Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Regan E Giesinger; Kiran More; Jodie Odame; Amish Jain; Robert P Jankov; Patrick J McNamara

doi:10.1038/pr.2017.200

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Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Journal article

Open access

Peer reviewed

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Regan E Giesinger, Kiran More, Jodie Odame, Amish Jain, Robert P Jankov and Patrick J McNamara

Pediatric research, Vol.82(6), pp.901-914

12/2017

DOI: 10.1038/pr.2017.200

PMID: 28820870

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Abstract

It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation, and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations, and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute hypoxemic respiratory failure in the preterm neonate, outline the pathophysiological conditions that may present as acute PH, and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system. Although PVR and respiratory management are highly interrelated, there may be a population of preterm neonates in whom inhaled nitric oxide may improve illness severity and may relate to outcomes. A management approach based on physiology that considers common clinical conundrums is provided. A more comprehensive understanding of the physiology may help in informed decision-making in clinical situations where conclusive scientific evidence is lacking. Regardless, high-quality research is required, and appropriate definition of the target population is paramount. A thoughtful approach to cardiovascular therapy may also provide an avenue to improve neurodevelopmental outcomes while awaiting more clear answers.

Acute Disease

Diagnosis, Differential

Hypertension, Pulmonary - diagnosis

Infant, Premature, Diseases

Heart - physiology

Humans

Infant, Premature

Hypertension, Pulmonary - drug therapy

Hypoxia - diagnosis

Vasodilator Agents - administration & dosage

Infant, Newborn

Details

Title: Subtitle: Controversies in the identification and management of acute pulmonary hypertension in preterm neonates
Creators: Regan E Giesinger - Department of Paediatrics, University of Toronto, Toronto, Canada
Kiran More - Neonatal Department, Christchurch Women's Hospital, Christchurch, New Zealand
Jodie Odame - Department of Physiology, University of Toronto, Toronto, Canada
Amish Jain - Department of Paediatrics, University of Toronto, Toronto, Canada
Robert P Jankov - Department of Paediatrics, University of Toronto, Toronto, Canada
Patrick J McNamara - Department of Paediatrics, University of Toronto, Toronto, Canada
Resource Type: Journal article
Publication Details: Pediatric research, Vol.82(6), pp.901-914
DOI: 10.1038/pr.2017.200
PMID: 28820870
ISSN: 0031-3998
eISSN: 1530-0447
Language: English
Date published: 12/2017
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093492602771

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