Ultrasound evaluation of persistent pulmonary hypertension of the newborn

Cover Page

Cite item

Full Text

Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is an urgent problem in neonatology and one of the leading causes of neonatal morbidity. PPHN is currently the most common cause of transient PH. PPHN usually occurs immediately after birth, persists during the first week of life, or later, depending on the degree of prematurity and immaturity of the newborn's lungs. Neonates with PPHN are at high risk for severe respiratory failure and asphyxia and its complications. Ultrasound examination of the heart is the primary method for diagnosing PPHN and is crucial for targeted treatment. Despite the existing ultrasound indicators, none of them is the final prognostic criterion for assessing PH; therefore, it is recommended that a newborn always undergo a comprehensive ultrasound of the heart, considering the specific features of the neonatal period.

About the authors

Alla A. Tarasova

Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: tarasova-aa@yandex.ru
ORCID iD: 0000-0002-8033-665X

D. Sci. (Med.), Prof.

Russian Federation, Moscow

References

  1. Abman SH. Pulmonary Hypertension: The Hidden Danger for Newborns. Neonatology. 2021;118(2):211-21. doi: 10.1159/000516107
  2. Mourani PM, Mandell EW, Meier M, et al. Early Pulmonary Vascular Disease in Preterm Infants Is Associated with Late Respiratory Outcomes in Childhood. Am J Respir Crit Care Med. 2019;199(8):1020-107. doi: 10.1164/rccm.201803-0428OC
  3. Steurer MA, Jelliffe-Pawlowski LL, Baer RJ, et al. Persistent Pulmonary Hypertension of the Newborn in Late Preterm and Term Infants in California. Pediatrics. 2017;139(1):e20161165. doi: 10.1542/peds.2016-1165
  4. Walsh-Sukys MC, Tyson JE, Wright LL, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics. 2000;105(Pt 1):14-20. doi: 10.1542/peds.105.1.14
  5. van Loon RL, Roofthooft MT, Hillege HL, et al. Pediatric pulmonary hypertension in the Netherlands: epidemiology and characterization during the period 1991 to 2005. Circulation. 2011;124(16):1755-64. doi: 10.1161/CIRCULATIONAHA.110.969584
  6. del Cerro Marín MJ, Sabaté Rotés A, Rodriguez Ogando A, et al. Assessing pulmonary hypertensive vascular disease in childhood. Data from the Spanish registry. Am J Respir Crit Care Med. 2014;190(12):1421-9. doi: 10.1164/rccm.201406-1052OC
  7. Pektas A, Pektas BM, Kula S. An epidemiological study of paediatric pulmonary hypertension in Turkey. Cardiol Young. 2016;26(4):693-7. doi: 10.1017/S1047951115001043
  8. Beghetti M, Berger RM, Schulze-Neick I, et al. Diagnostic evaluation of paediatric pulmonary hypertension in current clinical practice. Eur Respir J. 2013;42(3): 689-700. doi: 10.1183/09031936.00140112
  9. Nakanishi H, Suenaga H, Uchiyama A, et al. Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study. Arch Dis Child Fetal Neonatal Ed. 2018;103(6):F554-51. doi: 10.1136/archdischild-2017-313778
  10. Неонатология: национальное руководство: в 2 т. Под ред. Н.Н. Володина, Д.Н. Дегтярева. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2023. Т. 1 [Neonatologiia: natsional'noe rukovodstvo: v 2 t. Pod red. NN Volodina, DN Degtiareva. 2-e izd., pererab. i dop. Moscow: GEOTAR-Media, 2023. T. 1 (in Russian)]. doi: 10.33029/9704-7828-8-NNG-2023-1-752
  11. Sankaran D, Lakshminrusimha S. Pulmonary hypertension in the newborn – etiology and pathogenesis. Semin Fetal Neonatal Med. 2022;27(4):101381. doi: 10.1016/j.siny.2022.101381
  12. Martinho S, Adão R, Leite-Moreira AF, Brás-Silva C. Persistent Pulmonary Hypertension of the Newborn: Pathophysiological Mechanisms and Novel Therapeutic Approaches. Front Pediatr. 2020;8:342. doi: 10.3389/fped.2020.00342
  13. Hansen AR, Barnés CM, Folkman J, McElrath TF. Maternal preeclampsia predicts the development of bronchopulmonary dysplasia. J Pediatr. 2010;156(4):532-6. doi: 10.1016/j.jpeds.2009.10.018
  14. Nair J, Lakshminrusimha S. Update on PPHN: mechanisms and treatment. Semin Perinatol. 2014;38(2):78-91. doi: 10.1053/j.semperi.2013.11.004
  15. Sallmon H, Koestenberger M, Avian A, et al. Extremely premature infants born at 23-25 weeks gestation are at substantial risk for pulmonary hypertension. J Perinatol. 2022;42(6):781-8. doi: 10.1038/s41372-022-01374-w
  16. Hansmann G, Koestenberger M, Alastalo TP, et al. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. J Heart Lung Transplant. 2019;38(9):879-901. doi: 10.1016/j.healun.2019.06.022
  17. Hilgendorff A, Apitz C, Bonnet D, Hansmann G. Pulmonary hypertension associated with acute or chronic lung diseases in the preterm and term neonate and infant. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart. 2016;102 (Suppl. 2):ii49-56. doi: 10.1136/heartjnl-2015-308591
