Unusual Presentation of Persistent Pulmonary Hypertension of the Newborn

Anusha Siddappa, Shekar Subbaiah, Kishore Yerur, Ramapriya Kalkunte

Abstract

Pulmonary hypertension in a neonate is a complicated and often a life-threatening disease. Treating this condition is difficult, as it is characterized by an increased pulmonary vascular resistance, right-to-left shunt at the atrial and ductal levels along with severe hypoxemia.

We report a case of a term inborn neonate who had no significant antenatal and perinatal history. The neonate had mild respiratory distress at birth requiring oxygen supplementation. There were no significant clinical or radiological lung findings except cardiomegaly noted at birth. Two-dimensional echocardiography showed shunt lesions with mild persistent pulmonary hypertension of the newborn (PPHN) initially. By the second week of life, the pulmonary pressure increased, and it took almost a month for the neonate to respond to pulmonary vasodilators (as the neonate did not fulfill the criteria for inhaled nitric oxide). We urge clinicians to be cautious while treating shunt lesions, especially when PPHN develops early in the neonatal period, which is unusual and becomes refractory to pulmonary vasodilators.