Send to

Choose Destination
Pediatr Res. 2018 Jul;84(Suppl 1):68-77. doi: 10.1038/s41390-018-0082-0.

Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn.

Author information

Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands.
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
John Radcliffe Hospital, Oxford, United Kingdom.
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy.
Department of Pediatrics, Monash University, Melbourne, Australia.
Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA.
Department of Pediatrics, Goryeb Children's Hospital, Morristown, NJ, USA.
Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON, Canada.
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland.


Pulmonary hypertension contributes to morbidity and mortality in both the term newborn infant, referred to as persistent pulmonary hypertension of the newborn (PPHN), and the premature infant, in the setting of abnormal pulmonary vasculature development and arrested growth. In the term infant, PPHN is characterized by the failure of the physiological postnatal decrease in pulmonary vascular resistance that results in impaired oxygenation, right ventricular failure, and pulmonary-to-systemic shunting. The pulmonary vasculature is either maladapted, maldeveloped, or underdeveloped. In the premature infant, the mechanisms are similar in that the early onset pulmonary hypertension (PH) is due to pulmonary vascular immaturity and its underdevelopment, while late onset PH is due to the maladaptation of the pulmonary circulation that is seen with severe bronchopulmonary dysplasia. This may lead to cor-pulmonale if left undiagnosed and untreated. Neonatologist performed echocardiography (NPE) should be considered in any preterm or term neonate that presents with risk factors suggesting PPHN. In this review, we discuss the risk factors for PPHN in term and preterm infants, the etiologies, and the pathophysiological mechanisms as they relate to growth and development of the pulmonary vasculature. We explore the applications of NPE techniques that aid in the correct diagnostic and pathophysiological assessment of the most common neonatal etiologies of PPHN and provide guidelines for using these techniques to optimize the management of the neonate with PPHN.

Supplemental Content

Full text links

Icon for Nature Publishing Group Icon for PubMed Central
Loading ...
Support Center