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Pulmonary hypertension of the Newborn

https://read.qxmd.com/read/38325942/pathogenesis-and-physiologic-mechanisms-of-neonatal-pulmonary-hypertension-preclinical-studies
#21
REVIEW
Karen C Young, Augusto F Schmidt, April W Tan, Lourenco Sbragia, Ahmed Elsaie, Binoy Shivanna
Neonatal pulmonary hypertension (PH) is a devastating disorder of the pulmonary vasculature characterized by elevated pulmonary vascular resistance and mean pulmonary arterial pressure. Occurring predominantly because of maldevelopment or maladaptation of the pulmonary vasculature, PH in neonates is associated with suboptimal short-term and long-term outcomes because its pathobiology is unclear in most circumstances, and it responds poorly to conventional pulmonary vasodilators. Understanding the pathogenesis and pathophysiology of neonatal PH can lead to novel strategies and precise therapies...
March 2024: Clinics in Perinatology
https://read.qxmd.com/read/38325941/pulmonary-hypertension-in-established-bronchopulmonary-dysplasia-physiologic-approaches-to-clinical-care
#22
REVIEW
Steven H Abman, Satyan Lakshminrusimha
Preterm infants with bronchopulmonary dysplasia (BPD) are prone to develop pulmonary hypertension (PH). Strong laboratory and clinical data suggest that antenatal factors, such as preeclampsia, chorioamnionitis, oligohydramnios, and placental dysfunction leading to fetal growth restriction, increase susceptibility for BPD-PH after premature birth. Echocardiogram metrics and serial assessments of NT-proBNP provide useful tools to diagnose and monitor clinical course during the management of BPD-PH, as well as monitoring for such complicating conditions as left ventricular diastolic dysfunction, shunt lesions, and pulmonary vein stenosis...
March 2024: Clinics in Perinatology
https://read.qxmd.com/read/38325940/early-pulmonary-hypertension-in-preterm-infants
#23
REVIEW
Srinivasan Mani, Hussnain Mirza, James Ziegler, Praveen Chandrasekharan
Pulmonary hypertension (PH) in preterm neonates has multifactorial pathogenesis with unique characteristics. Premature surfactant-deficient lungs are injured following exposure to positive pressure ventilation and high oxygen concentrations resulting in variable phenotypes of PH. The prevalence of early PH is variable and reported to be between 8% and 55% of extremely preterm infants. Disruption of the lung development and vascular signaling pathway could lead to abnormal pulmonary vascular transition. The management of early PH and the off-label use of selective pulmonary vasodilators continue to be controversial...
March 2024: Clinics in Perinatology
https://read.qxmd.com/read/38325939/congenital-diaphragmatic-hernia-pulmonary-hypertension-and-pulmonary-vascular-disease
#24
REVIEW
Shiran S Moore, Roberta L Keller, Gabriel Altit
This review provides a comprehensive summary of the current understanding of pulmonary hypertension (PH) in congenital diaphragmatic hernia, outlining the underlying pathophysiologic mechanisms, methods for assessing PH severity, optimal management strategies, and prognostic implications.
March 2024: Clinics in Perinatology
https://read.qxmd.com/read/38325938/asphyxia-therapeutic-hypothermia-and-pulmonary-hypertension
#25
REVIEW
Regan Geisinger, Danielle R Rios, Patrick J McNamara, Philip T Levy
Neonates with a perinatal hypoxic insult and subsequent neonatal encephalopathy are at risk of acute pulmonary hypertension (aPH) in the transitional period. The phenotypic contributors to aPH following perinatal asphyxia include a combination of hypoxic vasoconstriction of the pulmonary vascular bed, right heart dysfunction, and left heart dysfunction. Therapeutic hypothermia is the standard of care for neonates with moderate-to-severe hypoxic ischemic encephalopathy. This review summarizes the underlying risk factors, causes of aPH in neonates with perinatal asphyxia, discusses the unique phenotypical contributors to disease, and explores the impact of the initial insult and subsequent therapeutic hypothermia on aPH...
