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Persistent pulmonary hypertension in the newborn

Narongsak Nakwan, Suksham Jain, Kishore Kumar, Shigeharu Hosono, Majeda Hammoud, Yasser Yahia Elsayed, Shabina Ariff, Babar Hasan, Waqar Khowaja, Poom Woei Bing
OBJECTIVES: To explore the incidence, etiologies, diagnostic methods, treatment options and outcomes in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to identify mortality risk factors in a study from six Asian countries. METHODS: A retrospective chart review of patients with documented PPHN from seven centers in six Asian countries (Japan, Kuwait, India, Pakistan, Singapore, and Thailand) between 1 January, 2014 and 31 December, 2016, was performed...
October 14, 2018: Journal of Maternal-fetal & Neonatal Medicine
Manon Gijtenbeek, Enrico Lopriore, Sylke J Steggerda, Arjan B Te Pas, Dick Oepkes, Monique C Haak
BACKGROUND: Newborns with anemia are at increased risk of persistent pulmonary hypertension of the newborn (PPHN), yet reports on the association between fetomaternal hemorrhage (FMH) and PPHN are rare. To optimize care for pregnancies complicated by FMH, clinicians should be aware of the risks of FMH and the possible diagnostic and therapeutic options. To increase the current knowledge, the incidence of PPHN and short-term neurologic injury in FMH cases were studied. STUDY DESIGN AND METHODS: We included all FMH cases (≥30 mL fetal blood transfused into the maternal circulation) admitted to our neonatal unit between 2006 and 2018...
October 13, 2018: Transfusion
Shinsuke Hoshino, Junpei Somura, Ouki Furukawa, Takahide Yanagi, Yoshihiro Maruo
The combination of persistent pulmonary hypertension of the newborn (PPHN) and transposition of the great arteries (TGA) has serious impacts on treatment and prognosis, often with adverse outcomes. We report the case of a male full-term newborn with TGA with intact ventricular septum and severe PPHN who died 2 h after birth; further, we examined his vascular histology. On autopsy, lung histology showed mild fibrous hypertrophy in the intima and moderate medial hypertrophy of the minimal pulmonary artery. Hypoplasia of the pulmonary artery was not detected...
May 2018: Journal of Cardiology Cases
Anurag Singh Sikarwar, Martha Hinton, Kallivalappil Thomas Santhosh, Premnath Dhanaraj, Mariel Talabis, Prashen Chelikani, Shyamala Dakshinamurti
OBJECTIVE: Persistent pulmonary hypertension of the newborn (PPHN) features hypoxemia, pulmonary vasoconstriction and impaired cardiac inotropy. We reported low basal and stimulated cAMP in hypoxic pulmonary artery smooth muscle cells (PASMC). We now examine pulmonary arterial adenylyl cyclase (AC) activity and regulation in hypoxic PPHN. APPROACH: PPHN was induced in newborn swine by normobaric hypoxia (FiO2 0.10) for 72hr; age-matched normoxic controls. We studied relaxation of pulmonary arterial rings to AC activator forskolin and sGC activator sodium nitroprusside (SNP) by isometric myography; ATP content, phosphodiesterase activity, AC content, isoform expression and catalytic activity in presence or absence of Gαs-coupled receptor agonists, forskolin, or trans-nitrosylating agents, in human and neonatal porcine PASMC, and HEK293T stably expressing AC isoform 6, after 72 hour hypoxia (10% O2) or normoxia (21% O2)...
September 20, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
Dina Johar, Sameh Magdeldin
Pulmonary artery hyperplasia is the result of proliferation of the pulmonary arterial smooth muscles (PASM). Hypoxia-induced PASM proliferation in the fetus and the newborn is the primary cause of persistent pulmonary hypertension of the newborn (PPHN). This study was performed to characterize the utility of the Laser Scanning Cytometry (LSC) method in elucidating arterial cytoskeletal remodeling in an in vitro model of PPHN. The aim was to demonstrate the following: (a) LSC is a valid method for the analysis of nuclear and cytosolic fluorescence and (b) the cumulative effects of mechanical stretch together with hypoxia promote reactive oxygen species (ROS) formation...
September 13, 2018: Hypertension Research: Official Journal of the Japanese Society of Hypertension
Shigeo Iijima, Daizo Ueno, Toru Baba, Akira Ohishi
BACKGROUND: Although persistent pulmonary hypertension of the newborn (PPHN) and infantile hypertrophic pyloric stenosis (HPS) are both well-known diseases that occur in early infancy, PPHN complicated by HPS is rare. As nitric oxide (NO) is an important mediator of biological functions, on both the vascular endothelium and smooth muscle cells, the decreased production of NO might play a role in the pathogenesis of both PPHN and HPS. We present the case of a neonate who developed HPS following PPHN, including a detailed review on research published to date, and we discuss the pathogenesis of PPHN and HPS...
