The provided text is a comprehensive overview of the management, diagnosis, and treatment strategies for Persistent Pulmonary Hypertension of the Newborn (PPHN). Here's a concise summary: **Diagnosis** * Echocardiography: to screen for PPHN and rule out structural heart lesions * Echocardiography with Doppler and color-flow mapping: to assess intracardiac shunt at ductus arteriosus and foramen ovale, as well as estimate pulmonary arterial systolic/diastolic pressures * Cranial ultrasonography: to assess for intraventricular bleeding and 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 due to echocardiographic findings typically being diagnostic * ECMO (extracorporeal membrane oxygenation): used when optimal ventilatory support fails to maintain acceptable oxygenation and perfusion **Management** * General principles: + Continuous monitoring of oxygenation, blood pressure, and perfusion + Maintaining 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: 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