March 2024: Clinics in Perinatology
https://read.qxmd.com/read/38325937/targeted-therapies-for-neonatal-pulmonary-hypertension-beyond-nitric-oxide
#26
REVIEW
Jeanne Carroll, Rohit Rao, Robin H Steinhorn
Pulmonary hypertension in the neonatal population can be acute or chronic and carries significant risk for morbidity and mortality. It can be idiopathic but more often is associated with comorbid pulmonary and heart disease. There are several pharmacotherapeutics aimed at pulmonary vasodilation. This review highlights the most common agents as well as those on the horizon for the treatment of pulmonary hypertension in the neonate.
March 2024: Clinics in Perinatology
https://read.qxmd.com/read/38325936/pulmonary-vascular-regulation-in-the-fetal-and-transitional-lung
#27
REVIEW
Hannah Holmes, Brahmdeep S Saini, Olivia J Moir, Jack R T Darby, Janna L Morrison, Liqun Sun, Mike Seed
Fetal lungs have fewer and smaller arteries with higher pulmonary vascular resistance (PVR) than a newborn. As gestation advances, the pulmonary circulation becomes more sensitive to changes in pulmonary arterial oxygen tension, which prepares them for the dramatic drop in PVR and increase in pulmonary blood flow (PBF) that occur when the baby takes its first few breaths of air, thus driving the transition from fetal to postnatal circulation. Dynamic and intricate regulatory mechanisms control PBF throughout development and are essential in supporting gas exchange after birth...
March 2024: Clinics in Perinatology
https://read.qxmd.com/read/38310865/association-between-antenatal-antibiotic-exposure-and-bronchopulmonary-dysplasia-a-systematic-review-and-bayesian-model-averaged-meta-analysis
#28
Karen Van Mechelen, Tamara M Hundscheid, Elke van Westering-Kroon, František Bartoš, Eduardo Villamor
INTRODUCTION: Antenatal antibiotic exposure has been suggested as a risk factor for bronchopulmonary dysplasia (BPD). We aimed to summarize the evidence from randomized controlled trials (RCTs) and observational studies on this potential association. METHODS: PubMed/Medline and Embase databases were searched. BPD was classified as BPD28 (supplemental oxygen during 28 days or at postnatal day 28), BPD36 (supplemental oxygen at 36 weeks postmenstrual age), BPD36 or death, and BPD-associated pulmonary hypertension (BPD-PH)...
February 2, 2024: Neonatology
https://read.qxmd.com/read/38306954/challenges-in-clinical-identification-of-right-ventricular-dysfunction-in-preterm-infants-with-persistent-pulmonary-hypertension-of-the-newborn
#29
JOURNAL ARTICLE
Faith Zhu, Caio Barbosa de Oliveira, Nada Mohsen, Ashraf Kharrat, Poorva Deshpande, Luc Mertens, Amish Jain
BACKGROUND: Right ventricular dysfunction, typically qualitatively diagnosed (Q-RVd) in preterm infants, requires echocardiography which is not always acutely available. We aimed to identify clinical indices of Q-RVd in very preterm infants (gestational age, GA <32 weeks) with persistent pulmonary hypertension of newborn (PPHN) and examine the reliability and validity of Q-RVd. METHODS: Forty-seven infants with mean ± SD GA of 26.8 ± 2...
January 23, 2024: Early Human Development
https://read.qxmd.com/read/38301267/ddx5-targeted-epigenetic-modification-of-pericytes-in-pulmonary-hypertension-following-intrauterine-growth-restriction
#30
JOURNAL ARTICLE
Chengcheng Hang, Lu Zu, Xiaofei Luo, Yu Wang, Lingling Yan, Ziming Zhang, Kaixing Le, Yajie Huang, Lixia Ye, Yuhan Ying, Kewei Chen, Xuefeng Xu, Qiannan Lv, Lizhong Du
Newborns with intrauterine growth restriction (IUGR) have a higher likelihood of developing pulmonary arterial hypertension (PAH) in adulthood. While there is increasing evidence suggesting that pericytes play a role in regulating myofibroblast transdifferentiation and angiogenesis in malignant and cardiovascular diseases, their involvement in the pathogenesis of IUGR-related PH and the underlying mechanisms remain incompletely understood. To address this issue, a study was conducted utilizing a Sprague-Dawley (SD) rat model of IUGR-related PH...
