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When you bring a child into this world, you hope and pray that s/he will be born healthy with no complications. Unfortunately, some complications can occur before, during, or shortly after birth that can pose a serious threat to your child. Though complications are rare, it is important to seek professional medical attention at the first sign of trouble.

PPHN (persistent pulmonary hypertension of the newborn) is a rare, but serious, birth complication in which the arteries to the newborn''s lungs are constricted. This prevents oxygen from reaching the blood, leading to respiratory failure and significant stress on the vital organs. While the cause of PPHN is often unknown, certain maternal risk factors, fetal stress, delivery complications, and use of certain medications during pregnancy can increase the risk of PPHN.

While doctors have long known that taking aspirin or NSAIDs late in pregnancy can lead to PPHN, researchers have discovered that third trimester use of Prozac can more than DOUBLE the risk that a child will develop PPHN.

Symptoms of PPHN—including low blood pressure, bluish skin tone, rapid heart rate, rapid breathing, and trouble breathing—can develop shortly after birth or up to two days after delivery. When a newborn shows signs of oxygen deprivation and respiratory distress, several tests can be preformed to rule out or make a PPHN diagnosis.

How is a PPHN diagnosis made?

There are tests that can be used to make or rule out a PPHN diagnosis. Imaging tests can be used to look at the newborn''s lungs, heart, and circulatory system, including:

• Chest x-rays are used to determine if the baby has lung disease and to see whether the heart is enlarged.
• Echocardiogram (ECG) is an ultrasound of the heart and can show if a baby has heart or lung disease. It can also show how the blood is flowing in the lungs and heart. This is very important in making a PPHN diagnosis.
• Ultrasound of the head may be used to check for bleeding in the brain.

Laboratory tests are also used to help make or rule out a PPHN diagnosis. These can include:

• Arterial blood gas (ABG) test identifies how much oxygen, carbon dioxide and acid is built up in the blood of the arteries. Normally, arteries contain high amounts of oxygen, though in babies with PPHN the levels of oxygen in the arterial blood are drastically lower.
• Complete blood count identifies the number of white and red blood cells and platelets in the blood.
• Pulse oximetry measures the levels of oxygen in the blood and helps doctors determine if the baby''s tissues are receiving enough oxygen.
• Serum electrolyte tests
• Lumbar puncture/spinal tap

How is PPHN treated?

Once a PPHN diagnosis is made, a neonatologist will direct the course of therapy in a neonatal intensive care unit (NICU), which is found in large hospitals and children''s hospitals. The primary goal of treatment is to get enough oxygen to the baby''s lungs and, consequently, the newborn''s vital organs and other tissues. A mechanical ventilator, sodium bicarbonate, nitric oxide, and other methods of treatment may be employed. In some cases, a procedure called extracorporeal membrane oxygenation (ECMO) may be necessary. This procedure requires invasive surgery, is difficult to monitor, and poses the risk of serious side effects. Therefore, this procedure is only used after other options have been exhausted.

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