Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn.
Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn.
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DOI：
10.1038/s41390-018-0082-0
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发表时间：
2018-07
影响因子：
3.6
通讯作者：
European Special Interest Group ‘Neonatologist Performed Echocardiography’ (NPE)
中科院分区：
文献类型：
--
作者：
de Boode WP;Singh Y;Molnar Z;Schubert U;Savoia M;Sehgal A;Levy PT;McNamara PJ;El-Khuffash A;European Special Interest Group ‘Neonatologist Performed Echocardiography’ (NPE)
肺动脉高压对足月新生儿（即新生儿持续性肺动脉高压（PPHN））和早产儿（在肺血管发育异常和生长受阻的情况下）的发病率和死亡率都有影响。在足月婴儿中，PPHN的特征是出生后肺血管阻力的生理性降低失败，导致氧合受损、右心室衰竭和肺-全身分流。肺血管不适应、不发达或不发达。在早产儿中，机制相似，早发性肺动脉高压（PH）是由于肺血管不成熟及其发育不良，而晚发性PH是由于肺循环的不适应，严重的支气管肺发育不良。如果不及时诊断和治疗，这可能导致肺源性肺病。在任何早产或足月新生儿出现提示PPHN的危险因素时，应考虑新生儿医生进行超声心动图（NPE）检查。在这篇综述中，我们讨论了足月和早产儿PPHN的危险因素，病因和病理生理机制，因为它们与肺血管的生长和发育有关。我们探讨了NPE技术的应用，这些技术有助于对最常见的新生儿PPHN病因进行正确的诊断和病理生理评估，并为使用这些技术优化新生儿PPHN的管理提供指导。
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.
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