2022 Southern Medical Research Conference
What Parents Need To Know About Persistent Pulmonary Hypertension Of The Newborn
Persistent pulmonary hypertension of the newborn is a serious condition that happens when a baby's circulatory system doesn't change so that more blood goes through the lungs when a baby begins to breathe air at birth.
Persistent pulmonary hypertension of the newborn (PPHN) occurs in approximately 2 of every 1,000 live births. Infants with this condition have a circulatory system that has not adjusted to breathing air outside the womb.
PPHN is a potentially fatal condition since not enough oxygen is reaching the bloodstream. It's important to know the signs and get immediate medical help if you believe your little one may have PPHN.
Read on for how to spot these signs and what they mean.
When a baby is developing, they receive oxygen from the placenta through the umbilical cord. Their lungs do not exchange oxygen and carbon dioxide while they are in the womb, and the blood vessels in their lungs are almost completely closed.
Within minutes of being born, the blood vessels in the lung should widen as the newborn begins to breathe air using their lungs. When these blood vessels widen, it causes a rapid increase in blood flow to the lungs. As blood flow increases, it flows through the lungs so the lungs can use the oxygen before the blood travels to the rest of the baby's body.
If this doesn't happen and a newborn's circulation system continues to bypass the lungs, it is known as PPHN. It is also called persistent fetal circulation.
Some common symptoms of PPHN include:
PPHN can be caused by issues with the blood vessels in a newborn's lungs. They may be atypically formed or underdeveloped. The blood vessels may also have a hard time adjusting to the air for a variety of reasons, such as illness or severe distress during delivery.
PPHN is typically diagnosed soon after a baby's birth.
In addition to checking the baby's delivery and health history, the doctor may request:
Treatment of PPHN focuses on:
Treatment depends on the newborn's general health, their symptoms, and how severe the condition is.
Treatment options can include:
IV medications given through a vein may also be used to help treat some underlying causes and symptoms. These medications may include:
If all other treatments do not help, doctors may use extracorporeal membrane oxygenation (ECMO) to take over the functions of the heart and lungs.
Newborn babies are at a higher risk of PPHN if they have:
While most newborns do not experience PPHN, when it happens, PPHN is a very serious medical event with a death rate of between 7.6 to 10.7%.
With current treatment options, more babies with PPHN survive. For infants with no other conditions and who have mild symptoms, the outlook is better, but they are more likely to need to go back into the hospital at some point during infancy.
Follow-up care for infants following PPHN is important because there can be long-term complications, such as:
Researchers in 2022 noted that Black babies had more adverse or poor outcomes from PPHN, followed closely by Hispanic and Asian infants. One reason for this may be systemic racism and inequities in prenatal care, healthcare, and access to care.
How long will it take a baby with PPHN to recover?It may take your baby's lungs weeks or even months to recover from PPHN. It's important to note that even after the lungs have had the chance to heal, the long-term effects of PPHN can continue.
Can older children get PPHN?PPHN technically only occurs in newborns, but older children can develop pulmonary hypertension from medical conditions like congenital heart and lung diseases.
What can I do to help prevent my baby from having PPHN?There is no way to completely remove the risk of PPHN, but getting regular prenatal care during pregnancy can increase the chances of having a healthy baby.
PPHN is a potentially fatal condition that will typically be diagnosed quickly after a baby's birth. It occurs when a newborn's circulation system does not adjust for breathing outside the womb. It's important to get medical help right away if you notice signs of PPHN.
Treatment focuses on ensuring the baby's organs get sufficient oxygen. This is important because long-term health complications can develop when this does not occur.
What To Know About High Blood Pressure During Pregnancy
High blood pressure, or hypertension, can occur during the first, second, and third trimester of pregnancy. There are three types of hypertension during pregnancy, and each has slightly different features.
In the United States, high blood pressure occurs in around 6–8% of pregnancies among women who are 20–44 years of age.
Without treatment, this issue, also known as hypertension, can lead to serious health complications for the pregnant person, the infant, or both. But in most cases, hypertension is preventable and treatable.
This article explores the different types of hypertension that can occur during pregnancy, including their risk factors and complications.
High blood pressure, for anyone, involves a reading of at least 140/90 millimeters of mercury (mm Hg).
Three types of high blood pressure can occur during pregnancy:
What is a healthy blood pressure during pregnancy?
Chronic hypertensionA person with chronic hypertension either had high blood pressure before pregnancy or developed it before week 20, in about the first half of pregnancy.
Gestational hypertensionThis type of high blood pressure starts during pregnancy, usually in the second half, or after 20 weeks.
A doctor diagnoses it if systolic pressure is at least 140 mm Hg, diastolic pressure is at least 90 mm Hg, or both.
