PPHN

Persistent Pulmonary Hypertension in the Newborn

[Name of the Institute]

Persistent Pulmonary Hypertension in the Newborn

Introduction

Persistent Pulmonary Hypertension (PPHN) is a potentially life-threatening disorder in newborns characterized by pulmonary hypertension (i.e., aberrant elevation of pulmonary artery pressure) that causes poor systemic oxygenation and right-to-left extra-pulmonary shunting of blood. PPHN occurs when the pulmonary circulation fails to transition from a high-resistance state in utero to a postnatal low-resistance state that enables effective pulmonary gas exchange and oxygenation. PPHN is a potentially life-threatening clinical syndrome that results from failure of the pulmonary vasculature to dilate after birth (Bassler, Choong, McNamara, Kirpalani, 2006, 1-5). Before birth, fetal circulation bypasses the lungs; after birth, the normal physiologic process diverts circulating blood to the lungs for oxygenation and recirculation. In this essay, I will discuss a compromised neonate with persistent pulmonary hypertension of the newborn, therefore it will take into account pathophysiological, diagnostic and grading issues surrounding PPHN; I will discuss the fetal, transitional and postnatal circulation in relation to PPHN. Also, I will discuss the role of the midwife and neonatal nurse. Furthermore, I will discuss the ethical issue that came out of this care scenario. In addition, the impact that technology and medical/nursing interventions have upon the NICU environment will then be addressed, demonstrating the services that are available to the parents and multi-disciplinary team. Pseudonyms will be used to ensure confidentially as stated by the Nursing and Midwifery Council (NMC) (2010) the mother will be referred to as JV and the neonate will be referred to as baby V.

Pathophysiology

In view of determining pulmonary hypertension variables, the flow and vascular resistance should distinguish between the pathophysiological effects of acute ROP from those of constant PH. If the pH is urgent and necessary to the untrained, not hypertrophied right ventricle, then develops an acute right heart failure, known in patients with massive pulmonary embolism.

Right ventricular function determined by many factors. These include pre-load, post-load, the effect of stretching of the pericardium, intrapleural pressure, perfusion pressure, left ventricular pressure and contractility state of the inter-ventricular septum (Boxwell, 2000, 21-25). This changes result in an approximately 10-fold increase, in blood flow, because of a major resistance in the pulmonary vessels occurs. If this adjustment, vascular resistance does not occur, called persistent pulmonary hypertension of the neonate (PPHN). PPHN is a clinical syndrome that occurs with various cardio-puhnonaire disorders characterized by persistent high vascular resistance in the pulmonary vessels after birth.

Because the clinical picture, of PPHN is an expression of the lack of postnatal adaptation in the pulmonary circulation, is to understand the basic function and structural development of the pulmonary circulation in utero important to gain more insight into the clinical picture of PPHN in its treatment (Shah, Ohlsson, 2011, 3-36).

Etiologies associated with PPHN

PPHN can be caused by one or more pharmacologic, anatomic, or environmental insults to the fetus or neonate, including.

Meconium (i.e., fetal stool) aspiration pneumonitis.

Diaphragmatic hernia.

Neonatal sepsis.

Chronic intrauterine hypoxia.

Hypothermia.

Premature closure of fetal, ductus, arteriosus (i.e., an artery connecting the aorta to the pulmonary artery, which allows circulating ...