A newborn baby is one of the greatest joys in life, isn't it? But it's also normal to feel a little scared and anxious, especially about the baby's health. Sometimes, newborn babies can have some breathing difficulties. That's a serious condition, but one that we can all manage well if we are all aware of. Let's talk about it simply today.
What is PPHN? What exactly is it?
Simply put, PPHN is a serious breathing problem that occurs in newborn babies. It happens when your baby comes out of your womb and starts breathing in the outside environment, and their circulatory system doesn't adapt properly.
Think of it this way. When your baby is in your womb, he gets his oxygen through the umbilical cord, through the placenta. At that time, not much blood goes to his lungs. This is because the blood vessels in the lungs (pulmonary arteries) are often blocked and narrowed. Some blood bypasses the lungs and goes directly to the rest of the body. It's like taking a different route when a road is blocked.
However, a big change should happen as soon as the baby is born and takes its first breath . Then, the blood vessels in the lungs that were closed need to open up (`(dilate)`). That's when oxygen enters the lungs along with the air. Then, the blood goes to the lungs through these opened blood vessels, picks up oxygen, and distributes that oxygen-filled blood to the entire body, especially to the brain, heart, and kidneys.
In a condition called PPHN, the blood vessels in the baby's lungs don't open properly, or not enough. What happens then? High blood pressure in the lungs (pulmonary hypertension) develops. This limits the amount of oxygen that reaches the baby's brain and other vital organs. This is a life-threatening medical emergency and treatment needs to be started immediately.
How common is this condition called PPHN?
PPHN occurs in about 2 out of every 1,000 live births. It is most common in babies born at term (between 37 and 42 weeks) and in babies born later than the due date (after 42 weeks). However, it can rarely occur in full-term babies.
What are the symptoms of PPHN? How do we recognize it?
If your baby has PPHN, they may show symptoms like:
- Breathing difficulties: breathing too fast or too slow, making a wheezing sound when breathing, and feeling like your chest is sinking in (`(retractions)`).
- Increased heart rate (`(Rapid heart rate)`).
- A baby's skin may appear blue (cyanosis), especially in areas like the lips, tongue, and fingertips.
- Low blood pressure (hypotension).
- Low blood oxygen levels .
- Hearing extra or unusual sounds (`(heart murmur)`) when listening to the heart.
If you notice one or more of these symptoms immediately after the baby is born, or within a few hours, it is very important to notify doctors immediately.
What are the factors that contribute to the development of PPHN?
Researchers are still not sure what exactly causes PPHN, but it is thought to be caused by the baby's lungs not developing properly or not being able to adapt (open) to the outside environment after they leave the womb.
What factors increase the risk of PPHN?
Although the exact cause is unknown, certain factors can increase a baby's risk of developing PPHN. Let's take a look at what they are:
- `Meconium aspiration` : This is when the baby's first stool (we call it `(Meconium)`, which is a bit thick and sticky) enters his respiratory system while he is still in the womb.
- Infections: Lung infections, such as pneumonia, or bloodstream infections.
- Respiratory distress syndrome (RDS): This is often seen in premature babies whose lungs are not fully developed.
- Birth asphyxia: A baby not receiving enough oxygen before or during birth.
- Diaphragmatic hernia: This occurs when a hole forms in the muscle that separates the baby's chest and abdomen (called the diaphragm). This allows some of the abdominal organs to push through the hole into the chest.
- Other congenital heart or lung abnormalities: For example, a small lung or a blocked heart valve.
- Use of certain medications during pregnancy: It has been suggested that the use of medications called ``NSAIDs`` (nonsteroidal anti-inflammatory drugs) and ``SSRIs`` (selective serotonin reuptake inhibitors), especially during late pregnancy, may also be affected. Therefore, if you are taking any medication during pregnancy, it is very important to talk to your doctor about it.
What are the long-term effects of PPHN?
About one in four (1 in 4) babies who survive PPHN develop some degree of disability due to lack of oxygen to the brain. These complications include:
- Developmental delays .
- Hearing issues , sometimes even deafness, can occur.
- Learning disabilities .
- Decreased ability to perform physical activities .
Therefore, it is very important to keep babies who have recovered from PPHN under continuous medical supervision and to monitor their development.
How is PPHN diagnosed?
Your baby's doctor can perform a variety of tests to determine if your baby has PPHN. Some of these include:
- Complete blood count (CBC): This measures the number of white blood cells, red blood cells, and platelets in the baby's blood.
- Pulse oximetry (pulse ox): This is a simple, non-invasive method of measuring the oxygen level in the baby's blood.
