What to do about pulmonary hypertension in newborns

  Persistent neonatal pulmonary hypertension, also known as persistent fetal circulation, is caused by a variety of reasons after the birth of a newborn, pulmonary vascular resistance continues to increase, pulmonary artery pressure exceeds the body artery pressure, so that the transition from fetal to “adult” circulation is impaired, and the right-to-left shunt of blood at the atrial and/or arterial duct level, resulting in The clinical manifestations are cyanosis, decreased oxygen saturation, and differences in oxygen saturation before and after monitoring the catheter. Cardiac ultrasound Doppler examination shows significantly elevated pulmonary artery pressure and right-to-left shunt at the arterial duct level. Combined with clinical manifestations, blood gas analysis and oxygenation status, the diagnosis of neonatal pulmonary hypertension can be made.  The principles of treatment for this disease are to reduce pulmonary vascular resistance, maintain body circulation pressure, ensure tissue perfusion, correct right-to-left shunt, improve oxygenation, and reduce hyperoxia and ventilatory injury.  (1) General and supportive treatment: continuous blood pressure monitoring, pre- and post-catheter oxygen monitoring; maintaining normal body temperature and acid-base balance.  (2) Mechanical ventilation and pulmonary surface active substance therapy.  (3) Maintenance of body circulation pressure: children often have cardiac insufficiency, early use of positive inotropic drugs and antihypertensive drugs can maintain blood pressure, improve cardiac function and reduce right-to-left shunt. At present, the clinical use of dobutamine, dobutamine, epinephrine and so on.  (4) NO inhalation: NO inhalation is a highly selective pulmonary vasodilator, early inhalation of NO can improve oxygenation and reduce the application of extracorporeal membrane pulmonary oxygenation. High-frequency shock ventilation helps to recruit more alveoli to facilitate NO entry, so high-frequency shock ventilation combined with early inhalation of NO treatment has the best effect.  (5) Prevention of complications: oral warfarin can prevent embolism; anti-platelet aggregation drugs can weaken the effect of platelets on endothelial cells and slow down endothelial sclerosis and plexiform damage.  (6) Atrial septal stoma.  (7) Perform single lung transplantation or heart-lung transplantation.