The person will also have:
While the rise in blood pressure is usually small, a healthcare professional will likely monitor it every week. If a person's blood pressure reaches 160/110 mm Hg or higher, serious complications can result.
Gestational hypertension usually goes away after delivery, but it can persist and either become chronic or increase the risk of chronic hypertension later in life.
PreeclampsiaPreeclampsia involves high blood pressure that occurs during pregnancy or after delivery. It can have severe effects.
This condition usually develops after week 20, often in the third trimester. If it happens before week 34, doctors call it early onset preeclampsia. It may develop in the weeks after delivery, but this is rare.
Experts do not know why some people develop preeclampsia and others do not. The risk may be higher for people who:
To diagnose preeclampsia, a doctor will:
Some people have no symptoms. If symptoms occur, they include:
People with preeclampsia have a higher risk of a rare but serious medical condition known as HELLP syndrome, which stands for:
Anyone with HELLP needs urgent medical attention.
To reduce the risk of severe complications, a person with preeclampsia may need to deliver early. This can lead to a low birth weight and other health problems for the newborn.
There may also be an increased risk of stroke, kidney disease, heart disease, and hypertension later in life.
Sometimes, preeclampsia is severe enough to cause seizures or a coma due to effects on the brain. In this case, the diagnosis is "eclampsia." It can occur during pregnancy or within 72 hours after delivery, and it is a medical emergency.
If hypertension is severe or uncontrolled, it can cause complications during and after pregnancy for the person and their baby. The specific complications depend on the type of high blood pressure.
Having hypertension during pregnancy increases the risk of more serious health conditions later in life, such as chronic hypertension, heart problems, and stroke.
In addition, a person with chronic hypertension before pregnancy has a higher risk of developing preeclampsia and gestational diabetes during pregnancy.
High blood pressure can increase the risk of health problems for the newborn, such as:
High blood pressure during pregnancy can decrease the flow of nutrients and oxygen through blood vessels, affecting fetal development.
If an early delivery is necessary, this can cause complications such as a low birth weight and difficulty breathing if the baby's lungs have not yet fully developed.
According to a 2018 review, hypertension can increase the risk of these health conditions for the parent and the child:
What happens if a baby is born at 36 weeks?
The American Heart Association notes that most people with hypertension have no symptoms, so a person may only find out during routine screening.
Monitoring blood pressure is an essential part of prenatal care. Having regular prenatal checkups can help a person keep track of their blood pressure and other vital signs, and access treatment if necessary.
Can you tell if you have high blood pressure?
A person cannot alter some risk factors for hypertension, such as:
Why are Black Americans more likely to have high blood pressure?
Risk factors that a person can manage to some extent include:
The best approach depends on the type of hypertension.
A healthcare professional can recommend ways to manage, and if possible, prevent, high blood pressure before, during, and after pregnancy.
It is not always possible to prevent high blood pressure during pregnancy, but some self-care strategies can help.
They include:
Medical professionals tend to recommend regular blood pressure screening, especially for people with risk factors, to detect it early.
High blood pressure is relatively common during pregnancy, and it may develop in people with no history of it. Without appropriate treatment, it can become severe and even life threatening.
Hypertension often causes no symptoms, so it is essential to monitor blood pressure regularly throughout pregnancy.
Having regular prenatal checkups can help prevent high blood pressure from becoming dangerous. If this occurs, the healthcare team can take steps to ensure the safety of the pregnant person and their baby.
Herbs And Supplements For Hypertension
One in five deaths in the United States each year are caused by cardiovascular disease, making it the leading cause of death. Hypertension, which affects roughly half of U.S. Adults, plays an important role in cardiovascular disease by increasing the risk of life-threatening events like heart attacks and strokes.
While doctors write more and more prescriptions to treat the rising number of patients with high blood pressure, some people are also seeking alternative medicine to help manage this condition.
There's nothing wrong with this approach, as long as people don't try to use herbs and supplements to replace prescription medications, says Paul Kalnins, ND, assistant professor at the National University of Natural Medicine in Portland, Oregon. That's because there aren't any herbs or supplements that can directly treat hypertension, Kalnins says.
When someone asks what 'natural products' treat hypertension, they are often asking unconsciously what herbs or supplements can replace pharmaceutical medications," Kalnins adds. "No herb or supplement is as good as existing pharmaceuticals."
Instead, what alternative therapies can offer patients is a way to address some of the underlying processes in the body that can contribute to what's known as essential, or primary, hypertension that isn't caused by other diseases, Kalnins says.
There are a few herbs and supplements that show promise for reducing factors that contribute to hypertension like stiffness in the arteries and inflammation. However, it's important to use caution when choosing them. Some may have ingredients that aren't listed on the labels, or an alternative treatment for hypertension may interact with prescription or over-the-counter medication. To be on the safe side, always talk to your healthcare provider before starting any new treatments.
