In the womb, we get fresh oxygen from our mothers through the placenta. Once we are born, our newborn lungs miraculously take over. Sometimes, however, this transition does not go smoothly, a condition called persistent pulmonary hypertension (PPHN for short). In cases of PPHN, blood does not flow into the baby’s lungs like it should, cutting off the baby’s oxygen supply, a potentially serious – even fatal – birth injury. There are even long-term disabilities that can result from PPHN, which might go undetected for some time.
What is PPHN?
When we are in the womb, our tiny fetal lungs do not play a role in breathing or circulation. We get fresh, oxygen-rich blood from our mothers through the placenta. Our circulatory system takes a route that bypasses our lungs, which are full of fluid at this time and not yet functioning. When we are born, the circulatory system reroutes the blood flow into our own lungs for fresh air, the fluid is expelled, and our own lungs take over.
For reasons that are not fully understood, this transfer does not always happen properly, and our circulation continues to bypass our newborn lungs and flow like it did in the womb. As a result, the lungs do not function fully if at all. This is PPHN. Without fresh air from the placenta or the baby’s lungs, there is a risk of respiratory failure, which can be fatal, or it can cause damage to the newborn’s vital organs, which desperately need oxygen. Even short periods without good circulation can cause significant organ damage.
The most serious risk is multi-organ damage due to oxygen deprivation. Severe respiratory failure can occur, which can be fatal. Some cases are fairly mild, but persistent cases of PPHN can require intensive care. Over recent decades, medicine has made advancements in managing PPHN, but the mortality rate still remains approximately 10% for moderate to severe cases of PPHN. There are also potential long-term effects of PPHN that may not be apparent until families have left the hospital. According to the National Institutes of Health, “studies identified a significant risk of hearing loss and neuro-developmental impairments among survivors of PPHN. Late onset hearing loss has been identified in infants that initially pass their hearing screen prior to discharge from the NICU.”
Risk Factors for PPHN
According to the National Institutes of Health, PPHN occurs in approximately two of every 1,000 live births. It is most common in full-term babies or babies born after their due dates, but it can occur in premature babies as well. Although the cause of PPHN remains elusive, the main risk factor appears to be when the baby has a congenital pulmonary (lung) disease. Environmental factors and medications might also play a role in the occurrence of PPHN. According to the Archives of Cardiovascular Disease, “Prenatal cigarette smoke has been found to increase the risk of PPHN among premature infants less than 30 weeks gestational age, suggesting a toxic effect on the pulmonary vascular development and maturation.”
Medications Associated with PPHN
The Archives of Cardiovascular Disease also reported associations between PPHN and certain medications given to mothers during pregnancy. These include non-steroidal anti-inflammatory medicines and selective serotonin receptor inhibitors.
Symptoms of PPHN in the Newborn
According to Stanford Children’s Health, the symptoms of PPHN will vary from one child to another, including the following:
- Looks sick at birth or in the first hours after birth
- Lips and skin look blue (cyanosis)
- Fast breathing
- Fast heart rate
- Low blood oxygen levels while getting 100% oxygen
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