Pulmonary Hypertension in Newborns

If your infant is diagnosed with persistent pulmonary hypertension of the newborn, or PPHN, you’ll want to know that you have the highest level of expertise and all the resources necessary to help him or her through this life-threatening condition. 

The Pulmonary Hypertension Comprehensive Care Center has extensive expertise with the treatment of newborns with PPHN. Our center is based in Columbia’s Department of Pediatrics, which is devoted to the care of children and discovery of new treatments for the most complex diseases. Our team of experts and support staff will help you and your infant through this difficult time.

What is PPHN?

During pregnancy, your baby’s blood circulation follows a different route than it does after birth. In utero, your baby’s lungs are not involved in giving oxygen to the blood. Blood is therefore diverted away from your baby’s lungs to other organs through a fetal blood vessel, called the ductus arteriosus. Upon birth, circulation changes as your baby begins to breathe air. Blood flows to the lungs, oxygen and carbon dioxide are exchanged, and oxygenated blood is sent to other parts of the body. The ductus arteriosus, no longer needed, constricts and closes.

In rare cases, this transition doesn’t happen when it should. Blood continues to be diverted away from the lungs, leading to high pressure in the lungs and trouble breathing, which is called PPHN. 

PPHN occurs in both premature and full-term babies. Symptoms become apparent within 72 hours of birth. 

Symptoms of PPHN

Newborns with PPHN will show signs that they are having trouble breathing:

• Grunting or moaning when the baby breathes out 
• Rapid breathing with retractions (pulling in of skin between the ribs or under the ribcage)
• Blue lips or around the mouth 
• Cold or blue hands and feet 
• Low blood oxygen levels, even after giving oxygen 
• Low blood pressure 

Diagnosis of PPHN

If your newborn is showing signs of difficulty breathing, your physician will order tests to determine if the cause is PPHN. Tests may include:

• X-ray: A chest X-ray will help determine if your baby has an enlarged heart. 
• Echocardiogram: A non-invasive ultrasound of the heart will show the heart and lungs as well as the blood flow to these organs.
• Ultrasound: An ultrasound of your baby’s head will check for bleeding in the brain.
• Blood test: A blood test will measure the number of red blood cells, which carry oxygen, as well as white blood cells and platelets. Your doctor may also measure the electrolytes in the blood.
• Arterial blood gas test (ABG): Blood drawn from the arteries will measure the oxygen and carbon dioxide levels in your baby’s blood.
• Pulse oximetry: A painless test that measures and monitors the amount of oxygen your baby’s tissues are receiving. 

Treatment of PPHN

Our goal when treating newborns with PPHN is to increase the flow of oxygen to your baby’s organs, maintain normal blood pressure, and prevent serious problems that can occur due to lack of oxygen. You baby may be given a sedative to allow her to rest, which decreases her need for oxygen. Other treatments include medicines and respiratory therapy options, such as:

• Oxygen: Your baby may receive supplemental oxygen through a mask or plastic hood. 
• Assisted ventilation: A ventilator takes over your baby's breathing through a tube which is inserted into your baby's windpipe.
• Nitric oxide: This gas relaxes blood vessels and improves blood flow to the lungs. It is given through the ventilator.
• High frequency oscillatory ventilation: This type of ventilation is used when other types of ventilation aren't effective.

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation, or ECMO for short, is used for babies with serious heart or lung failure. It is a life-saving therapy for newborns and children that uses a piece of equipment to act as an artificial heart and lung. The heart-lung machine delivers oxygen to the blood, allowing the child's heart and lungs to recover.

The ECMO Center at NewYork-Presbyterian Hospital was among the first in the world to use this life-saving technology successfully in infants. We have the largest ECMO program in the tri-state area and among the best survival rates nationally and internationally. We are one of only a few worldwide centers to be awarded Platinum Level Center of Excellence status from Extracorporeal Life Support Organization