The prenatal pulmonary hypertension is resolved postnatally by endothelial nitric oxide production. Nearly all pulmonary problems in term and near-term infants after birth are associated with some degree of pulmonary hypertension, characteristically with shunts through the ductus arteriosus and foramen ovale. These are secondary forms of PPHN. Primary forms are rare, most likely associated with intrauterine hypoxia; a correlation with primary pulmonary hypertension is speculative, a coincidence in single persons has been reported occasionally. The evidence-based therapy of PPHN is inhaled nitric oxide, which improved oxygenation in 5 large clinically controlled studies. ECMO has been proven to be beneficial in the randomized UK ECMO trial. Should patients not to be ventilated (which is essential nowadays for NO) inhaled iloprost might be an alternative; a controlled clinical study is under way. Quite frequently, infants and toddlers with chronic lung disease have a form of pulmonary hypertension (bronchopulmonary dysplasia, interstitial lung disease, cystic fibrosis). Other forms mentioned in the Evian Classifications are very rare in this age group, more frequent is pulmonary hypertension as a consequence of congenital heart disease. In patients with chronic lung disease, no evidence-based therapy to treat pulmonary hypertension exists. The standard approach is the long-term home oxygen therapy; some data indicate that iloprost or sildenafil are alternatives, however, this should be tested in the catheter lab in selected cases. The prognosis is poor. More and more cases of pulmonary hypertension in very preterm infants are reported who do not have considerable lung disease, especially in children with severe intrauterine growth retardation. Bolus application of iloprost has been reported as an ultimate rescue treatment in these patients.
|Translated title of the contribution||Special therapy of pulmonary hypertension in newborns and infants|
|Journal||Intensiv- und Notfallbehandlung|
|Number of pages||9|
|Publication status||Published - 2004|
Research Areas and Centers
- Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)