Primary Pulmonary Hypertension in Newborns FAQ

What are the Symptoms of PPHN?

• rapid breathing (also called tachypnea)
• rapid heart rate
• respiratory distress, including signs such as flaring nostrils and grunting
• cyanosis (when the skin has a bluish tinge), even while the baby is receiving extra oxygen to breathe

A baby with PPHN may also maintain low oxygen levels in the blood while receiving 100% oxygen.
 

What are the Treatment Options?

The main goal of treatment for persistent pulmonary hypertension of the newborn (PPHN) is to increase oxygen levels to the baby's organs to avoid serious health problems. Treatment may include a wide range of mechanical ventilation and respiratory therapy options, including high frequency oscillatory ventilation and inhaled nitric oxide.

• Oxygen - 100 percent supplemental oxygen may be given to your baby through a mask or plastic hood.
   
• Assisted Ventilation - During this procedure, a tube is inserted into your baby's windpipe and a ventilator takes over your baby's breathing and oxygen is given.
   
• Nitric Oxide - Research has shown that this gas is effective in treating PPHN because it relaxes contracted lung blood vessels and improves blood flow to the lungs. It is given through the ventilator.
   
• High Frequency Oscillatory Ventilation - This type of ventilation may improve the oxygen level in the blood if other types of ventilation are not effective.

In addition, an extracorporeal membrane oxygenation (ECMO) machine may be used for patients who are experiencing serious heart or lung failure. It delivers oxygen to the brain and body as temporary support while the PPHN resolves. ECMO is similar to a heart-lung bypass machine, which takes over your baby's heart and lung functions with an external pump and oxygenator. Blood is drained from the patient to an artificial lung, where oxygen is added and carbon dioxide is removed, and then the blood is pumped back into your child. 

What are SSRIs?

Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of anti-depressants for treating depression, anxiety disorders, and some personality disorders. These drugs are designed to elevate the level of the neurotransmitter serotonin. A low level of serotonin is currently seen as one among several neurochemical symptoms of depression. Low levels of serotonin in turn can be caused by an anxiety disorder, because serotonin is needed to metabolize stress hormones.

These medications evolve their effects at the serotonin transporter. They increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell. They have no or only weak effects at other monoamine transporters, thus having little direct influence on the level of other neurotransmitters. That distinguishes them from the older tricyclic anti-depressants (TCAs), thus they are named selective. SSRIs are considered to be considerably safer than TCAs, since the toxic dose is much higher and they are said to have fewer and less strong side effects and drug interactions.
 

Is there a link between SSRI's and PPHN?

A case-control study found that infants of women who took an SSRI after 20 weeks of gestation had six times the risk of the lung disorder compared with babies born of drug-free women, reported Christina D. Chambers, Ph.D., M.P.H., of the University of California and colleagues in the Feb. 9 issue of the New England Journal of Medicine.
 

Which Drugs are Classified as SSRI's?

• citalopram (Celexa, Cipramil, Emocal, Sepram)
• escitalopram oxalate (Lexapro, Cipralex)
• fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem)
• fluvoxamine maleate (Luvox, Faverin)
• sertraline (Zoloft, Lustral)