Management of Pulmonary Hypertension in Preterm Infants—A Review

Abstract

Persistent pulmonary hypertension of newborn is being increasingly diagnosed in extremely premature infants, especially if associated with preterm prelabour rupture of membranes and lung hypoplasia. Late-onset pulmonary hypertension (PH) associated with bronchopulmonary dysplasia is because of pulmonary vascular remodeling and altered vasoreactivity. PH in both these settings is associated with around 20% increase in higher mortality and morbidity. The steps in the management of early-onset PH in these neonates, like in term infants, are supportive measures, oxygenation, lung recruitment, and ventilation. In extremely preterm infants, PH occurs because of the paucity of the pulmonary vascular bed and may not respond well to pulmonary vasodilators, such as iNO and sildenafil. Magnesium sulfate can be effective in reducing the pulmonary pressure, especially in resource-limited settings. Milrinone is considered in neonates with PH and poor cardiac function. In preterm infants with PH secondary to bronchopulmonary dysplasia, the emphasis is on oxygen therapy, nutrition, and correction of comorbidities along with some role of vasodilators.