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Pulmonary Hipertension
of newborn) and CPAP
Pediatric department of RSD Ryacudu Kotabum
Lampung Utara, Lampung
Febrian Pramana P dr
Ismi citra ismail dr SpA
Differential
Janin : VS + VD moving together
Neonatus : VS moving faster than VD
Janin : VD Push high pressure of sisytemic system(tekanan
sistemik)
VS push lower pressure (plasenta)
Neonatus : VD push high pressure of systemic
system(tekanan paru)
VS push lower pressure(tekanan sistemik)
PPHN
Definisi : Classically, PPHN is defined as a failure of the
normal postnatal fall in pulmonary vascular resistance
which leads to persisting right to left shunts across the
fetal channels and resultant hypoxia
Ethiology of PPHN
PPHN can be:
Idiopathic _ 20%
Associated with a variety of lung diseases:
Pathophysiology
PPHN is more common in term & near-term (> 34 wks G/A)
neonates.
1- Underdevelopment
Underdevelopment of the pulmonary vasculature is
observed in:
Renal agenesis
Thoracic dystrophy
Alveolar-capillary dysplasia
Pulmonary hypoplasia or dysplasia.
PPHN
2- Maldevelopment
Maldevelopment of the pulmonary vasculature
This vascular muscular hypertrophy encroaches on the vascular
lumen and obstructs blood flow.
Example:
Chronic stress, increased blood flow in utero
PPHN
3- Maladaptation
Maladaptation of pulmonary vasculature:
Acidosis,
Hypoxia,
Hypercarbia,
Aspiration,
Hypothermia,
Hypoglycemia,
Hemorrhage.
PPHN
10
Clinical Presentation
Asphyxia
Tachypnea, respiratory distress
Loud, single second heart sound (S2) or a harsh systolic murmur
Complete blood count with differential: To evaluate for high hematocrit level (polycythemia and
Management Strategies
Oxygen
High enough to act as vasodilator, not just oxygenator
Ventilation
To keep CO2 normal
Studies of Hyperventilation showed immediate improvement but increased lung damage,
decreased hearing
BP
High normal To reduce differential pressure between pulmonary and systemic
circulations
Continuous Positive
Airway Pressure
Mechanical ventilator
High-flow nasal cannula
Nasal prong CPAP device
Airway Devices
Bubble CPAP
Clinical Application
CPAP Component
PIP : Peak inspiratory pressure
PEEP : Positive end expiratory pressure
FiO2 : Oksigen friksion
Air
O2
Assessment of Function
Patient Management
Daftar Pustaka
Kinsella JP, Abman SH. Recent developments in the
pathophysiology and treatment of persistent pulmonary
hypertension of the newborn. J Pediatr 1995; 126:853-64.
European Respiratory Journal, vol. 15 2000 Effects of
biphasic positive airway pressure in patients with chronic
obstructive lung disease