Satyan Lakshminrusimha, MD and Eric Gibson, MD
Systemic hypotension is a common and challenging to treat phenomenon in infants with PPHN. Dr. Lakshminrusimha discusses strategies for optimal management of systemic hypotension in this population of infants.
Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of failed adaptation of the normal fall in PVR that occurs following birth, and is associated with significant neonatal mortality and morbidity. Systemic hypotension is a naturally occurring phenomenon in PPHN, and can further complicate the treatment of this condition. Most of the drugs commonly used to treat systemic hypotension in neonates unfortunately have adverse effects on the pulmonary circulation in the form of increased pulmonary artery pressures and pulmonary vasoconstriction. Moreover, few of these medications have been well studied in randomized control trials and their use is therefore supported only by low quality evidence. Dr. Lakshminrusimha has worked to develop physiology-based algorithms to treat systemic hypotension with the goal of using pharmacotherapies that can minimize pulmonary vasoconstriction and cardiac dysfunction. These algorithms have been successful at several institutions, and interestingly indicate a trend toward vasopressin use in specific patient scenarios.