Quite often, malformations in the development of the child or complications during pregnancy can cause the development of pulmonary hypertension in newborns. This condition requires careful monitoring of the child by medical personnel.
Babies who have just been born may have problems with the cardiovascular system, which is called pulmonary hypertension in newborns. In this case, there is persistent constriction of the pulmonary arterioles, as well as increased pulmonary vascular resistance. As a result of pathology in children, pulmonary blood flow decreases.
In the presence of pulmonary hypertension in newborns, there is a small amount of meconium in the trachea - the first feces, and the color of the amniotic fluid also changes. Pathology can occur both in children born at term and in post-term children. This is explained by the fact that vascular smooth muscles develop especially actively only at the endpregnancy.
In the case of premature babies, pulmonary hypertension in newborns can only begin to develop if there is a respiratory disorder. Due to pathology, blood pressure in the pulmonary artery begins to rise. In the right part of the heart, as a rule, there are malfunctions. Due to the strong load on the ventricle of the heart, its complete or partial dysfunction occurs. The situation is much more complicated in the presence of hypocalcemia and hypoglycemia - a reduced amount of calcium and glucose in the child's blood.
Disease statistics
To learn more about what it is - pulmonary hypertension, you should read the statistics. The disease occurs in only 1-2 newborns per thousand. Almost 10% of children who need intensive care suffer from pulmonary hypertension. It is worth noting that most of them were born at term or slightly post-term.
Pulmonary hypertension is several times more common in children who were born by caesarean section - about 85% of all cases. Almost the entire number of diagnoses was made to newborn babies already in the first three days of their life. Thanks to such early diagnosis, it is possible to minimize the number of deaths, because if treatment is not started on time, then approximately 80% of sick babies can die after living only a few days. Today, medicine is well aware of what it is - pulmonary hypertension, so the disease is treatable.
Causes of disease development
The main cause of the development of pulmonary hypertension in both full-term and post-term babies is considered to be a chronic form of asphyxia or hypoxia. The main manifestation of the disease will be a violation in the development and functioning of the smooth muscles of the pulmonary artery, which leads to heavy breathing in the child. Also, the following factors will influence the appearance of pathology:
- Lung damage of a hypoxic nature.
- A diaphragmatic hernia may be a cause of pulmonary hypertension in newborns.
- There was an increase in pressure in the venous system of the lungs.
- There is vascular obstruction.
- A newborn baby has sepsis.
- The baby suffers from a congenital heart defect.
- During fetal development, there was a delay in maturation of vessel walls.
If the walls of the vessels located in the lungs do not have time to develop and mature, this leads to a violation of their structure and heavy breathing in the child. As a result of this, there is a decrease in the number of pulmonary vessels that can fully function. The ICD-10 code for pulmonary hypertension in newborns is P29.3.
Existing risk factors
Specialists also identify several additional factors that can trigger the development of pulmonary hypertension in a newborn baby. The duct of an artery may be closed due to the following reasons:
- a woman took non-steroidal anti-inflammatory drugs during pregnancyorigin;
- acidosis;
- newborn has a blood disorder called polycythemia;
- there is a hereditary predisposition;
- intrauterine hypoxemia occurred;
- in the womb the baby was regularly exposed to hypoxia;
- a woman was taking medications that contained lithium during pregnancy;
- other medicines;
- releasing toxins.
Persistent pulmonary hypertension is a very complex and dangerous disease that can cause blood clots and heart failure in a newborn baby. In this case, disturbances in the rhythm of the heart are often observed, and the child has a very small weight. In advanced cases, there may be a delay in the development of the baby or even death. In the case of this pathology, it is necessary to determine individual symptoms as soon as possible and prescribe treatment for pulmonary hypertension.
In women during pregnancy, you can also notice a violation of the fetal heart rhythm, as well as gestation is not quite normal. Quite often, pulmonary hypertension develops in newborns with heart disease. Additional risk factors that can trigger the development of this disease include a difficult birth, a too low Apgar score for a newborn baby.