Alternative Medicine for Blood PressureThe following herbs and supplements may be beneficial for addressing some of the underlying causes of high blood pressure:
Hawthorn This northern European plant has been used as a heart-disease remedy for centuries. Some small studies in humans have found hawthorn effective at reducing inflammation and arterial stiffness, with modest reductions in blood pressure as result. Other small studies have found hawthorn less effective, however.
"With hypertension, there is low-grade inflammation in the arterial walls, which means the blood vessels constrict and don't dilate naturally," explains Kalnins. "The compounds in hawthorn can help relax those arterial walls." It's possible that hawthorn may interact with digoxin (Digitek, Lanoxin), a medication used to treat certain heart disorders, so do not use these two treatments together without guidance from your doctor.
Fish Oil Fish oil has been touted as a worthwhile dietary supplement because it's a good source of omega-3 fatty acids, which, among other things, has naturally occurring anti-inflammatory properties. Some research has found fish oil particularly effective at reducing what's known as systolic blood pressure, the "top number" that shows the pressure blood exerts on artery walls when the heart beats. Fish oil also has the added benefit of driving down triglycerides, a type of fat in the body that can be dangerous at high levels.
Numerous studies show that diet is the most effective way of getting the benefits of omega-3 sources like fish oil. Due to the high cost of wild fish and concerns over mercury levels of cheaper, farm-raised fish, dietary supplements from reputable sources are recommended as well. "Supplements should come from a source that checks the mercury levels in fish oil," Kalnins says.
Garlic The compounds found in garlic help regulate the immune response involved in the inflammatory process and have been shown to lower lipid levels. Supplements made from kyolic aged garlic extract — which comes from organically grown garlic bulbs aged over 20 months at room temperature — may be particularly beneficial. A recent meta-analysis of 12 clinical trials found kyolic aged garlic extract significantly reduced both systolic blood pressure and what's known as diastolic blood pressure, the "bottom number" that shows the pressure blood exerts on artery walls when the heart rests between beats.
Magnesium There is a fair amount of evidence showing diets high in magnesium may lower hypertension risk. Magnesium's role as an alternative treatment for hypertension is intimately related to calcium. Arterial smooth muscle requires calcium for contraction, but people with high blood pressure tend to accumulate calcium in these muscles — hence, the widespread use of calcium channel blocker medication. Magnesium is thought to be a natural calcium channel blocker: It opposes the effects of calcium by relaxing the arterial muscle. Some healthcare professionals haven't seen much success with magnesium as a hypertension treatment specifically.
A recent research review suggests the effectiveness of magnesium may depend on who is taking it. This review examined data from 49 trials testing the impact of magnesium on people with normal blood pressure, individuals with untreated hypertension, patients with blood pressure that's not well controlled by medication, and patients whose medicines do keep their blood pressure in check. While magnesium didn't always help people with previously untreated hypertension, this supplement did appear to help improve blood pressure in patients whose hypertension wasn't well controlled with prescription drugs.
Coenzyme Q10 The supplement coenzyme Q10 (Co-Q10) is also involved in the contraction of smooth muscle, specifically the efficiency of contraction. "Co-Q10 increases the activity of mitochondria, which is where energy is made, so it essentially gives more energy to the heart muscle," says Kalnins. Scientists are still working to pinpoint exactly which people might benefit most from taking this supplement as a way to help manage the underlying causes of high blood pressure.
One recent meta-analysis of data from 17 clinical trials found Co-Q10 helped lower systolic blood pressure in people with metabolic diseases such as diabetes, for example. However, an earlier meta-analysis found moderate-quality evidence that Co-Q10 doesn't have a clinically meaningful impact on people with primary hypertension.
Folic Acid Folic acid is sometimes given as an alternative treatment for hypertension because of its effects on the arterial walls. There is some evidence that accumulation of the amino acid homocysteine in the blood can damage these walls. Folic acid, typically given in combination with vitamins B6 or B12, reduces homocysteine levels. A recent meta-analysis of 22 studies with more than 40,000 patients found folic acid supplements significantly reduced systolic blood pressure.
The Bottom LineDietary supplements aren't tested and regulated as strictly as prescription and over-the-counter medication. In fact, manufacturers can market a supplement without having to prove safety or effectiveness.
Beyond this, a lot of what we know about the potential benefits of herbs and supplements for managing the underlying causes of hypertension is based on lab tests, animal studies, or small human trials, Kalnins says.
That's why you should research supplements and talk with your regular doctor about potential interactions and side effects before using an alternative treatment for hypertension.
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