Pulmonary hypertension in newborns: Signs and more Health ConditionsHealth ConditionsAlzheimer's & DementiaAnxietyArthritisAsthma & AllergiesBreast CancerCancerCardiovascular HealthCOVID-19Dermatology & SkincareDiabetesEnvironment & SustainabilityExercise & FitnessEye HealthHeadache & MigraineHealth EquityHIV & AIDSHuman BiologyInflammatory Bowel DiseaseLeukemiaLGBTQIA+Men's HealthMental HealthMultiple Sclerosis (MS)NutritionParkinson's DiseasePsoriasisSexual HealthWomen's HealthDiscoverNewsLatest NewsOriginal SeriesMedical MythsHonest NutritionThrough My EyesNew Normal HealthPodcastsHow to understand chronic painWhat is behind vaccine hesitancy?The amazing story of hepatitis C, from discovery to cureNew directions in dementia researchCan psychedelics rewire a depressed, anxious brain?Why climate change matters for human healthToolsGeneral HealthDrugs A-ZHealth HubsHealth ToolsBMI Calculators and ChartsBlood Pressure Chart: Ranges and GuideBreast Cancer: Self-Examination GuideSleep CalculatorHealth ProductsAffordable Therapy OptionsBlood Pressure MonitorsDiabetic SuppliesFitness TrackersHome GymsGreen Cleaning ProductsHow to Shop for CBDQuizzesRA Myths vs FactsType 2 Diabetes: Managing Blood SugarAnkylosing Spondylitis Pain: Fact or FictionConnectAbout Medical News TodayWho We AreOur Editorial ProcessContent IntegrityConscious LanguageNewslettersSign UpFollow UsMedical News TodayHealth ConditionsDiscoverToolsConnectSubscribe What to know about pulmonary hypertension in newbornsMedically reviewed by Karen Gill, M.D. — By Rachel Ann Tee-Melegrito on May 29, 2022Persistent pulmonary hypertension of the newborn is a serious disorder that occurs when a baby fails to adapt to the circulatory transition as they breathe through their lungs after birth. Share on Pinterestrubberball/Getty ImagesCirculatory adaptation occurs minutes after birth as the baby transitions from receiving oxygen from the placenta through the umbilical cord to breathing independently. When this does not happen, the blood flow from the heart to the lungs becomes insufficient. In turn, not enough oxygen reaches the bloodstream to supply the brain and the rest of the body. This article discusses pulmonary hypertension in newborns, its signs and symptoms, risks, and complications. What is it Persistent pulmonary hypertension of the newborn (PPHN) occurs when conditions like low oxygen levels or breathing problems prevent natural circulatory changes. During pregnancy, babies get their oxygen from the placenta, an organ in the womb supplying oxygen and nutrients from the mother’s blood to the baby through the umbilical cord. Upon taking their first breath, the blood vessels of the newborn’s lungs widen or dilate. This dilation should cause a rapid increase in blood flow to the lungs, closing the fetal pathway and causing circulation changes. This process causes blood to travel through the lungs to get oxygen before it flows to the rest of the body. In PPHN, pulmonary arteries do not widen enough, limiting the blood flow to the lungs and causing the pressure in the lungs’ blood vessels to build up. This condition also results in the persistence of the old blood pathway where blood flows from the right to the left atrium, which bypasses the lungs. How common is it PPHN happens in 2 in every 1,000 live births. It occurs more in full-term babies, those born past their due dates, and those born after 42 weeks. Doctors are also diagnosing PPHH increasingly more in premature babies. Despite advances in care, it is still one of the leading causes of morbidity and death among babies, reaching a 4–33% mortality rate. Signs and symptoms Doctors can identify symptoms of PHNN at birth or within the first hours of birth. These include:rapid breathing and shortness of breathrespiratory distress, including nose-flaring, grunting, or moaningretractions or pulling in of the skin under the ribs when breathing hard and fastcyanosis or pale blue color of the skin, lips, skin, hands, and feetlow blood oxygen levels, even when doctors provide 100% oxygenhands and feet are cool to the touchlow blood pressurelow APGAR scoresheart murmur, or the presence of an extra or an abnormal heartbeatweak pulses Possible complications Meanwhile, 1 in 4 babies who survive will have some impairment because of PPHN. Lack of oxygen to the brain may cause long-term health problems, including:developmental delayshearing problems such as deafnessfunctional disabilities, or decreased ability to perform physical activities Causes PPHN occurs when the blood vessels in the lungs fail to dilate. Conditions that prevent the vessels from dilating include:severe distress during delivery, including meconium aspiration syndromeinfections, such as pneumonia and sepsis in the newbornproblems with the placenta, such as placenta previa and placenta abruptioncongenital abnormalities, including:diaphragmatic herniablocked heart valvesunderdeveloped lungscollapsed lungtaking certain drugs during pregnancy, including:NSAIDslarge doses of aspirinantidepressants Risk factors Babies are at a higher risk of PPHN if they have:aspirated meconium — breathed in their bowel movements before birthasphyxia — having too little oxygen before or during birthinfection in their blood, such as sepsis or lungs, such as pneumoniaabnormal lung or heart developmentborn to a mother with diabetesborn large for gestational age Diagnosis A pediatrician will check for the baby’s health status and delivery history. They will then do the following tests to determine if the newborn has PPHN:Monitoring oxygen saturation levels: This measures the oxygen saturation level in different body parts to see whether the newborn’s tissues are receiving enough oxygen.Echocardiogram: This test sends sound waves to generate an image of the heart and blood vessels. It is the most reliable test to establish a diagnosis of PPHN and look for structural heart diseases.X-ray: Checks for underlying lung or heart disease, including meconium aspiration syndrome and pneumonia. It also identifies whether the heart is too large.Blood tests:arterial blood gas levels measure the level of