  18. Клайдайтер У., Поцца Р.Д., Хаас Н.А. Детская эхокардиография. Ультразвуковое исследование сердца у детей. Ультразвуковая диагностика врожденных пороков сердца. Пер. с нем. под ред. М.И. Пыкова, А.А. Тарасовой. 2-е изд., испр. М.: МЕДпресс-информ, 2024 [Klaidaiter U, Potstsa RD, Khaas NA. Detskaia ekhokardiografiia. Ul'trazvukovoe issledovanie serdtsa u detei. Ul'trazvukovaia diagnostika vrozhdennykh porokov serdtsa. Per. s nem. pod red. MI Pykova, AA Tarasovoi. 2-e izd., ispr. Moscow: MEDpress-inform, 2024 (in Russian)].
  19. Отто К.М. Клиническая эхокардиография. Практическое руководство. Под общ. ред. В.А. Сандрикова. М.: Логосфера, 2019 [Otto KM. Klinicheskaia ekhokardiografiia. Prakticheskoe rukovodstvo. Pod obshch. red. VA Sandrikova. Moscow: Logosfera, 2019 (in Russian)].
  20. Koestenberger M, Apitz C, Abdul-Khaliq H, Hansmann G. Transthoracic echocardiography for the evaluation of children and adolescents with suspected or confirmed pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and D6PK. Heart. 2016;102 (Suppl. 2):ii14-22. doi: 10.1136/heartjnl-2014-307200
  21. More K, Soni R, Gupta S. The role of bedside functional echocardiography in the assessment and management of pulmonary hypertension. Semin Fetal Neonatal Med. 2022;27(4):101366. doi: 10.1016/j.siny.2022.101366
  22. Koestenberger M, Ravekes W, Everett AD, et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr. 2009;22(6):715-9. doi: 10.1016/j.echo.2009.03.026
  23. Kurath-Koller S, Avian A, Cantinotti M, et al. Normal Pediatric Values of the Subcostal Tricuspid Annular Plane Systolic Excursion (S-TAPSE) and Its Value in Pediatric Pulmonary Hypertension. Can J Cardiol. 2019;35(7):899-906. doi: 10.1016/j.cjca.2019.01.019
  24. Malowitz JR, Forsha DE, Smith PB, et al. Right ventricular echocardiographic indices predict poor outcomes in infants with persistent pulmonary hypertension of the newborn. Eur Heart J Cardiovasc Imaging. 2015;16(11):1224-31. doi: 10.1093/ehjci/jev071
  25. Levy PT, Dioneda B, Holland MR, et al. Right ventricular function in preterm and term neonates: reference values for right ventricle areas and fractional area of change. J Am Soc Echocardiogr. 2015;28(5):559-69. doi: 10.1016/j.echo.2015.01.024
  26. Jain A, Mohamed A, El-Khuffash A, et al. A comprehensive echocardiographic protocol for assessing neonatal right ventricular dimensions and function in the transitional period: normative data and z scores. J Am Soc Echocardiogr. 2014;27(12):1293-304. doi: 10.1016/j.echo.2014.08.018
  27. Patel N, Mills JF, Cheung MM. Use of the myocardial performance index to assess right ventricular function in infants with pulmonary hypertension. Pediatr Cardiol. 2009;30(2):133-7. doi: 10.1007/s00246-008-9285-1
  28. Aggarwal S, Natarajan G. Echocardiographic correlates of persistent pulmonary hypertension of the newborn. Early Hum Dev. 2015;91(4):285-9. doi: 10.1016/j.earlhumdev.2015.02.008
  29. Aggarwal S, Stockman PT, Klein MD, Natarajan G. The right ventricular systolic to diastolic duration ratio: a simple prognostic marker in congenital diaphragmatic hernia? Acta Paediatr. 2011;100(10):1315-8. doi: 10.1111/j.1651-2227.2011.02302.x
  30. Sehgal A, Athikarisamy SE, Adamopoulos M. Global myocardial function is compromised in infants with pulmonary hypertension. Acta Paediatr. 2012;101(4):410-3. doi: 10.1111/j.1651-2227.2011.02572.x
  31. Patel N, Mills JF, Cheung MM. Assessment of right ventricular function using tissue Doppler imaging in infants with pulmonary hypertension. Neonatology. 2009;96(3):193-9. doi: 10.1159/000215585
  32. Sciomer S, Magrì D, Badagliacca R. Non-invasive assessment of pulmonary hypertension: Doppler-echocardiography. Pulm Pharmacol Ther. 2007;20(2): 135-40. doi: 10.1016/j.pupt.2006.03.008
  33. Le Duc K, Rakza T, Baudelet JB, et al. Diastolic ventricular function in persistent pulmonary hypertension of the newborn. Front Pediatr. 2023;11:1175178. doi: 10.3389/fped.2023.1175178
  34. Levy PT, Holland MR, Sekarski TJ, et al. Feasibility and reproducibility of systolic right ventricular strain measurement by speckle-tracking echocardiography in premature infants. J Am Soc Echocardiogr. 2013;26(10):1201-23. doi: 10.1016/j.echo.2013.06.005
  35. Hasan H, Chouvarine P, Diekmann F, et al. Validation of the new paediatric pulmonary hypertension risk score by CMR and speckle tracking echocardiography. Eur J Clin Invest. 2022;52(11):e13835. doi: 10.1111/eci.13835
  36. Levy PT, El-Khuffash A, Patel MD, et al. Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age. J Am Soc Echocardiogr. 2017;30(7):685-98.e1. doi: 10.1016/j.echo.2017.03.003

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2025 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 


Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).