PPHN

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Hello,
Not sure if this is the right sub-topic..it is the best one that I could find.

DD had PPHN when she was born. It was picked up more than 12 hours after she was born, though she was probably showing symptoms much earlier, as she wasn't feeding. Appalling appalling post natal ward, which did not have even a saturation monitor to check her oxygen levels..

She was a full term baby, though very small (2.3 kg/5 lbs). Apart from the PPHN at birth, she has been fine from what we can see, except for being monitored for Asthmatic symptoms.

My question is: Are there parents out there who have had children who had PPHN at birth..And do you have any info to share. Am asking this because of two concerns:

1. The consultant who treated her at birth was kind of open-ended about consequences. He said there has been no sufficient research to point to long term consequences and at the same time, neither sufficient data to rule out the same.

2. From my limited iknowledge, the cause for PPHN itself isn't clear. There is a theory that taking anti-depressants during pregnancy may be a cause. But, I hadn't used any. Given this, am worried if we go for another child, will there be a significant risk of the child having PPHN
   And that thought really

Will be most grateful if you have any experiences/info that you can share.

Thanks

Hello, I know a little bit about PPHN, but tbh you will probably have found this info yourself. In any case, it is rare (affects about one in 1000 babies in the general population). There does seem to be a possible link with SSRI use especially after 20 weeks of pregnancy ( raises the risk to about 1:100 to 1:200). There is also a bit of evidence that taking NSAIDs like Ibuprofen during late pregnancy may increase the risk of PPHN in the baby. I've just had a quick look at a couple of papers and apparently c-section delivery, high maternal BMI, and maternal diabetes are also recognised risk factors. There is no mention of having previously having a baby with PPHN being specifically associated with increased risk in future pregnancies.

Before babies are born their circulation is slightly different to how it is once they are born, one of the big differences is that the blood supply to the lungs in utero is minimal and as soon as the baby is born the vessels to the lungs open up and the supply to the lungs increases.
PPHN just means that, for some reason or another, the vessels to the lungs don't open up properly in the first few hours of life. This can be for many many reasons - it's not an illness in itself but a symptom if you see what I mean. As such, there isn't an increased risk of it happening to another baby.

Anecdotal, I know, but none of the babies I have looked after with pphn have had siblings who've had pphn. In some cases it has been one of those things that happen and get better again and we never really get to e bottom of it, most cases I've seen have been due to either an infection or things like having inhaled meconeum or a difficult delivery causing the oxygen level to be low

Also, it isn't a problem of the lungs as such, more the blood supply to the lungs (the lungs often look absolutely perfect on x rays even when a child has oxygen saturation levels half what they should be!) so as long as there wasn't a long period of ventilation there shouldn't be any long term breathing problems associated with it.

It is a very rare thing to happen and basically exclusive to the first few days of life (pulmonary hypertension can happen at any age but pphn can only happen to very new babies who's circulation is still trying to get adjusted to having to get oxygen from the outside world rather than the placenta) so you may find that talking to your gp doesn't give you many answers, however when you do get pregnant again it may be worth arranging an appointment with one of the neonatal doctors to talk through your concerns, speak to your midwife and see if this can be arranged

It would be interesting if brufen caused it as thats the same drug which given early enough in the nicu closes the hole in the hearts seen in many prems without needing surgery.

Ibuprofen closes a particular duct that should close when feta, circulation changes to outside world circulation. This duct isn't really implicated in pphn though and the drugs we give to keep this duct open (in heart problems needing urgent surgery) doesn't work in pphn. It isn't the ductus that's the problem, it's the pulmonary vessels

This leaflet includes the current scientific evidence about ibuprofen and pphn
www.medicinesinpregnancy.org/Medicine--pregnancy/Ibuprofen/

Thanks so much sallysparrow157, Poppet45, LittlePeasMummy1 for taking the time to reply. Really appreciate it.

Sorry for the length of this post.

As you have said, talking to the GP doesn't help here.

Two things that plague me often are:

1. The fact that it was picked up rather late and if the period of oxygen deprivation could have done some damage which will have a long term consequence.. It constantly bothers me.

She was born 6am-ish and her Apgar was normal; she had her first (BF) feed but didn't have anything at all after that despite me tryin15 hrs after she was born and her saturation levels had fallen to around 50 i think by that time.