February 1, 2024: American Journal of Respiratory Cell and Molecular Biology
https://read.qxmd.com/read/38294582/impact-of-heterozygous%C3%A2-alk1-mutations-on-the-transcriptomic-response-to-bmp9-and-bmp10-in-endothelial-cells-from-hereditary-hemorrhagic-telangiectasia-and-pulmonary-arterial-hypertension-donors
#31
JOURNAL ARTICLE
T Al Tabosh, H Liu, D Koça, M Al Tarrass, L Tu, S Giraud, L Delagrange, M Beaudoin, S Rivière, V Grobost, M Rondeau-Lutz, O Dupuis, N Ricard, E Tillet, P Machillot, A Salomon, C Picart, C Battail, S Dupuis-Girod, C Guignabert, A Desroches-Castan, S Bailly
Heterozygous activin receptor-like kinase 1 (ALK1) mutations are associated with two vascular diseases: hereditary hemorrhagic telangiectasia (HHT) and more rarely pulmonary arterial hypertension (PAH). Here, we aimed to understand the impact of ALK1 mutations on BMP9 and BMP10 transcriptomic responses in endothelial cells. Endothelial colony-forming cells (ECFCs) and microvascular endothelial cells (HMVECs) carrying loss of function ALK1 mutations were isolated from newborn HHT and adult PAH donors, respectively...
January 31, 2024: Angiogenesis
https://read.qxmd.com/read/38281939/short-term-effect-of-intravenous-treprostinil-in-term-and-preterm-infants-with-pulmonary-hypertension
#32
JOURNAL ARTICLE
Yoo-Jin Kim, Seung Han Shin, Ee-Kyung Kim, Han-Suk Kim
BACKGROUND: Pulmonary hypertension (PH) is a life-threatening condition in newborns. We aimed to assess the clinical and echocardiographic responses of term and preterm infants to treprostinil. METHODS: This retrospective study included newborns diagnosed with PH and treated with treprostinil as additional therapy after inhaled nitric oxide administration in the neonatal intensive care unit of a tertiary center. Term and preterm infants were compared in terms of echocardiographic findings and clinical findings 4 weeks after treprostinil treatment...
January 29, 2024: BMC Pediatrics
https://read.qxmd.com/read/38275461/advanced-diagnostics-of-respiratory-distress-syndrome-in-premature-infants-treated-with-surfactant-and-budesonide-through-computer-assisted-chest-x-ray-analysis
#33
JOURNAL ARTICLE
Tijana Prodanovic, Suzana Petrovic Savic, Nikola Prodanovic, Aleksandra Simovic, Suzana Zivojinovic, Jelena Cekovic Djordjevic, Dragana Savic
This research addresses the respiratory distress syndrome (RDS) in preterm newborns caused by insufficient surfactant synthesis, which can lead to serious complications, including pneumothorax, pulmonary hypertension, and pulmonary hemorrhage, increasing the risk of a fatal outcome. By analyzing chest radiographs and blood gases, we specifically focus on the significant contributions of these parameters to the diagnosis and analysis of the recovery of patients with RDS. The study involved 32 preterm newborns, and the analysis of gas parameters before and after the administration of surfactants and inhalation corticosteroid therapy revealed statistically significant changes in values of parameters such as FiO2 , pH, pCO2 , HCO3 , and BE (Sig...
January 19, 2024: Diagnostics
https://read.qxmd.com/read/38272494/ssris-in-women-of-reproductive-age-a-systematic-review-of-local-formularies
#34
JOURNAL ARTICLE
Elizabeth Lovegrove, Alice Maidwell-Smith, Beth Stuart, Miriam Santer
BACKGROUND: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of Selective Serotonin Reuptake Inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, post-partum haemorrhage (PPH) and Persistent Pulmonary Hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice...
January 25, 2024: BJGP Open
https://read.qxmd.com/read/38245631/assessment-of-hemodynamic-dysfunction-in-septic-newborns-by-functional-echocardiography-a-systematic-review
#35
Flaminia Pugnaloni, Domenico Umberto De Rose, Florian Kipfmueller, Neil Patel, Maria Paola Ronchetti, Andrea Dotta, Pietro Bagolan, Irma Capolupo, Cinzia Auriti
BACKGROUND: Neonatal sepsis remains a leading cause of mortality in neonatal units. Neonatologist-performed echocardiography (NPE) offers the potential for early detection of sepsis-associated cardiovascular dysfunction. This review examines available echocardiographic findings in septic neonates. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed prospective observational, cross-sectional, case control, and cohort studies on septic newborns with echocardiographic assessments from PubMed, Scopus and Embase...
