PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (Treatment)

1. Goals: Maintain systemic blood pressure to overcome right-to-left shunt and decrease pulmonary vascular resistance to facilitate oxygenation. 2. Supportive therapies a. Inotropic and vasopressor agents – To support cardiac function and maintain systemic blood pressure b. Sedatives/analgesics – Agitation and pain can worsen pulmonary vasoconstriction. c. Neuromuscular blocking agents – Usually reserved for neonates who respond inadequately to appropriate sedation/analgesia d. Surfactant replacement

i. Shown to improve oxygenation and reduce need for extracorporeal membrane oxygenation (ECMO) when PPHN is secondary to RDS, pneumonia/sepsis, or meconium aspiration (i.e., disease states in which surfactant deficiency/inactivation occurs) ii. Greatest benefit in those with relatively mild disease e. ECMO – May be indicated for severe pulmonary hypertension