Trwała hipertonia płucna noworodka (PPHN)

This text appears to be a summary of management strategies for Persistent Pulmonary Hypertension of the Newborn (PPHN). Here is a condensed version of the key points: **Diagnostic Tests** * Echocardiography: To screen and diagnose PPHN, rule out structural heart lesions * Doppler and color-flow mapping echocardiography: To assess intracardiac shunts and pulmonary arterial pressures * Cranial ultrasonography: To evaluate 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: Rarely used to exclude congenital heart disease due to echocardiographic findings being typically diagnostic **Management Principles** * Continuous monitoring of oxygenation, blood pressure, and perfusion * Maintaining normal body temperature * Correction of electrolytes/glucose abnormalities and metabolic acidosis * 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 and 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 and typically reserved for newborns who cannot be treated with sedatives alone) * Extracorporeal membrane oxygenation (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