Early Pulmonary Hypertension in Preterm Infants
Pulmonary hypertension (PH) in preterm neonates has multifactorial pathogenesis with unique characteristics. Premature surfactant-deficient lungs are injured following exposure to positive pressure ventilation and high oxygen concentrations resulting in variable phenotypes of PH. The prevalence of early PH is variable and reported to be between 8% and 55% of extremely preterm infants. Disruption of the lung development and vascular signaling pathway could lead to abnormal pulmonary vascular transition. The management of early PH and the off-label use of selective pulmonary vasodilators continue to be controversial. (Source...
Source: Clinics in Perinatology - December 16, 2023 Category: Perinatology & Neonatology Authors: Srinivasan Mani, Hussnain Mirza, James Ziegler, Praveen Chandrasekharan Source Type: research
Asphyxia, Therapeutic Hypothermia, and Pulmonary Hypertension
Neonates with a perinatal hypoxic insult and subsequent neonatal encephalopathy are at risk of acute pulmonary hypertension (aPH) in the transitional period. The phenotypic contributors to aPH following perinatal asphyxia include a combination of hypoxic vasoconstriction of the pulmonary vascular bed, right heart dysfunction, and left heart dysfunction. Therapeutic hypothermia is the standard of care for neonates with moderate-to-severe hypoxic ischemic encephalopathy. This review summarizes the underlying risk factors, causes of aPH in neonates with perinatal asphyxia, discusses the unique phenotypical contributors to dis...
Source: Clinics in Perinatology - December 15, 2023 Category: Perinatology & Neonatology Authors: Regan Geisinger, Danielle R. Rios, Patrick J. McNamara, Philip T. Levy Source Type: research
Etiology, Diagnosis and Management of Persistent Pulmonary Hypertension of the Newborn in Resource-limited Settings
Persistent Pulmonary Hypertension of the Newborn (PPHN) is more common in Low and middle income countries (LMICs) due to high incidence of sepsis, perinatal asphyxia and meconium aspiration syndrome. Presence of hypoxic respiratory faillure and greater than 5% difference in preductal and post ductal saturation increases clinical sucipision for PPHN. The availability of Inhaled nitric oxide and extracorporaeal membrane oxygenation is limited but pulmonary vasodilators such as sildenafil are readily available in most LMICs. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - December 13, 2023 Category: Perinatology & Neonatology Authors: Prathik Bandiya, Rajeshwari Madappa, Ajay Raghav Joshi Source Type: research
Neonatal Pulmonary Hypertension: Phenotypes, Physiology, and Management
tIn the early 1970s, several case reports and series outlined neonates with cyanosis, respiratory distress associated with right-to-left shunt across the ductus arteriosus, right ventricular hypertrophy, and pulmonary hypertension (PH) diagnosed by cineradiography, ECG, or cardiac catheterization.1,2 These infants had either parenchymal lung disease or pulmonary oligemia on chest radiograph and were called persistent pulmonary vascular obstruction in newborn3 or persistent transitional circulation,1 persistent fetal circulation, and subsequently, persistent pulmonary hypertension of the newborn. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - December 13, 2023 Category: Perinatology & Neonatology Authors: Satyan Lakshminrusimha, Steven H. Abman Tags: Preface Source Type: research
Pathogenesis and Physiologic Mechanisms of Neonatal Pulmonary Hypertension
Neonatal pulmonary hypertension (PH) is a devastating disorder of the pulmonary vasculature characterized by elevated pulmonary vascular resistance and mean pulmonary arterial pressure. Occurring predominantly because of maldevelopment or maladaptation of the pulmonary vasculature, PH in neonates is associated with suboptimal short-term and long-term outcomes because its pathobiology is unclear in most circumstances, and it responds poorly to conventional pulmonary vasodilators. Understanding the pathogenesis and pathophysiology of neonatal PH can lead to novel strategies and precise therapies. The review is designed to ac...
