Division of Neonatology, Department of Pediatrics, University of California, Davis, California, USA; Department of Pediatrics, Adventist Health Rideout Hospital, Marysville, CA, USA.
Division of Neonatology, Department of Pediatrics, University of California, Davis, California, USA.
Semin Fetal Neonatal Med. 2022 Aug;27(4):101381. doi: 10.1016/j.siny.2022.101381. Epub 2022 Aug 7.
A disruption in the well-orchestrated fetal-to-neonatal cardiopulmonary transition at birth results in the clinical conundrum of severe hypoxemic respiratory failure associated with elevated pulmonary vascular resistance (PVR), referred to as persistent pulmonary hypertension of the newborn (PPHN). In the past three decades, the advent of surfactant, newer modalities of ventilation, inhaled nitric oxide, other pulmonary vasodilators, and finally extracorporeal membrane oxygenation (ECMO) have made giant strides in improving the outcomes of infants with PPHN. However, death or the need for ECMO occurs in 10-20% of term infants with PPHN. Better understanding of the etiopathogenesis of PPHN can lead to physiology-driven management strategies. This manuscript reviews the fetal circulation, cardiopulmonary transition at birth, etiology, and pathophysiology of PPHN.
出生时胎儿到新生儿心肺过渡的不协调会导致严重低氧性呼吸衰竭伴肺血管阻力升高（PVR）的临床难题，这种情况被称为新生儿持续性肺动脉高压（PPHN）。在过去的三十年中，表面活性剂、新型通气方式、吸入一氧化氮、其他肺血管扩张剂，以及最后体外膜氧合（ECMO）的出现，在改善 PPHN 婴儿的预后方面取得了巨大进展。然而，10-20%的足月 PPHN 婴儿仍会死亡或需要 ECMO。更好地了解 PPHN 的病因发病机制可以导致基于生理学的管理策略。本文综述了 PPHN 的胎儿循环、出生时心肺过渡、病因和病理生理学。
