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. 2023 Oct;40(14):1495-1508.
doi: 10.1055/a-1711-0778. Epub 2021 Dec 1.

Evidence-Based Guidelines for Acute Stabilization and Management of Neonates with Persistent Pulmonary Hypertension of the Newborn

Molly K Ball  1   2 , Ruth B Seabrook  1   2 , Elizabeth M Bonachea  1   2 , Bernadette Chen  1   2   3 , Omid Fathi  1   2 , Craig A Nankervis  1   2 , Ahmed Osman  1   2 , Amy B Schlegel  1   2 , Jacqueline Magers  4 , Taylor Kulpa  5 , Paula Sharpin  5 , Mary Lindsay Snyder  5 , Robert J Gajarski  1   6 , Deipanjan Nandi  1   6 , Carl H Backes Jr  1   2   6   7
Affiliations

Evidence-Based Guidelines for Acute Stabilization and Management of Neonates with Persistent Pulmonary Hypertension of the Newborn

Molly K Ball et al. Am J Perinatol. 2023 Oct.

Abstract

Persistent pulmonary hypertension of the newborn, or PPHN, represents a challenging condition associated with high morbidity and mortality. Management is complicated by complex pathophysiology and limited neonatal specific evidence-based literature, leading to a lack of universal contemporary clinical guidelines for the care of these patients. To address this need and to provide consistent high-quality clinical care for this challenging population in our neonatal intensive care unit, we sought to develop a comprehensive clinical guideline for the acute stabilization and management of neonates with PPHN. Utilizing cross-disciplinary expertise and incorporating an extensive literature search to guide best practice, we present an approachable, pragmatic, and clinically relevant guide for the bedside management of acute PPHN. KEY POINTS: · PPHN is associated with several unique diagnoses; the associated pathophysiology is different for each unique diagnosis.. · PPHN is a challenging, dynamic, and labile process for which optimal care requires frequent reassessment.. · Key management goals are adequate tissue oxygen delivery, avoiding harm..

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Conflict of interest statement

O.F. reports payment or honoraria from the University of Florida, Jacksonville Honorarium for Pediatric Grand Rounds presented at UF Jacksonville in January 2020, “Building & Implementing a Small Baby Program.” O.F. reports support from Atom Medical (Tokyo, Japan) for travel and lodging to visit NICUs in Japan in October 2019 and collaborate on the care of extremely preterm infants. M.K.B. reports monetary support for travel/meeting attendance for NeoHeart 2019, to present as conference faculty. M.K.B. reports leadership or fiduciary role for Neonatal Cardiac Special Interest Group, Children's Hospital Neonatal Consortium.

Figures

Figure 1:
Figure 1:. Comprehensive clinical care guideline for acute stabilization PPHN not associated with CDH
*** Relative contra-indications to pulmonary vasodilator therapies: severe left ventricular dysfunction, obstructed total anomalous pulmonary venous return, critical congenital heart disease with systemic perfusion dependent upon right-to-left shunting across the ductus arteriosus. Abbreviations: PPHN=persistent pulmonary hypertension of the newborn, CDH=congenital diaphragmatic hernia, UAC=umbilical arterial line, BP=blood pressure, UOP=urine output, MAS=meconium aspiration syndrome, OI=oxygenation index, MAP=mean airway pressure, HFOV=high frequency oscillatory ventilation, CCHD=critical congenital heart disease, PFO=patent foramen ovale, PDA=patent ductus arteriosus, PA=pulmonary artery, RV=right ventricle, LV=left ventricle, TAPVR=total anomalous pulmonary venous return, R=right, L=left, PVR=pulmonary vascular resistance, SVR=systemic vascular resistance, IV=intravenous, IH=inhaled, HR=heart rate, bpm=beats per minute
See this image and copyright information in PMC

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