Persistent Pulmonary Hypertension of the Newborn: Physiology, Hemodynamic Assessment and Novel Therapies
Patrick J. McNamara.
Persistent pulmonary hypertension of the newborn (PPHN) remains a serious disorder with significant mortality
and long term morbidity. Inhaled nitric oxide is the only approved vasodilator therapy in neonates, but 40% of infants
are non-responders. Recent biological evidence has enhanced our understanding of the cellular mechanisms involved in
cardiopulmonary transition at birth, paving the way for potential alternate therapies as published in recent reviews. Optimal
clinical care of infants with PPHN necessitates a comprehensive understanding and evaluation of cardiopulmonary
hemodynamics. Targeted neonatal echocardiography (TnECHO) is increasingly being implemented to guide clinical decision
making. The purpose of this review is to outline the role of TnECHO in better defining the cardiopulmonary physiology
in PPHN and its application in clinical practice. In addition we briefly review the physiology, pathogenesis and novel
therapeutic agents currently under investigation for management of PPHN.
Keywords: Cardiovascular physiology, hemodynamics, persistent pulmonary hypertension of the newborn, targeted neonatal
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