The provided text appears to be a medical treatment protocol for Persistent Pulmonary Hypertension of the Newborn (PPHN). Here's a summary of the main points: **Diagnostic Tests** * Echocardiography: to screen and assist in diagnosing PPHN and rule out structural heart lesions * Echocardiography with Doppler and color-flow mapping: to assess the presence and direction of intracardiac shunts at the ductus arteriosus and foramen ovale, as well as estimate pulmonary arterial systolic and diastolic pressures * Cranial ultrasonography: to assess for intraventricular bleeding and peripheral areas of hemorrhage or infarct if ECMO is being considered * Cranial ultrasonography with Doppler flow: to assess whether a nonhemorrhagic infarct is present * Brain computed tomography scanning or magnetic resonance imaging: to evaluate for central nervous system injury **Procedures** * Cardiac catheterization: rarely utilized 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 by recruiting areas of atelectasis; to avoid overexpansion * High-frequency ventilation: used in newborns with underlying parenchymal lung disease and low lung volumes * Correction of hypoglycemia, hypocalcemia, acidosis, and alkalosis * Induced paralysis: controversial, typically reserved for newborns who cannot be treated with sedatives alone * 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: 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