Quite often, defects 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.
Children who have only recently been born may have problems with the cardiovascular system, which is called pulmonary hypertension in newborns. In this case, there is a persistent narrowing of the pulmonary arterioles, as well as increased resistance of the vessels of the lungs. As a result of pathology in children, pulmonary blood flow decreases.
In the presence of pulmonary hypertension in newborns, a small amount of meconium - the first feces - is located in the trachea, and the color of the amniotic fluid also changes. Pathology can occur both in children born on time and in those born. This is explained by the fact that the smooth muscles of blood vessels especially actively develop only at the end of pregnancy.
In the case of premature babies, pulmonary hypertension in newborns can begin to develop only in the presence of respiratory distress. Due to the pathology, blood pressure in the pulmonary artery begins to increase. In the right heart, as a rule, malfunctions are observed. Due to the heavy 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 blood of the child.
Disease statistics
To learn more about what it is - pulmonary hypertension, you should familiarize yourself with the statistics. The disease occurs only in 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 on time or slightly postponed.
Pulmonary hypertension is several times more common in children who were born using cesarean section - about 85% of all cases. Almost the entire number of diagnoses was delivered to newborn babies already in the first three days of their life. Thanks to this early diagnosis, it is possible to minimize the number of deaths, because if you do not start treatment on time, then about 80% of sick babies can die after only a few days. Today, medicine is well aware of what pulmonary hypertension is, so the disease is treatable.
Causes of the disease
The main reason for the development of pulmonary hypertension in both full-term and postponed babies is considered to be a chronic form of asphyxiation 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 affect the appearance of pathology:
- Damage to the lungs of a hypoxic nature.
- Diaphragmatic hernia can cause pulmonary hypertension in newborns.
- An increase in pressure occurred in the venous system of the lungs.
- There is obstruction of the vessels.
- A newborn baby has sepsis.
- The baby suffers from congenital heart disease.
- During intrauterine development, a delay in the maturation of the walls of the vessels was observed.
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 highlight several additional factors that can trigger the development of pulmonary hypertension in a newborn baby. The duct of the artery may be closed due to the following reasons:
- during pregnancy, a woman took anti-inflammatory drugs of non-steroidal origin;
- acidosis;
- a newborn has a blood disease such as polycythemia;
- there is a hereditary predisposition;
- intrauterine hypoxemia has occurred;
- in the womb, the child was regularly exposed to hypoxia;
- during pregnancy, a woman took medications that contained lithium;
- other medicines;
- the release of toxins.
Persistent pulmonary hypertension is a very complex and dangerous disease that can cause blood clots in a newborn baby, heart failure. In this case, irregularities 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 rhythm of the heart of the fetus, and gestation is not entirely normal. Quite often, pulmonary hypertension develops in newborns with heart disease. Additional risk factors that can provoke the development of this disease can be called a difficult birth, too low an Apgar score for a newborn baby.
Forms of the disease
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 effectiveness of the treatment. Pulmonary hypertension in a newborn baby may be primary (PLHN). In this case, immediately after the baby is born, 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 with 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 does not find any deviations in it, but 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 walls of blood vessels occurs, and these changes are irreversible.
Stages of the 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 quite reversible, has a pretty good prognosis. The diagnosis can be made in the presence of indicators of blood pressure in the pulmonary trunk, which reach a mark of 26-35 mm. Hg. Art.
- The second stage - pressure indicators are in the range of 36-45 mm. Hg. Art.
- The third stage - blood pressure indicators increase to a mark of 46-55 mm. Hg. Art.
- The fourth stage is the most difficult, and most often its treatment does not bring a positive result. In this case, the blood pressure in the pulmonary trunk will exceed the mark of 55 mm. Hg. Art.
Symptoms of the disease
The very first symptom that manifests itself in the presence of pulmonary hypertension in a child can be called shortness of breath, which does not pass even in a state of complete rest. Not only the lungs of the newborn suffer, but also other elements of the body. Muscle cramps are quite often present, after some time a violation in full growth and development can be noticed, weight is very slowly gaining. Other symptoms of pulmonary hypertension include:
- immediately after birth, cyanosis begins to develop, there is cyanosis of the skin;
- pneumonia develops;
- desaturation;
- tachypnea - greatly rapid breathing in the baby;
- the child has a small amount of meconium in the trachea;
- the liver is greatly increased in size;
- a newborn has a diaphragmatic hernia.
In almost all cases, blood pressure decreases very much, but with the development of a pulmonary crisis, there can be a sharp jump. At the same moment, pulmonary hypertension occurs. Newborns with pulmonary hypertension may suffer from hypercapnia. 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 increased in size - there is cardiomegaly.