Disease forms
There are not only different symptoms and treatment of pulmonary hypertension, but also forms of this disease. The correct definition of the form also affects the efficiencytreatment. Pulmonary hypertension in a newborn child may be primary (PHN). In this case, immediately after the birth of the baby, there are no clear symptoms of pathology, but after some time persistent arterial hypoxemia is observed. The secondary form of pulmonary hypertension is accompanied by aspiration of the first feces of the child (meconium), pneumonia, pulmonary vasoconstriction (the vascular lumen begins to narrow rapidly).
Pathology can develop in three different ways. In the first situation, the pulmonary bed continues to develop normally and no deviations are found in it, but at the same time the baby suffers from hypoxia, acidosis and some other diseases. In the second situation, vascular hypertrophy occurs, but the cross-sectional area does not decrease. The third case is considered the most severe, when hypertrophy of the vessel walls occurs, and these changes are irreversible.
Stages of development of pathology
In the case of newborn children, the pathology is divided into stages in the same way as in an adult:
- The first stage is considered to be completely reversible, has a fairly good prognosis. The diagnosis can be made in the presence of blood pressure indicators in the pulmonary trunk, which reach the level of 26-35 mm. rt. st.
- Second stage - pressure indicators are in the range of 36-45 mm. rt. st.
- Third stage - blood pressure indicators increase to the level of 46-55 mm. rt. st.
- The fourth stage is the most difficult, and most often its treatment does not bring a positive result. In suchcase, the arterial pressure in the pulmonary trunk will exceed 55 mm. rt. st.
Disease symptoms
The very first symptom that appears when a child has pulmonary hypertension can be called shortness of breath, which does not go away even in a state of complete rest. Not only the lungs of the newborn suffer, but also other elements of the body. Quite often there are muscle cramps, after a while you can notice a violation in full growth and development, weight is gained very slowly. Other symptoms of pulmonary hypertension include:
- immediately after birth, cyanosis begins to develop, there is cyanosis of the skin;
- pneumonia develops;
- desaturation;
- tachypnea - very rapid breathing in a baby;
- the child has a small amount of meconium in the trachea;
- liver greatly enlarged;
- A newborn has a diaphragmatic hernia.
In almost all cases, blood pressure drops very much, but with the development of a pulmonary crisis, there can be a sharp jump. At the same time, pulmonary hypertension occurs. Newborns with pulmonary hypertension may be hypercapnic. In the presence of such a pathology, the child has too much carbon dioxide in the blood. If you take an x-ray, you can see that the heart is slightly enlarged in size - there is cardiomegaly.
When persistent pulmonary hypertension develops in children, heart murmurs begin to appear. The pliable places of the chest are retracted, andthe amount of carbon dioxide increases simultaneously with the development of hypoxia in the baby. These symptoms cannot be eliminated by oxygen therapy alone. Only a specialist will be able to choose the right treatment after a thorough examination of the child.
Diagnosis of pathology
After the baby has the first signs of pulmonary hypertension, doctors conduct a thorough examination to exclude the presence of this pathology. The presence of cyanosis, a reaction to the supply of oxygen for breathing the crumbs, is also excluded or confirmed. For diagnostics, several different methods are used to get the most reliable result.
Electrocardiography
An ECG can only give an accurate result if there is a lesion in the right ventricle. You can also determine the presence of deviations in his work. It is worth remembering that certain changes are considered the norm for a newborn baby.
Echocardiography
This method will not allow you to say for sure that the child has pulmonary hypertension. Echo is considered an additional method to the ECG, so that the specialist has the opportunity to get a detailed picture of the ongoing diagnosis. EchoCG allows you to determine if the child has congenital heart defects, as well as other abnormalities in the development of this organ. In addition, using this diagnostic method, you can most accurately assess the functionality of the myocardium.
X-ray
Examination of the child's chest using X-rays is carried out inmost cases in order to detect the presence of an increase in the size of the right side of the heart.