- Arterial blood gas (ABG): This measures how well the baby's body is receiving oxygen and how well it is removing carbon dioxide.
- Chest X-ray: This helps to see if the baby's heart is enlarged or if there are any lung conditions.
- Echocardiogram (echo): This is a detailed ultrasound of the baby's heart. It assesses how blood is flowing to the heart and lungs.
- Head ultrasound: This helps to check for any bleeding in the baby's brain.
- Serum electrolyte tests: These tests are used to check the balance of minerals in the baby's blood.
- Lumbar puncture (spinal tap): This test may sometimes be done to check if the baby has any infections.
It is not necessary to do all of these tests; doctors will decide which tests to do based on the baby's condition.
How is PPHN treated?
The main goal of treating PPHN is to increase oxygen flow to the baby's organs and prevent serious complications. There are various treatments for this:
- Oxygen: The baby can be given 100% oxygen through a nasal cannula, nasal prongs, or a mask.
- Mechanical ventilation: A doctor inserts a tube into the baby's windpipe (trachea) and uses a ventilator to help the baby breathe.
- Controlling blood pressure: The baby may be given medication to control blood pressure through a vein (`(IV)`).
- Nitric oxide: Nitric oxide is a gas that helps open (dilate) the blood vessels in your baby's lungs, improving blood flow to the lungs.
- High-frequency oscillatory ventilation: This is also a special type of ventilation. It can help improve the oxygen levels in the baby's blood.
- Extracorporeal membrane oxygenation (ECMO): This machine is used when a baby's heart or lungs are too weak to be controlled by other treatments. It temporarily takes blood from the baby's body, adds oxygen to it, and returns it to the body, providing oxygen to the brain and other parts of the body. It works like an artificial lung.
Can we prevent PPHN?
As we've discussed before, there's no way to completely prevent PPHN because we don't yet know exactly what causes it . However, avoiding certain medications during pregnancy can help reduce your risk. So, if you're pregnant, be sure to talk to your doctor before taking any medication to make sure it's safe to take during pregnancy.
How long does it take to recover from PPHN?
Most babies recover from PPHN within a week or two . However, some babies may take longer, sometimes months, to fully recover. Even after your baby recovers, it is important to protect them from colds, flu, and other viral infections. This can be done by washing your hands frequently, limiting your baby's exposure to crowds, and keeping your baby away from people who are sick. It is also a good idea for everyone in your household to get the flu vaccine every year.
In particular, it is essential to take your baby for regular medical checkups and specialist visits to ensure that their development is progressing properly.
What is the survival rate and outlook for PPHN?
PPHN is a serious condition, and unfortunately, between 7% and 10% of babies with the condition die from complications. Of the babies who survive, about 25%, or about one in four, may have long-term effects (such as developmental delays, learning disabilities, and hearing loss) caused by the lack of oxygen to the brain.
When should you take your baby to a doctor?
After your baby recovers from PPHN, be sure to take your baby to all follow-up appointments . This will help your doctor continue to monitor your baby. In the meantime, seek medical advice immediately if your baby shows any of the following symptoms:
- If you get a fever.
- If you reduce your milk intake, or if you don't drink milk at all.
- If your chest sinks in when you breathe, or if you breathe with your nostrils wide open.
- If you make a whistling or grunting sound when breathing.
- If the skin starts to turn blue or gray.
When you find out that your newborn has a condition like PPHN, it's normal to feel a mix of sadness, fear, anger, and confusion. That's natural. Learn as much as you can about PPHN from the doctors and nurses who are treating your baby. They will tell you everything you can about your baby's condition, and how you can comfort and help them. In time, you will become an expert on your baby's condition, and you will gain the confidence to do everything you can for your baby.
Important things to remember (Take-Home Message)
- PPHN is a serious breathing problem in newborns. In this condition, the blood vessels in the lungs do not open properly, preventing the body from getting enough oxygen.
- Although the exact cause of this is not yet known , there are risk factors such as meconium aspiration, infection, RDS, and reduced oxygenation during birth.
- If you experience symptoms such as difficulty breathing, blue skin, or rapid heartbeat, seek medical advice immediately.
- Treatments include oxygen, ventilator support, nitric oxide, and ECMO.
- Although it is impossible to completely prevent it , it is important to take only safe medications during pregnancy as directed by a doctor.
- Long-term medical monitoring and growth checks are essential after recovery.
- You are not alone at a time like this. Get support from doctors and family. There are many things you can do for your baby.
` PPHN, newborn, respiratory distress, pulmonary hypertension, oxygen, neonatal care, cyanosis
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