Source: Clinics in Perinatology - December 11, 2023 Category: Perinatology & Neonatology Authors: Karen C. Young, Augusto F. Schmidt, April W. Tan, Lourenco Sbragia, Ahmed Elsaie, Binoy Shivanna Source Type: research
Targeted Therapies for Neonatal Pulmonary Hypertension: Beyond Nitric Oxide
Pulmonary hypertension in the neonatal population can be acute or chronic and carries significant risk for morbidity and mortality. It can be idiopathic but more often is associated with comorbid pulmonary and heart disease. There are several pharmacotherapeutics aimed at pulmonary vasodilation. This review highlights the most common agents as well as those on the horizon for the treatment of pulmonary hypertension in the neonate. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - December 9, 2023 Category: Perinatology & Neonatology Authors: Jeanne Carroll, Rohit Rao, Robin H. Steinhorn Source Type: research
Pulmonary Vascular Regulation in the Fetal and Transitional Lung
Fetal lungs have fewer and smaller arteries with higher pulmonary vascular resistance (PVR) than a newborn. As gestation advances, the pulmonary circulation becomes more sensitive to changes in pulmonary arterial oxygen tension, which prepares them for the dramatic drop in PVR and increase in pulmonary blood flow (PBF) that occur when the baby takes its first few breaths of air, thus driving the transition from fetal to postnatal circulation. Dynamic and intricate regulatory mechanisms control PBF throughout development and are essential in supporting gas exchange after birth. Understanding these concepts is crucial given ...
Source: Clinics in Perinatology - December 7, 2023 Category: Perinatology & Neonatology Authors: Hannah Holmes, Brahmdeep S. Saini, Olivia J. Moir, Jack R.T. Darby, Janna L. Morrison, Liqun Sun, Mike Seed Source Type: research
Inhaled Nitric Oxide in Neonatal Pulmonary Hypertension
Pivotal trials investigating the use of inhaled nitric oxide (iNO) in the 1990s led to approval by the Food and Drug Administration in 1999. Inhaled nitric oxide is the only approved pulmonary vasodilator for persistent pulmonary hypertension of the newborn (PPHN). Selective pulmonary vasodilation with iNO in near-term and term neonates with PPHN is safe, and targeted use of iNO in less mature neonates with pulmonary hypertension (PH) can be beneficial. This review addresses a brief history of iNO, clinical features of neonatal PH, and the clinical application of iNO. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - November 29, 2023 Category: Perinatology & Neonatology Authors: Michael W. Cookson, John P. Kinsella Source Type: research
Congenital Diaphragmatic Hernia
This review provides a comprehensive summary of the current understanding of pulmonary hypertension (PH) in congenital diaphragmatic hernia, outlining the underlying pathophysiologic mechanisms, methods for assessing PH severity, optimal management strategies, and prognostic implications. (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - November 9, 2023 Category: Perinatology & Neonatology Authors: Shiran S. Moore, Roberta L. Keller, Gabriel Altit Source Type: research
Comorbidities and Late Outcomes in Neonatal Pulmonary Hypertension
Long-term outcomes of persistent pulmonary hypertension of newborn (PPHN) depend on disease severity, duration of ventilation, and associated anomalies. Congenital diaphragmatic hernia survivors may have respiratory morbidities and developmental delay. The presence of PPHN is associated with increased mortality in hypoxic-ischemic encephalopathy, though the effects on neurodevelopment are less clear. Preterm infants can develop pulmonary hypertension (PH) early in the postnatal course or later in the setting of bronchopulmonary dysplasia (BPD). BPD-PH is associated with higher mortality, particularly within the first year....
Source: Clinics in Perinatology - November 6, 2023 Category: Perinatology & Neonatology Authors: Emily S. Stieren, Deepika Sankaran, Satyan Lakshminrusimha, Catherine A. Rottkamp Source Type: research
CME Accreditation Page
(Source: Clinics in Perinatology)
Source: Clinics in Perinatology - October 21, 2023 Category: Perinatology & Neonatology Source Type: research
Neonatal Transfusion Medicine
CLINICS IN PERINATOLOGY (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - October 21, 2023 Category: Perinatology & Neonatology Authors: Ravi Mangal Patel, Amy Keir Source Type: research
Copyright
ELSEVIER (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - October 21, 2023 Category: Perinatology & Neonatology Source Type: research
Contributors
LUCKY JAIN, MD, MBA (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - October 21, 2023 Category: Perinatology & Neonatology Source Type: research
Contents
Lucky Jain (Source: Clinics in Perinatology)
Source: Clinics in Perinatology - October 21, 2023 Category: Perinatology & Neonatology Source Type: research
