In persistent pulmonary hypertension of the newborn (PPHN), the ratio of pulmonary vascular resistance to systemic vascular resistance is increased. Extrapulmonary shunts (patent ductus arteriosus and patent foramen value) allow for right-to-left shunting and hypoxaemia. Systemic hypotension can occur in newborns with PPHN due to variety of reasons, such as enhanced peripheral vasodilation, impaired left ventricular function and decreased preload. Systemic hypotension can lead to end organ injury from poor perfusion and hypoxaemia in the newborn with PPHN. Thus, it must be managed swiftly. However, not all newborns with PPHN and systemic hypotension can be managed the same way. Individualised approach based on physiology and echocardiographic findings are necessary to improve perfusion to essential organs. Here we present a review of the physiology and mechanisms of systemic hypotension in PPHN, which can then guide treatment.
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Funding HMS’s effort was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH) (through grant UL1 TR001860 and linked award KL2 TR001859) and by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH (1R21 1HD099239-01). Dr Lakshminrusimha was supported by NICHD and NIH (5R01 HD072929-09). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the NIH.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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