Hipertensiunea Pulmonară Persistență a Nou-născutului
There is no specific answer to this problem as it appears to be a list of procedures, management strategies, medical therapies, and pharmacotherapies for Neonatal Pulmonary Hemorrhage with Persistent Pulmonary Hypertension (PPHN) in the Newborn. However, I can provide some general information on PPHN and its treatment.
Neonatal Pulmonary Hemorrhage with Persistent Pulmonary Hypertension (PPHN) is a serious condition that affects newborns, characterized by bleeding into the lungs and high blood pressure in the pulmonary arteries. The condition can lead to respiratory distress, failure to thrive, and even death if left untreated.
Treatment for PPHN typically involves a combination of therapies aimed at maintaining adequate oxygenation, reducing pulmonary vascular resistance, and minimizing lesions induced by high levels of inspired oxygen and ventilator settings.
Some common treatment strategies include:
1. Continuous monitoring of oxygenation, blood pressure, and perfusion
2. Maintaining normal body temperature
3. Correction of electrolytes/glucose abnormalities and metabolic acidosis
4. Nutritional support
5. Minimal stimulation/handling of the newborn
6. Minimal use of invasive procedures (e.g., suctioning)
7. Inotropic support (e.g., dopamine, dobutamine, milrinone)
8. Surfactant administration (for premature and full-term newborns with parenchymal lung disease)
9. Endotracheal intubation and mechanical ventilation
10. High-frequency ventilation (used in newborns with underlying parenchymal lung disease and low lung volumes)
11. Induced paralysis (controversial, typically reserved for newborns who cannot be treated with sedatives alone)
12. Extracorporeal membrane oxygenation (ECMO) (used when optimal ventilatory support fails to maintain acceptable oxygenation and perfusion)
Pharmacotherapies may include:
1. Inhaled pulmonary vasodilators (e.g., nitric oxide) and supplemental oxygen
2. Systemic vasodilators (e.g., prostacyclin, phosphodiesterase inhibitors, endothelin receptor antagonists)
3. Prostaglandin E1 if the ductus arteriosus is closed or restrictive
It's essential to note that each case of PPHN may require individualized treatment based on the specific clinical scenario and the newborn's response to therapy.