September 3, 2018: BMC Pediatrics
Reem Masarwa, Benjamin Bar-Oz, Einat Gorelik, Shimon Reif, Amichai Perlman, Ilan Matok
OBJECTIVE: There is a marked increase in the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the last decade. Many newborns are likely to be exposed during pregnancy and labor. We aimed to evaluate the association between exposure to SSRIs and SNRIs during pregnancy and the risk for persistent pulmonary hypertension of the newborn (PPHN). To compare the risk for PPHN between specific SSRI agents. DATA SOURCES: MEDLINE, EMBASE, and Cochrane were searched up to July 2017...
August 28, 2018: American Journal of Obstetrics and Gynecology
V R Viraraghavan, Sushma Nangia, B H Prathik, Babu S Madarkar, Deepshika Rani, Arvind Saili
BACKGROUND: Delivery room management of infants born via meconium-stained amniotic fluid (MSAF) is quite controversial. No study has tried to quantify the amount of meconium that can be aspirated from the trachea of a non-vigorous neonate born through MSAF. AIMS: To study the yield of meconium in non-vigorous neonates born through MSAF undergoing endotracheal (ET) suctioning. METHODS: This was a prospective observational study conducted from 1 March 2015 to 31 October 2015...
August 30, 2018: Paediatrics and International Child Health
Y N Prashantha, P N Suman Rao, Saudamini Nesargi, B S Chandrakala, Kalyan Chakravarthy Balla, A Shashidhar
BACKGROUND: Different methods have been used for therapeutic hypothermia for neonates with moderate-to-severe hypoxic ischaemic encephalopathy (HIE). As standard cooling devices are expensive, there is a need to establish the safety and efficacy of low-cost devices such as ice packs (IP) and phase changing material (PCM). AIM: To assess the efficacy and safety of therapeutic hypothermia (TH) and the clinico-laboratory profile of neonates who underwent cooling with IP or PCM...
August 15, 2018: Paediatrics and International Child Health
Emi Hamajima, Masahiro Noda, Emina Nai, Satoka Akiyama, Yoji Ikuta, Natsuko Obana, Takahiro Kawaguchi, Kenta Hayashi, Kunihiro Oba, Tomohiro Yoshida, Tatsuo Katori, Masayuki Kokaji
This case report describes a male neonate with Graves' disease. The mother's pregnancy was complicated by poorly controlled Graves' disease. The neonate was diagnosed with thyroxine (T3)-predominant Graves' disease with low free triiodothyronine (T4) and high free T3 during antithyroid drug therapy. The patient also presented with persistent pulmonary hypertension of the newborn due to hyperthyroidism and airway stenosis caused by goiter. It was difficult to control thyroid function and maintain free T4 levels with inorganic iodine, thiamazole, and levothyroxine sodium hydrate...
2018: Clinical Pediatric Endocrinology: Case Reports and Clinical Investigations: Official Journal of the Japanese Society for Pediatric Endocrinology
Willem P de Boode, Yogen Singh, Zoltan Molnar, Ulf Schubert, Marilena Savoia, Arvind Sehgal, Philip Levy, Patrick McNamara, Afif El-Khuffash
Pulmonary hypertension contributes to morbidity and mortality in both the term newborn infant, referred to as persistent pulmonary hypertension of the newborn (PPHN), and the premature infant, in the setting of abnormal pulmonary vasculature development and arrested growth. In the term infant, PPHN is characterized by the failure of the physiological postnatal decrease in pulmonary vascular resistance that results in impaired oxygenation, right ventricular failure, and pulmonary-to-systemic shunting. The pulmonary vasculature is either maladapted, maldeveloped, or underdeveloped...
July 2018: Pediatric Research
G Liu, H-W Wu, Z-G Li
OBJECTIVE: To explore the effect of sildenafil combined with inhalational nitric oxide (NO) therapy on the curative effects and serum levels of hypoxia-inducible factor (HIF)-1α, endothelin-1 (ET-1), and calcium in persistent pulmonary hypertension of the newborn (PPHN). PATIENTS AND METHODS: Eighty-six patients with neonatal pulmonary hypertension treated in Xuzhou Children's Hospital from March 2015 to February 2016 were randomly divided into the observation group and control group, treated with sildenafil and sildenafil combined with inhalational NO, respectively...
July 2018: European Review for Medical and Pharmacological Sciences
Jayalaxmi Shripati Aihole, Aruna Gowdra, Deepak Javaregowda, Vinay Jadhav, M Narendra Babu, Ravidra Sahadev
Background: Congenital diaphragmatic hernia (CDH) is a complex developmental defect having a multifactorial etiology; i majority of cases (~80%), the cause is not known. Survival rates for patients with CDH have increased over the past decade with early prenatal detection and better postnatal management including surgery. Clinical profile and the outcome of 83 CDH neonates were studied and analyzed over a period of 12 years in our institute. Aims and Objectives: The clinical study was to analyze the clinical profile and outcome of CDH among the neonates in a tertiary care referral neonatal and pediatric center in Karnataka, India...