January 20, 2024: Pediatric Research
https://read.qxmd.com/read/38218773/the-tortuous-diagnosis-of-one-case-of-neonatal-hyperthyroidism
#36
JOURNAL ARTICLE
Lin Zhu, Jing Wang, Wei Liu
OBJECTIVE: To outline the clinical signs, diagnosis, and course of care for a single case of neonatal hyperthyroidism while also summarizing common diagnostic errors related to this condition. METHODS: Medical records of the neonate of hyperthyroidism were collected and analyzed in combination with literature. RESULTS: The neonate's mother had thyroid disease, but her thyrotropin receptor antibody (TRAb) levels were not monitored during pregnancy...
January 13, 2024: BMC Pediatrics
https://read.qxmd.com/read/38212386/vasopressin-in-newborns-with-refractory-acute-pulmonary-hypertension
#37
JOURNAL ARTICLE
Simon Ouellet, Christine Drolet, Geneviève Morissette, Annie Pellerin, Audrey Hébert
BACKGROUND: Acute pulmonary hypertension (aPH) in newborns can be life threatening and challenging to manage. In newborns with refractory aPH, there is currently limited therapeutic agents. METHODS: Retrospective single-center cohort study in newborns less than one month old who were treated with vasopressin for a minimum of one hour in the context of refractory aPH in the neonatal and pediatric intensive care units of a tertiary university center between 2016 and 2022...
January 11, 2024: Pediatric Research
https://read.qxmd.com/read/38206041/respiratory-function-testing-for-guiding-ventilator-mode-conversion-in-congenital-diaphragmatic-hernia
#38
JOURNAL ARTICLE
Sasagu Kimura, Katsuaki Toyoshima, Tomoyuki Shimokaze, Kaoru Katsumata, Tomoko Saito, Rikuo Hoshino
INTRODUCTION: For patients with a congenital diaphragmatic hernia, conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) are used in initial ventilatory management. HFOV has recently been recommended as a rescue therapy; however, we use HFOV for initial ventilation management, with a preoperative challenge test for CMV conversion and respiratory function testing at the time of CMV conversion. We aimed to compare patient characteristics between CMV conversion- and HFOV-preferred treatment groups...
January 11, 2024: Pediatric Pulmonology
https://read.qxmd.com/read/38165156/lung-biopsies-in-infants-and-children-in-critical-care-situation
#39
JOURNAL ARTICLE
Yaël Levy, Lauren Bitton, Chiara Sileo, Jérôme Rambaud, Yohan Soreze, Camille Louvrier, Hubert Ducou le Pointe, Harriet Corvol, Erik Hervieux, Sabine Irtan, Pierre-Louis Leger, Blandine Prévost, Aurore Coulomb L'Herminé, Nadia Nathan
INTRODUCTION: Lung biopsy is considered as the last step investigation for diagnosing lung diseases; however, its indication must be carefully balanced with its invasiveness. The present study aims to evaluate the diagnostic yield of lung biopsy in critically ill patients hospitalized in the pediatric intensive care unit (ICU). MATERIAL AND METHODS: Children who underwent a lung biopsy in the ICU between 1995 and 2022 were included. Biopsies performed in the operating room and post-mortem biopsies were excluded...
January 2, 2024: Pediatric Pulmonology
https://read.qxmd.com/read/38150123/monitoring-persistent-pulmonary-hypertension-of-the-newborn-using-the-arterial-to-end-tidal-carbon-dioxide-gradient
#40
JOURNAL ARTICLE
Emma E Williams, Nadja Bednarczuk, Mahesh Nanjundappa, Anne Greenough, Theodore Dassios
Persistent pulmonary hypertension of the newborn (PPHN) can be monitored theoretically by the difference of the partial pressure of arterial (PaCO2 ) to end-tidal CO2 (EtCO2 ). We aimed to test the hypothesis that the PaCO2 -EtCO2 gradient in infants with PPHN would be higher compared to infants without PPHN. Prospective, observational study of term-born ventilated infants with echocardiographically-confirmed PPHN with right-to-left shunting and term-born control infants without respiratory disease. The PaCO2 -EtCO2 gradient was calculated as the difference between the PaCO2 measured from indwelling arterial sample lines and EtCO2 measured by continuous Microstream sidestream capnography...
December 27, 2023: Journal of Clinical Monitoring and Computing
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