Based on the provided text, I will summarize the management strategies for Persistent Pulmonary Hypertension of the Newborn (PPHN). **Diagnosis** * Echocardiography: To screen and assist in making the diagnosis of PPHN and to rule out a structural heart lesion * Echocardiography with Doppler and color-flow mapping: To assess presence/direction of the intracardiac shunt at the ductus arteriosus and foramen ovale, as well as estimate the pulmonary arterial systolic/diastolic pressures * Cranial ultrasonography: To assess for intraventricular bleeding and for peripheral areas of hemorrhage or infarct if ECMO is being considered * Brain computed tomography scanning or magnetic resonance imaging: To evaluate for central nervous system injury **Procedures** * Cardiac catheterization: Rarely utilized to exclude congenital heart disease (e.g., obstructed anomalous pulmonary venous return, pulmonary vein stenosis) because echocardiographic findings are 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 by recruiting areas of atelectasis; to avoid overexpansion * High-frequency ventilation: Used in newborns with underlying parenchymal lung disease and low lung volumes; therapy is best in centers with clinicians experienced in achieving/maintaining optimal lung distention * Correction of hypoglycemia, hypocalcemia, acidosis, and alkalosis * Induced paralysis: Controversial; paralytic agents are typically reserved for newborns who cannot be treated with sedatives alone (Note: paralysis, especially with pancuronium, may promote atelectasis of dependent lung regions and promote ventilation-perfusion mismatch.) * ECMO: Used when optimal ventilatory support fails to maintain acceptable oxygenation and perfusion **Pharmacotherapy** * Inhaled pulmonary vasodilators (e.g., nitric oxide) and supplemental oxygen * Systemic vasodilators are potentially beneficial for chronic PPHN after the newborn period (e.g., prostacyclin, phosphodiesterase inhibitors, endothelin receptor antagonists) * 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