oxygen and carbon dioxide in the bloodcomplete blood count with differential look for signs of infection and monitors for conditions such as polycythemia and hyperviscosity syndrome, which can lead to or worsen PPHNglucose and serum electrolyte levels Treatment The treatment of PPHN depends on the underlying cause, severity, symptoms, and general health. The main goals of treatment are to:increase the oxygen levels in the newborn’s bloodmaintain appropriate blood pressureopen the blood vessels in the lungs to improve blood flow Respiratory support Doctors will supply newborns with oxygen through various means:Supplemental oxygen: Medical professionals send oxygen through a small tube with prongs placed in the nostrils, a plastic hood, or a mask.Endotracheal tube: Doctors place a tube through the windpipe, known as the trachea, to provide oxygen.Ventilator or mechanical breathing machine: A breathing tube connected to a ventilator passes through the windpipe. The machine breathes for the newborn until they can do it by themselves.Continuous positive air pressure: This is a noninvasive machine that gently delivers oxygen into the lungsHigh-frequency oscillation ventilation: This machine rapidly delivers very short bursts of oxygen through a breathing tube. This machine aims to improve oxygen levels when others are not effective. Nitric oxide Nitric oxide is the only drug approved for widening or dilating the pulmonary blood vessels used specifically for the treatment of PPHN. Doctors administer nitric oxide through the breathing machine to reach the lungs directly. Medication Different medications can help treat PPHN, depending on the underlying cause and related symptoms. Doctors usually administer these medications through an IV line directly into the vein. These may include: Blood pressure medication: These keep the newborn’s blood pressure stable.Sedatives: These drugs help keep the baby calm and help the machines that give them oxygen work better.Surfactants: Surfactants help the lungs work better, allowing them to use oxygen and remove carbon dioxide. Doctors give these through a breathing tube to premature infants and full-term babies with parenchymal lung disease. Antibiotics: Doctors prescribe these to treat infections.Inotropes: These medicines go directly into the bloodstream to keep the newborn’s blood pressure high, inducing the heart to pump more blood into the lungs. Supportive care Doctors will also check the following for a newborn:maintain body temperaturecheck glucose and electrolyte levelscorrect metabolic imbalances and blood abnormalitiesprovide nutritional supportassess blood pressuremonitor oxygen levels Extracorporeal membrane oxygenation ECMO Doctors use ECMO when all the other approaches fail to increase the newborn’s oxygen saturation levels. It takes over the functions of the lungs and the heart. They drain blood from the newborn into an artificial lung, which places oxygen and removes carbon dioxide from the newborn’s blood. Doctors then pump the blood back to the newborn. Summary PPHN is a severe condition. It occurs when the newborn fails to transition from fetal circulation to the expected circulation, which involves the heart pumping blood to the lungs. Different factors may cause this, but it often occurs in babies with a difficult birth and full-term and babies born past their due dates. The goal of treatment is to increase the oxygen levels in the blood. Long-term health problems and complications can occur if the baby does not get enough oxygen delivered to the brain and other organs. Last medically reviewed on May 29, 2022HypertensionPediatrics / Children's HealthParenthood06 Months06 Months 1 Year 8 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Balest, A. (2021). Persistent pulmonary hypertension of the newborn. https://www.msdmanuals.com/professional/pediatrics/respiratory-problems-in-neonates/persistent-pulmonary-hypertension-of-the-newbornMartinho, S., et al. (2020). Persistent pulmonary hypertension of the newborn: Pathophysiological mechanisms and novel therapeutic approaches.https://www.frontiersin.org/articles/10.3389/fped.2020.00342/fullMathew, B., et al. (2017). Persistent pulmonary hypertension in the newborn. https://www.mdpi.com/2227-9067/4/8/63/htmOng, M., et al. (2019). Racial and ethnic differences in pediatric pulmonary hypertension: An analysis of the pediatric pulmonary hypertension network registry. https://www.jpeds.com/article/S0022-3476(19)30529-3/referencesPersistent pulmonary hypertension of the newborn (PPHN). (2015.). https://www.ucsfbenioffchildrens.org/conditions/persistent-pulmonary-hypertension-of-the-newborn-pphnPersistent pulmonary hypertension of the newborn (PPHN). (2022).https://www.nationwidechildrens.org/conditions/persistent-pulmonary-hypertension-of-the-newborn-pphnSharma, V., et al. (n.d.). Persistent pulmonary hypertension of the newborn.https://mhnpjournal.biomedcentral.com/track/pdf/10.1186/s40748-015-0015-4.pdfFEEDBACK:Medically reviewed by Karen Gill, M.D. — By Rachel Ann Tee-Melegrito on May 29, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageNew guidelines for pediatric pulmonary hypertension The American Heart Association and American Thoracic Society have produced guidelines to help doctors, health workers and parents care for children…READ MOREWhat are the five classes of pulmonary hypertension?Medically reviewed by Adithya Cattamanchi, M.D. Pulmonary hypertension, which is high blood pressure in the pulmonary arteries, is broken into five categories. Learn more.READ MOREPulmonary hypertension: Diagnosis Tests doctors may use to diagnose pulmonary hypertension include blood tests, cardiac catheterization, and pulmonary function tests. Learn more.READ MOREDifferent treatments for hypertension Treatment for hypertension can include medications such as beta-blockers and lifestyle adjustments such as maintaining a moderate weight and staying…READ MOREHypertension research: 2020 overview Here, we look at some of this year's most interesting research into high blood pressure. We cover COVID-19, thigh circumference, dairy intake, and…READ MORE