Combattre hypertension arterielle.
Persistance de l’Hypertension Pulmonaire du Nouveau-Né (PPHN)
The provided text appears to be a medical document related to Postnatal Pulmonary Hemorrhage Syndrome (PPHN) management. Here's a condensed version of the key points:
**Diagnostic Tests:**
* Echocardiography to screen for and diagnose PPHN and rule out structural heart lesions
* Echocardiography with Doppler and color-flow mapping to assess intracardiac shunts and pulmonary artery 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 central nervous system injury
**Procedures:**
* Cardiac catheterization is rarely used due to echocardiographic findings being typically diagnostic
**Management Principles:**
* 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 ECMO use when optimal ventilatory support fails to maintain acceptable oxygenation and perfusion
**Pharmacotherapy:**
* Inhaled pulmonary vasodilators (e.g., nitric oxide) and supplemental oxygen
* Systemic vasodilators for chronic PPHN after the newborn period
* Prostaglandin E1 if the ductus arteriosus is closed or restrictive in the setting of suprasystemic pulmonary artery pressures and/or right ventricular dysfunction leading to poor systemic perfusion