With the development of persistent pulmonary hypertension in children, heart murmurs begin to appear. The pliable places of the chest are retracted, and the amount of carbon dioxide increases simultaneously with the development of baby hypoxia. These symptoms cannot be eliminated only through oxygen therapy. Only a specialist can choose the right treatment after a thorough examination of the child.
Pathology diagnostics
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 respiration of the crumbs, is also excluded or confirmed. For diagnosis, several different methods are used to get the most reliable result.
Electrocardiography
Using an ECG, you can get an accurate result only 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 diagnosis. Echocardiography allows you to determine whether a child has congenital heart defects, as well as other abnormalities in the development of this organ. In addition, using this diagnostic method, you can accurately assess the myocardial functionality.
Roentgenography
X-ray examination of a child’s chest is carried out in most cases in order to detect the presence of an increase in the size of the right heart.
Confirm the presence of pulmonary hypertension in a newborn child can also be done using 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 are the deviations from the norm. The hyperoxia test allows you to determine the amount of right and left choice in a child. As a differential diagnosis, hypertoxic, hyperventilation tests can be used. For a final confirmation of the diagnosis, the attending physician may prescribe a magnetic resonance diagnosis.
Disease treatment
Therapy of this pathology was originally aimed at putting in order (lowering) the pressure in the pulmonary vessels. Immediately carried out oxygen treatment, and it will completely depend on what condition the child is in. Oxygen can enter the baby’s body through a mask or a specialized ventilator. As a result, there is an instant improvement in vascular oxygenation. The procedure is carried out rather slowly, because in the event of a sharp drop in the level of carbon dioxide in the blood, blood vessels will again begin to narrow - an attack of vasoconstriction will recur.
Quite often, doctors can prescribe mechanical ventilation - mechanical ventilation of newborns. Thanks to this, the lungs open quite quickly. Nitric oxide begins to relax smooth muscles, which leads to the expansion of the pulmonary vessels. In addition, blood flow in this organ is significantly increased. In severe cases, extracorporeal membrane oxygenation is an additional therapy.
To maintain a normal level of calcium, liquid, glucose in the body of a newborn baby, special medications are used. If the child has sepsis, antibiotics cannot be dispensed with. Vasoconstrictors are also used for treatment, the most common of which are Tubokurarin, Tolazolin, sodium nitroprusside, alpha-adrenergic antagonists.
Also, special medications can be used to prevent the development of heart failure. These include Dopamine, Adrenaline and Dobutamine. Sometimes medications can be used to prevent hypoxia, such as Eufillin. In order for the lungs to open completely, specialists can administer a dose of Surfactant.
If there are suggestions that pulmonary hypertension was triggered by an infection, then antibiotic therapy is a mandatory treatment. Diuretics or anticoagulants can very rarely be used. There must be certain indications for their use, because the risk of using such drugs is very high, which is a hallmark of the treatment of pulmonary hypertension in adults.
Possible complications
Pulmonary hypertension is a very dangerous disease, in the presence of which a newborn increases the load on the heart several times. According to statistics, 8 out of 10 children with a similar disease can live only a few days and die due to acute heart failure. It builds up too quickly, and the condition worsens due to constant hypoxemia. If you do not start treatment, then the other two children are unlikely to survive at least five years.
Also, complications include thrombosis, a lag in development, both mental and physical. Children suffering from pulmonary hypertension are often worried about hypertensive crises.
Pathology Prevention
Specialists today cannot name the exact list, following the points of which, it would be possible to 100% exclude the risk of developing pulmonary hypertension in a newborn baby. 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, the following simple tips will be useful:
- During pregnancy, you need to lead a healthy lifestyle.
- Care must be taken to minimize the risk of fetal infection in the womb.
- You can not take any medications while bearing a child without the recommendation of a doctor or without his control.
- It is necessary to follow all the advice and instructions of a gynecologist who observes a woman during her pregnancy.
Forecast
With pulmonary hypertension in newborns, the prognosis is quite favorable. According to statistics, over the past few years, the incidence of pulmonary hypertension has significantly decreased. Of 1,500 pregnancies, pathology occurs only a couple of times. If in time to detect the disease and begin immediate treatment, then 9 out of 10 newborn children survive, and by the first year of life their health condition relatively normal.
Persistent pulmonary hypertension, which develops in a newborn baby, can cause serious complications and even death, which is why pulmonary hypertension in newborns is dangerous. In this regard, you need to start treatment as soon as possible. When the first signs appear, you should seek the help of specialists. The sooner treatment is started, the more chances a child has for a healthy and fulfilling life. Medical staff should draw up a treatment protocol for persistent pulmonary hypertension in the newborn.
Do not 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 the count goes on for minutes, and every hour of the life of a still weak newborn child may be the last. Therefore, therapy should be started as quickly as possible and not lose precious time.