Paeds Cases · fetal-neonatal-and-perinatal
Persistent pulmonary hypertension of the newborn
Clinical case of a term infant with meconium aspiration and persistent pulmonary hypertension, covering recognition and stepwise management.
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RACP DWEMRCPCH ClinicalABP General Pediatrics
Prompt
A 40-week male infant born through thick meconium-stained liquor develops severe respiratory distress within minutes of birth. He is intubated in the delivery room. At 1 hour, pre-ductal SpO2 is 82% on 100% FiO2; post-ductal SpO2 is 60%.
Clinical Case
A 40-week, 3.6 kg male infant is born via spontaneous vaginal delivery through thick meconium-stained liquor. Apgar scores are 3 at 1 minute and 5 at 5 minutes. He is intubated and suctioned under direct laryngoscopy in the delivery room for poor respiratory effort and cyanosis. At 1 hour of age in the NICU, pre-ductal SpO₂ is 82% on 100% FiO₂ and post-ductal SpO₂ is 60%. Blood pressure is 45/22 (mean 30). Capillary refill is 4 seconds. [1]
References5ShowHide
- [1]Singh Y Pathophysiology and Management of Persistent Pulmonary Hypertension of the Newborn Clin Perinatol, 2021.PMID 34353582
- [3]Christou H Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn Crit Care Med, 2000.PMID 11098980
- [4]Abman SH Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society Circulation, 2015.PMID 26534956
- [5]Finer NN Nitric oxide for respiratory failure in infants born at or near term Cochrane Database Syst Rev, 2006.PMID 17054129
- [7]Siefkes HM Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn: an illustrated review Arch Dis Child Fetal Neonatal Ed, 2021.PMID 33478959