July 2018: Journal of Indian Association of Pediatric Surgeons
Kaashif Aqeeb Ahmad, Jesse Banales, Cody Lance Henderson, Susanne Erika Ramos, Katherine Marie Brandt, George Charles Powers
OBJECTIVES: Evaluate the short-term effects of IV epoprostenol in neonates with persistent pulmonary hypertension (PPHN) of the newborn. STUDY DESIGN: We reviewed 36 patients with inhaled nitric oxide (iNO) refractory PPHN placed on IV epoprostenol from 2010 to 2015. Patients were categorized as responders or non-responders (who either died or required extracorporeal membranous oxygenation). RESULTS: There were 15 responders and 21 non-responders...
September 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Douglas Bush, Csaba Galambos, D Dunbar Ivy, Steven H Abman, Kristine Wolter-Warmerdam, Francis Hickey
OBJECTIVES: To determine the incidence, characteristics of, and risk factors contributing to the development of pulmonary hypertension in children with Down syndrome. STUDY DESIGN: This retrospective, review of a large cohort (n = 1242) of children with Down syndrome receiving care at a specialized referral center evaluated clinical data and serial echocardiograms from a clinic database and electronic medical records. Pulmonary hypertension characteristics and comorbidities were reviewed...
July 17, 2018: Journal of Pediatrics
Xingrao Ke, Hollis Johnson, Xigang Jing, Teresa Michalkiewicz, Yi-Wen Huang, Robert H Lane, Girija G Konduri
Decreased expression of endothelial nitric oxide synthase (eNOS), a key mediator of perinatal transition, characterizes persistent pulmonary hypertension of the newborn (PPHN) in neonates and a fetal lamb model; the mechanisms are unclear. We investigated whether increased DNA CpG methylation at the eNOS promoter in estrogen response elements (EREs) and altered histone code together contribute to decreased eNOS expression in PPHN. We isolated pulmonary artery endothelial cells (PAEC) from fetal lambs with PPHN induced by prenatal ductus arteriosus constriction from 128 to 136 days gestation or gestation-matched twin controls...
October 1, 2018: Physiological Genomics
Yu Han Koh, Rebecca Cooksey, Peter Prager
We report a case of a male, term newborn with known left congenital diaphragmatic hernia (CDH) who presented with circulatory compromise requiring maximal inotropic support in the first 24 hours of life. Repeat X-ray at 24 hours showed pneumatosis intestinalis. Emergency laparotomy was performed for suspected necrotising enterocolitis. The terminal ileum to the sigmoid colon were frankly necrotic with multiple perforations. Subtotal colectomy was performed. Although the recovery was protracted, the baby had a favourable outcome with progressive weight gain on follow-up at 3, 6 and 9 months of age...
June 28, 2018: BMJ Case Reports
Dyuti Sharma, Hélène Coridon, Estelle Aubry, Ali Houeijeh, Véronique Houfflin-Debarge, Rémi Besson, Philippe Deruelle, Laurent Storme
Persistent pulmonary hypertension (PPHN) remains a severe complication of the transition to extra-uterine life with significant morbidity and mortality in the newborns. Dehydroepiandrosterone (DHEA) represents a new pharmacological agent with vascular effects, including improvement of PPHN in several animal models. We hypothesized that DHEA could decrease pulmonary vascular resistance (PVR) in the pulmonary circulation of fetal sheep. We studied the effect of intravenous infusion of DHEA in fetal lambs using chronically instrumented sheep at 128 days of gestation...
2018: PloS One
Narongsak Nakwan
Persistent pulmonary hypertension of the newborn (PPHN) is a complication of several respiratory diseases characterized by an elevation in pulmonary vascular resistance with resultant right-to-left shunting of blood and severe hypoxemia in the neonatal period. PPHN carries a high rate of morbidity and mortality, particularly in limited-resource settings (low-income and/or developing country). Echocardiography remains the gold standard for diagnosis of PPHN. Modern therapies such as inhaled nitric oxide, high-frequency oscillatory ventilation, extracorporeal membrane oxygenation, and/or other pulmonary vasodilators agents can reduce the mortality rate of PPHN...
June 19, 2018: American Journal of Perinatology
Martina A Steurer, Scott Oltman, Rebecca J Baer, Sky Feuer, Liang Liang, Randi A Paynter, Larry Rand, Kelli K Ryckman, Roberta L Keller, Laura L Jelliffe-Pawlowski
BACKGROUND: There is an emerging evidence that pulmonary hypertension is associated with amino acid, carnitine, and thyroid hormone aberrations. We aimed to characterize metabolic profiles measured by the newborn screen (NBS) in infants with persistent pulmonary hypertension of the newborn (PPHN) METHODS: Nested case-control study from population-based database. Cases were infants with ICD-9 code for PPHN receiving mechanical ventilation. Controls receiving mechanical ventilation were matched 2:1 for gestational age, sex, birth weight, parenteral nutrition administration, and age at NBS collection...
June 12, 2018: Pediatric Research
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