Increased pressure in the vessels of the lungs or pulmonary hypertension is diagnosed in people of different age categories. Barely born baby for various reasons can also be prone to this pathology.
In this case, it is a question of pulmonary hypertension in newborns, also known as persistent or persistent fetal blood circulation in a newborn( ICD-10 code P29.3).
Description and statistics
Persistent fetal circulation in the newborn is a kind of signal of the baby's body about the impossibility of complete adaptation of blood circulation in the lungs of the to life outside the womb of the mother.
In the prenatal period of development, the lungs undergo a number of changes that prepare them for functioning in the air, but at this time the placenta "breathes" for them.
After the birth of the baby, the "real" breath of the should start, but sometimes it happens with pathology for a number of reasons. 
With pulmonary hypertension, there is a sharp jump in pressure within the vascular bed of the lungs, which causes the child's heart to become very stressed.
The newborn's body, trying to avoid a threatening heart failure, produces an emergency pressure reduction in the lungs by reducing the volume of blood circulating in them - the blood is "dumped" through the open oval window in the heart or the open arterial duct.
According to statistics, pathology occurs in 1-2 infants of 1000 .Approximately 10% of newborns needing intensive care suffer from this disease. In this case, most of them are full-born or born children.
Significantly more frequent syndrome of fetal circulation is found in in children born with caesarean section - approximately in 80-85% of cases.
The overwhelming number of corresponding diagnoses( 97%) was delivered by in the first three days of life of small patients - such early diagnosis allows to reduce the number of deaths at times, since 80% of sick children can die without timely medical assistance.
Causes and risk factors
In rare cases, the causes of pulmonary hypertension can not be established - then the pathology is called primary or idiopathic. But most often the cause of inadequate pressure increase in the pulmonary vessels becomes:
- Prenatal stress of in the form of hypoxia, hypoklikemia, hypocalcemia, meconium aspiration or amniotic fluid aspiration. As a result, after birth, there may be a spasm of the arterioles of the lungs with subsequent sclerotic changes in their walls.
- Delay in utero maturation of vessel walls with partial preservation of their embryonic structure and after birth. Such vessels are susceptible to spasm to a much greater extent.
- Congenital diaphragmatic hernia , in which the lungs in general and their vessels in particular are underdeveloped and can not function properly.
- Increased pulmonary blood flow in the fetus due to premature closure of the embryonic arterial duct and oval aperture.
- Congenital heart and lung defects of in a child: lung hypoplasia, interventricular septal defects, transposition of major vessels, etc. Another article describes a detailed classification of congenital heart defects.
Risk factors for this pathology are:
- intrauterine hypoxia;
- intrauterine infection or sepsis;
- a doctor's prescription of some medicines for a pregnant woman( non-steroidal anti-inflammatory, antibiotics, aspirin;
- polycythemia in a newborn is a cancer that causes a significant increase in the number of red blood cells in the blood;
- congenital heart and lung defects in a child
Types and stages of the disease
Different authorsclassify this pathology for different reasons:
| Basis for classification | Types of pulmonary hypertension |
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| Nature and duration of the |
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As in the case of pulmonary hypertension in adults, persistent fetal circulation in children is 4 degrees. In most cases, the disease is diagnosed at the first, reversible stage - then it is compensated by treatment.
Dangers and complications
Without timely medical care, 4 out of 5 infants with persistent fetal circulation will die within the first 3 days, and the rest will die before they celebrate their fifth birthday.
The death of babies can come from of rapidly developing heart failure and persistent hypoxemia ( lack of oxygen).
Symptoms of
Newborn with pulmonary hypertension immediately after birth or several hours later:
- breathes heavily, with shortness of breath;
- when inhaled, the chest is drawn inwards;
- has pronounced cyanosis( blueing) of the skin and mucous membranes;
- responds poorly to oxygen: the condition does not improve properly.
About other symptoms of this disease( not only in babies) and its treatment read here.
When to see a doctor and to what?
In the case of detectable signs of respiratory failure in a newborn, the doctor should be treated immediately - every minute of delay can prove fatal!
Diagnosis
Diagnosis of the child is based on:
- Anamnestic data - the history of pregnancy and childbirth.
- Data of examination and auscultation of the heart.
- Results of laboratory studies. Diagnostic value has indicators of oxygenation of the blood( oxygen saturation), which for this disease is always extremely low.
- Results of instrumental research. The electrocardiogram in this case is of little informative. Radiography and ultrasound with a doppler are of great diagnostic value.
- Reactions of the child's body to oxygen supply - with pulmonary hypertension, oxygenation indicators after oxygen donation remain virtually unchanged.
As a result of the diagnostic measures, an experienced doctor will be able to correctly diagnose and to perform differential diagnostics of pulmonary hypertension in children and other similar in its clinical manifestations - congenital heart disease, pulmonary embolism( about its symptoms and treatment - here), myocarditis,diseases of the respiratory system.
And do you know how varicocele manifests in adolescents and children? Find out how to diagnose a disease at home and how to actually cure it. What is Kawasaki's disease and for what reasons does it develop in children? Everything about its danger and precautions is here.
Treatment methods
Treatment of newborns with this pathology is performed in the intensive care unit and involves a number of measures to reduce pressure in the vessels of the lungs, to relieve their spasm and prevent complications:
- Performing artificial lung hyperventilation with .Recently, the practice of adding to the respiratory mixture of nitric oxide, which increases the effectiveness of treatment.
- The introduction of drugs that relax the walls of the vessels and eliminate their spasm( prostaglandins, Tolazolin, sodium nitroprusside and others).At the same time, a constant control of blood pressure is necessary.
- In severe cases with a high risk of death, the method of extracorporeal membrane oxygenation is used. This is an invasive technique of oxygenation of the child's blood with oxygen by means of a special apparatus - a membrane oxygenator.
This unit is connected to the baby with the help of subclavian catheters, cleans and oxygenates the child's blood. Sometimes, in order to replenish the volume of circulating blood, the newborn uses donor blood.
- Introduction of drugs to prevent the development of heart failure ( Dopamine, Dobutamine, Epinephrine) and hypoxia( Eufillin).
- Introduction of surfactant for the full disclosure of lungs.
- Antibiotic therapy in case of an alleged infectious cause of the disease.
- Diuretics and anticoagulants in pediatric practice are used rarely and only on strict indications unlike the treatment of adults with pulmonary hypertension.
Forecasts and prevention measures
In the operative diagnosis and treatment, the prognosis for life in children with pulmonary hypertension is generally favorable: 9 out of 10 babies survive. Typically, the state of the child is stabilized by the year 1 .
Prophylaxis of pulmonary hypertension in a newborn should be carried out by his mother during the pregnancy. To do this, she must exclude all possible risk factors from her life:
- do not smoke;
- to minimize the likelihood of intrauterine infection of the fetus;
- do not take medication without authorization;
- strictly follow all the recommendations of a gynecologist.
These recommendations will avoid many problems and complications of the child's health, to take care of the baby's future even before his birth. If the child did not manage to avoid pulmonary hypertension, the child does not need to despair. It is necessary to contact a professional doctor as soon as possible who will be able to help the child and compensate for his health.