You can also confirm the presence of pulmonary hypertension in a newborn baby with the help of a general, biochemical blood test. Also, experts conduct a study of the gas composition of the blood, which allows you to accurately determine what level of oxygen and carbon dioxide is in it and what deviations from the norm are. The test for hyperoxia allows you to determine the number of right and left choices in a child. As a differential diagnosis, hypertoxic, hyperventilation tests can be used. To finally confirm the diagnosis, the attending physician may prescribe magnetic resonance imaging.
Treatment of disease
Therapy of this pathology is initially aimed at putting in order (lowering) the pressure in the pulmonary vessels. Oxygen treatment is carried out immediately, and it will depend entirely on the condition of the child. Oxygen can be supplied to the baby's body through a mask or a specialized ventilator. As a result, there is an immediate improvement in vascular oxygenation. The procedure is carried out quite slowly, because in the event of a sharp drop in the level of carbon dioxide in the blood, the vessels will begin to narrow again - an attack of vasoconstriction will repeat.
Quite often, doctors can prescribe artificial lung ventilation - IVL for newborns. Due to this, the lungs open quite quickly. Nitric oxide begins to relax smooth muscles, which leads to the expansion of pulmonary vessels. Besides,significantly increases blood flow in this organ. In especially severe cases, extracorporeal membrane oxygenation is an additional therapy.
To maintain a normal level of calcium, fluid, glucose in the body of a newborn child, special medications are used. If a child has sepsis, antibiotics cannot be dispensed with. Vasoconstrictors are also used for treatment, the most common of which include Tubocurarine, Tolazoline, sodium nitroprusside, alpha-adrenergic antagonists.
Also, special drugs can be used for treatment to prevent the development of heart failure. These include Dopamine, Adrenaline and Dobutamine. Sometimes drugs can be used to prevent hypoxia, such as Eufillin. To make the lungs open completely, specialists can inject a dose of Surfactant.
If there are suggestions that pulmonary hypertension was provoked by an infection, then antibiotic therapy is a mandatory method of treatment. Very rarely, diuretics or anticoagulants may be used. There must be certain indications for their use, because the risk of using such drugs is very high, which is a distinguishing feature from the treatment of pulmonary hypertension in adults.
Possible Complications
Pulmonary hypertension is a very dangerous disease, in the presence of which the load on the heart of a newborn increases several times. Statistics show that 8 out of 10 childrenwith a similar disease can live only a few days and die due to acute heart failure. It builds up too fast, and at the same time the condition worsens due to constant hypoxemia. If treatment is not started, the other two children are unlikely to be able to live at least until the age of five.
Also, complications include thrombosis, developmental delay, both mentally and physically. Children suffering from pulmonary hypertension often experience hypertensive crises.
Prevention of pathology
Today, experts cannot name an exact list, following the points of which, it would be possible to 100% eliminate the risk of developing pulmonary hypertension in a newborn child. This can be explained by the fact that no one is immune from the most common causes of this pathology. But at the same time, it will be useful to follow these simple tips:
- Be he althy during pregnancy.
- Efforts should be made to minimize the risk of infection of the fetus in the womb.
- No medication should be taken while pregnant without a doctor's recommendation or supervision.
- You must follow all the advice and instructions of a gynecologist who observes a woman throughout her pregnancy.
Forecast
With pulmonary hypertension in newborns, the prognosis is quite favorable. According to statistics, over the past few years, the number of cases of developing pulmonaryhypertension. Out of 1500 pregnancies, pathology occurs only a couple of times. If the disease is detected in time and treated immediately, then 9 out of 10 newborns survive, and by about the first year of life, their he alth is relatively normal.
Persistent pulmonary hypertension that develops in a newborn baby can cause serious complications and even death, which is why pulmonary hypertension in newborns is dangerous. In this regard, it is necessary to start treatment as soon as possible. When the first signs appear, you should seek help from specialists. The sooner treatment is started, the more chances the child has for a he althy and fulfilling life. He alth care providers should develop a protocol for the treatment of persistent pulmonary hypertension in the newborn.
Don't waste time and think that everything will pass in a couple of hours or a couple of days. Pulmonary hypertension is a disease in which minutes count, and every hour of the life of a still weak newborn child can be the last. Therefore, therapy should be started as soon as possible and not waste precious time.
