Diagnosis and management of pulmonary hypertension of the newborn

Persistent pulmonary hypertension of the newborn (PPHN) is a clinical condition associated with significant mortality and morbidity unless managed quickly and expertly. PPHN occurs following failure of normal postnatal adaptation of the fetal circulation. If pulmonary pressures fail to reduce following birth the resulting pulmonary hypertension leads to right to left shunting of blood which will lead to hypoxaemia, cyanosis and poor perfusion. The thrust of treatment is early diagnosis, appropriate ventilator strategies to help lower pulmonary pressures, aggressive cardiovascular support to maintain systemic pressures and minimal handling.