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