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Persistent Pulmonary Hypertension

What is persistent pulmonary hypertension (PPHN)?

Persistent pulmonary hypertension (PPHN) is also known as persistent fetal circulation. In this condition, a newborn baby's circulation changes back to the circulation of a fetus, where much of the blood flow bypasses the lungs.

Who is affected by persistent pulmonary hypertension?

About one in every 500 to 700 babies develops PPHN. It occurs most often in full-term or post-term babies after a difficult birth, or birth asphyxia (a condition that results from too little oxygen).

What causes persistent pulmonary hypertension?

During pregnancy, the fetal lungs are not used to exchange oxygen and carbon dioxide, so the lungs need less blood supply. The fetal circulation sends most of the blood supply away from the lungs through special connections in the heart and the large blood vessels. When a baby begins to breathe air at birth, this fetal circulation changes dramatically. The change in pressure in the lungs helps close the fetal connections and redirect the blood flow. Now blood is pumped to the lungs to help with the exchange of oxygen and carbon dioxide.

Illustration demonstrating fetal circulation
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When a baby has lowered oxygen levels or difficulty breathing at birth, these changes may not occur and the baby's circulation returns back to the fetal system with blood directed away from the lungs. The lung pressure stays high. That is why this condition is called persistent pulmonary hypertension.

Why is persistent pulmonary hypertension a concern?

When blood is shunted away from the baby's lungs, it is difficult for the lungs to do the work of exchanging oxygen and carbon dioxide. Even breathing air with 100 percent oxygen, babies with PPHN have low blood oxygen levels. This can be serious, as all of the body's organs are dependent on oxygen-rich blood being pumped to them and may become damaged from lack of oxygen.

What are the symptoms of persistent pulmonary hypertension?

The following are the most common symptoms of persistent pulmonary hypertension. However, each baby may experience symptoms differently. Symptoms may include:

The symptoms of PPHN may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is persistent pulmonary hypertension diagnosed?

In addition to a complete medical and delivery history and physical examination at birth, diagnostic procedures for PPHN may include:

Treatment for persistent pulmonary hypertension:

Specific treatment for persistent pulmonary hypertension will be determined by your baby's physician based on:

Treatment may include:

Treatment of PPHN is aimed at increasing the oxygen to the rest of the body systems. Long-term health problems may be related to damage from lowered oxygen in the body.

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