffering from PPHN. Diagnosing PPHN can be challenging when respiratory distress or other noticeable indications exist, yet x-rays reveal no underlying problem with the function of the lungs or internal organs. It’s often necessary to conduct an array of tests including an echocardiogram to get a clear picture of the infant’s pulmonary arteries.
The doctor may want to check the baby’s blood flow circulation through the use of a cardiac ultrasound test. The data recorded from this test can be used to create a treatment plan to relax the lungs’ blood vessels, enhance oxygen levels in the blood flow, and maintain normal blood pressure. The results of the test may lead the doctor to the diagnosis of an underlying ailment that is aggravating the condition such as meconium aspiration syndrome, neonatal pneumonia, or a congenital diaphragmatic hernia.
Other tests doctors may use to verify a diagnosis of PPHN in the newborn infant include:
- Ultrasound Test – used to discover any hemorrhaging in the brain associated with PPHN
- Arterial Blood Gas Test – used to assess the oxygen delivered throughout the body
- Lumbar Puncture – this is a spinal tap to verify or rule out the presence of an infection
- Serum Electrolyte Test – produces important data on blood associated mineral balances
- Pulse Oximetry – these measurements calculate the oxygen level in the bloodstream to verify whether or not the baby is receiving enough oxygen throughout its body
In order to treat the infant properly for the birth injury of PPHN, doctors must ensure the baby is receiving all of the oxygen it needs to survive. Doctors may also recommend and administer nitric oxide to help the infant’s body use the available oxygen. A special ventilator may also be part of the treatment plan, enabling the baby to breathe normally. Severe cases of PPHN may require a temporary heart-lung bypass in order to give the child enough time to recover from the condition.
The most frequently used methods of treating PPHN in infants include:
- Regular maintenance of the baby’s blood pressure
- Providing nutritional support
- Using noninvasive procedures instead of invasive procedures when possible with the same results
- Monitoring on a continuous basis the baby’s oxygenation levels and blood pressure
- Minimally handling the baby during recovery
- Correcting the infant’s glucose and electrolyte abnormalities acquired from the defect
Therapeutic methods are also often employed when one or more of the above treatments are provided.
These are many of the injuries our clients’ children have sustained
Claims for medical malpractice involving PPHN injuries
If your newborn was delivered with the condition of persistent pulmonary hypertension, and as a result suffered serious or even permanent injury such as cerebral palsy, developmental delays, seizures, or hearing loss, we can help. Our team at Crandall & Pera Law has the resources and know-how to determine any responsible parties who may have provided negligent care to your infant. If this is the case, we can advocate strongly on your behalf for any compensation you are owed for the losses your family has endured as a result. We have you covered in Ohio and Kentucky. To arrange a free, initial consultation, call us today at 877.955.0020 or complete our contact form.