The PNC ward was absolutely horrible horrible place..We were constanly asking for attention because she was not feeding (at that point I had no clue that it could be indicative of any underlying problem) which we never got. In fact, we were told in so many words that lookking after the baby is our problem and not theirs. It was a bank holiday weekend and perhaps staff were overstretched. There were 5 incident reports that were filed.
Anyway, thats a diff story.

Eventually, around 8pm-ish, a family member who happens to be a paediatrician came as she was going to be with me for the night, and she picked it up immediately and believe it or not, there was no saturation monitor in the PNC ward. And then she was moved to NICU and ventilated and then they had to wait for a bed to be available in Royal Brompton to which she was transferred in an ambulance. She remained there for 2 days and was given only Nitric oxide treatment; she was tube fed with IV fluids ( i think) and with expressed milk from the second day and she remained in the local hospital NICU for another week before coming home.

2. As regards the possible causes that you have outlined, LittlePeasMummy1, I might have read the same paper that you have mentioned; the one that I read mentioned race of the mother as well as being a factor; that doesn't apply to me. But, C-section and a high BMI (28) apply.

My waters broke; my BP (which has been normal all along) shot up; and i was induced and after 8cm dilated, they ruled that baby wasn't coping and did an emergency C-section.

3)Long term Consequences: we haven't observed any developmental delays as such (something we were told to keep an eye on) and her hearing tests (a possible side effects of the drugs used we were told) have been fine as well.

But, I haven't been able to get information on consequences; the consultant who treated her was open ended about it saying that there hasn't been any long term study on that and haven't been able to get much in terms of anecdotal evidence either.

Would be very grateful if you have something related that you can share

Thanks in advance

I don't think anyone on here's going to really be able to answer your biggest question, which I think is "Can you please guarantee me that she is absolutely 100% fine as if this had never happened, and that with another child there is 0% chance of this happening again".

Babies (and kids) are such complicated creatures that don't read the text books. So we can see tiny micropremmies who were as sick as dogs who go on to amaze us all, and yet there are term babies who were absolutely fine, then go on to have all sorts of problems for no obvious reason. But we can still try to partly answer, and hope that helps a bit.

1)Was she harmed by low oxygen levels? Probably not. Why not? Well...she was probably getting worse during that time, so the oxygen levels probably hadn't been as low as that for all that time, but had been drifting lower. And more importantly, baby blood is different to adult blood. They have a different sort of haemoglobin to us, which is designed to grab every last bit of oxygen available and deliver it really efficiently to where it's needed - because they're used to getting second hand oxygen before they're born. So that saturation level isn't much lower than a baby is designed to cope with before they're born. So they tend to do surprisingly well - I've seen quite a lot of cardiac babies do well having had levels nearly that low for days and weeks. I can also think of several non-cardiac babies who had levels probably (like your baby we can't know for sure how long) that low for days, and are now bright active healthy kids.

Were her heart/lungs harmed by the PPHN? Probably not. There can be damage from some of the causes of PPHN (meconium in the lungs for instance) but not usually just by the process. You can get a bit of damage from having to use a ventilator, but for someone ventilated for days rather than weeks you'd expect that to heal up as the lungs grow (although being more likely to have wheezy problems in the first few years is a bit more common having been ventilated for any reason as a baby)

2. Causes? Well...most of the time we know, because it's been obvious (meconium, sepsis etc) But not always. I've known a few babies do it for no really obvious reason, and they had a few things in common: they were section babies, they tended not to have had a really good hearty cry when they were born, to be a bit on the small side, often they were a little bit cold and hadn't fed well so their sugars were a little bit low. Obviuously, I don't know how much of that is true for your DD, but PPHN is what I think of as a "vicious spiral" condition. They're more likely to develop it if they've not inflated their lungs really well (cried lots), or if they're a bit cold, or have low sugars, or if they've got a bit floppy and chin tucked partially blocking their airway, but if they're developing it then those problems get more likely, which makes it worse etc. And much of the treatment is about interrupting that downward spiral and dragging them back up...I don't know if your DD did the classic thing of needing loads and loads and loads doing, and then suddenly really improving? Almost like there's a tipping point. And like sallysparrow, I've never known a sibling be affected.

3)oops, covered some of this in one. Honestly, we always like to follow up for a couple of years any baby sick enough to be ventilated, to check on their development. Because the more milestones we see coming on time, the more relaxed we get. Noone is ever going to be able to 100% tell you that she's 100% totally the person she would have been. But based on what you've told us, she'd be one of the ones that I would be extremely optimistic would actually be 100%.