— Hipertensión Pulmonar Persistente del Nuevo Nacido (PPHN) —
The provided text appears to be a summary of the management and treatment options for Persistent Pulmonary Hypertension of the Newborn (PPHN). Here's a condensed version of the information:
**Diagnosis**
* Echocardiography: To screen and diagnose PPHN, and rule out structural heart lesions.
* Echocardiography with Doppler and color-flow mapping: To assess intracardiac shunt direction and pulmonary arterial systolic/diastolic pressures.
* Cranial ultrasonography: To assess for intraventricular bleeding and peripheral areas of hemorrhage or infarct.
* Brain computed tomography scanning or magnetic resonance imaging: To evaluate for central nervous system injury.
**Procedures**
* Cardiac catheterization: Rarely used to exclude congenital heart disease due to echocardiographic findings being typically diagnostic.
**Management**
* Continuous monitoring of oxygenation, blood pressure, and perfusion.
* Maintaining a normal body temperature.
* Correction of electrolytes/glucose abnormalities and metabolic acidosis.
* Nutritional support.
* Minimal stimulation/handling of the newborn.
* Minimal use of invasive procedures (e.g., suctioning).
**Medical Therapy**
* Inotropic support (e.g., dopamine, dobutamine, milrinone).
* Surfactant administration for premature and full-term newborns with parenchymal lung disease.
* Endotracheal intubation and mechanical ventilation to maintain normal functional residual capacity.
* High-frequency ventilation for newborns with underlying parenchymal lung disease and low lung volumes.
* Correction of hypoglycemia, hypocalcemia, acidosis, and alkalosis.
* Induced paralysis (controversial) and Extracorporeal Membrane Oxygenation (ECMO) for optimal ventilatory support failure.
**Pharmacotherapy**
* Inhaled pulmonary vasodilators (e.g., nitric oxide) and supplemental oxygen.
* Systemic vasodilators (e.g., prostacyclin, phosphodiesterase inhibitors, endothelin receptor antagonists) for chronic PPHN after the newborn period.
* Prostaglandin E1 if the ductus arteriosus is closed or restrictive.