Have you ever been a little worried or worried about your little one's breathing after they were born? Sometimes, newborn babies can have serious breathing problems. Today we're going to talk about one such serious condition, but it's definitely important to be aware of. This is medically called Persistent Pulmonary Hypertension of the Newborn, or PPHN for short.
Simply put, what is PPHN?
To understand this, we first need to understand the difference in how a baby breathes while in the mother's womb and after birth.
Think about it, when your baby is inside your womb, he gets the oxygen he needs from you through the umbilical cord. At that time, the baby's lungs are not working. Therefore, the blood vessels that go to the lungs (we call them pulmonary arteries) are often stiff and blocked. Blood mostly bypasses the lungs to go to the rest of the body.
But a big change should happen as soon as the baby is born and takes its first breath . As the baby's lungs fill with air, those previously constricted blood vessels should open up. Only then can the blood go to the lungs, pick up oxygen, and carry that oxygen-filled blood to the entire body, especially the brain, heart, and kidneys.
In a condition called PPHN, that's not what happens. Even after the baby is born, the blood vessels in his lungs don't open properly. They remain tight. Then, because not enough blood goes to the lungs, the baby's organs don't get the oxygen they need.
PPHN is a very serious, life-threatening medical emergency that can occur in a newborn baby. It usually occurs shortly after birth.
How common is this condition?
This is not a very common condition. About two (2) out of every 1,000 live births are at risk of developing PPHN. It is most common in babies born at term (between 37 and 42 weeks) and in babies born after 42 weeks. However, it can rarely occur in premature babies.
What are the symptoms of PPHN?
It is very important to be aware of these symptoms, because if you see them, you should seek medical advice immediately.
| Symptom | A simple explanation |
|---|---|
| Difficulty breathing | Things like a very rapid or slow breathing rate, a wheezing sound when breathing, and a pulling in of the chest. |
| Increased heart rate | Abnormally high heart rate in the baby. |
| Blue/gray discoloration of the skin (Cyanosis) | When there is not enough oxygen in the blood, the baby's skin, especially the lips, tongue, and fingertips, may turn blue or gray. |
| Low blood pressure (Hypotension) | The baby's blood pressure is abnormally low. |
| Decreased oxygen levels in the blood | The baby's blood oxygen level is very low when measured with medical equipment. |
| Abnormal heart sounds (Heart Murmur) | Hearing an extra or unusual sound from the heart when the doctor examines it with a stethoscope. |
What are the causes and risk factors for PPHN?
Researchers haven't found a specific cause for this yet , but it's believed that the condition may be caused by the blood vessels in the baby's lungs not developing properly, or by the baby's inability to adapt (open) to the outside world after birth.
Although the exact cause is unknown, certain factors may increase the risk of developing PPHN.
| Risk factor | What happens with this? |
|---|---|
| Meconium Aspiration | The thick, dark green stool (meconium), which is the baby's first stool, can enter the baby's lungs. This can damage the lungs and cause PPHN. |
| Infections | Serious infections such as lung infections like pneumonia or blood poisoning. |
| Respiratory Distress Syndrome (RDS) | Breathing difficulties often occur in premature babies because their lungs are not fully developed. |
| Birth Asphyxia | Lack of oxygen to the brain and body before or during birth. |
| Diaphragmatic Hernia | A hole in the diaphragm (the muscle that separates the chest and abdomen) allows the organs in the abdomen to protrude into the chest. This interferes with the development of the lungs. |
| Other birth defects | Other problems such as congenital lung abnormalities or a blocked heart valve. |
| Some medications taken during pregnancy | Some painkillers (NSAIDs) and some antidepressants (SSRIs) taken during the last half of pregnancy can affect this. |
Can PPHN cause long-term effects?
Yes. This is a serious condition, as it can cause long-term effects due to the lack of oxygen to the brain and other organs. About 1 in 4 (25%) babies who survive PPHN will develop some form of disability.
They are:
- Developmental delays
- Hearing impairment or deafness
- Learning difficulties
- Decreased ability to perform physical activities
How is PPHN diagnosed?
If doctors suspect that a baby has this condition, they will perform several tests to confirm the diagnosis.
| Test | What do you see in this? |
|---|---|
| Complete Blood Count (CBC) | Measuring the number of white blood cells, red blood cells, and platelets in the blood. This can help determine if there is an infection. |
| Pulse Oximetry (Pulse Ox) | A small device is attached to the baby's finger or leg and continuously measures the oxygen level in the blood. |
| Arterial Blood Gas (ABG) | Take a blood sample and accurately measure its oxygen and carbon dioxide levels. |
| Chest X-ray | To check if the heart is enlarged or if there are any other lung conditions. |
| Echocardiogram (Echo) | This is a scan of the heart. It is essential to evaluate blood flow to the heart and lungs and confirm the condition of PPHN. |
| Head Ultrasound (head scan) | Checking for bleeding in the brain due to lack of oxygen to the brain. |
How is PPHN treated?
The main goal of PPHN treatment is to increase the amount of oxygen reaching the baby's organs . This can help prevent serious complications. Several treatment methods are used for this.
| Treatment method | What happens with this? |
|---|---|
| Providing oxygen | Giving the baby 100% oxygen through a small tube attached to the nose, a mask, or an oxygen hood. |
| Mechanical Ventilation | A tube is inserted into the baby's windpipe and a ventilator is used to breathe for the baby. |
| Medications to control blood pressure | Administering medication to restore blood pressure through saline (IV). |
| Nitric Oxide | This is a gas. Giving this gas through a respirator helps to dilate the constricted blood vessels in the lungs. |
| ECMO (Extracorporeal Membrane Oxygenation) | This is a very complex treatment that is used as a last resort. If the baby's heart and lungs fail, the ECMO machine takes blood from the body, adds oxygen to it, and returns it to the body. It's like an external heart and lungs. |
How long does it take for the baby to recover?
Most cases of PPHN resolve within a week or two, but some babies may take months to fully recover. During this time, it is important to protect your baby from colds, flu, and other viral infections.
- Wash your hands thoroughly.
- Avoid taking the baby to crowded places.
- Keep the baby away from people who are sick.
- Everyone in the household should get the annual flu vaccine.
Also, it is essential to attend clinics on the scheduled dates to see if the baby's growth and development is normal.
When should I see the doctor?
After your baby comes home from the hospital, you need to be very careful. If you notice any of the following symptoms, seek medical attention immediately. Take your baby to the Emergency Department (ETU) of the nearest hospital.
- If the baby has a fever.
- If you are not drinking enough milk.
- If your chest is drawn in when you breathe or if you breathe with your nostrils wide open.
- If you hear a whistling or groaning sound when breathing.
- If the baby's skin starts to turn blue or gray again.
When you find out that your baby has PPHN, you may feel a lot of emotions, such as sadness, fear, anger, and confusion. This is normal. The best thing you can do is to learn as much as you can about the condition from the doctors and nurses who are treating your baby. This will help you understand the situation better. Over time, you will become your own expert on your baby's condition. You will feel confident that you are doing everything you can for your baby.
Take-Home Message
- PPHN is a serious, but treatable, breathing problem in newborns.
- This is a medical emergency that requires immediate hospitalization and treatment.
- Always be on the lookout for warning signs like your baby's skin turning blue and breathing rapidly.
- The main goal of treatment is to provide enough oxygen to the baby's brain and other organs.
- Even after the baby recovers, it is very important to maintain regular contact with the doctor to monitor long-term development.
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