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2.1
Persistent Fetal Circulation
Circulation Persistent Fetal

Presentation

Heart size was variable but some degree of cardiomegaly was commonly present. Tolazoline, a potent vasodilator, was useful diagnostically and may have resulted in increased survival. [ncbi.nlm.nih.gov]

Persistent Fetal Circulation AKA PHTN PHTN that leads to right to left shunt of the PDA and PFO No CHD Increased PAPs Cyanosis present Newborn's circulation system does not adapt to breathing outside the womb Full-term or post-term babies who have had [quizlet.com]

Hematological

  • Prolonged Bleeding

    Other adverse effects of nitric oxide include dependency ( 69 ) and prolonged bleeding times (nitric oxide inhibits platelet adhesion ( 12, 70 ). Nitric oxide is the treatment of choice for PFC and can be potentially life-saving. [ncbi.nlm.nih.gov]

Entire Body System

  • Hypothermia

    Causes of perinatal hypoxia, acidosis and hypothermia Sepsis Diaphragmatic hernia Hyaline membrane disease Pulmonary thromboembolism References Fishman, Alfred P., and Dickinson W. [derangedphysiology.com]

    Avoid hypothermia in the neonate. [patient.info]

    Factors that increase pulmonary vascular resistance include acidosis, hypoglycemia, hypothermia, and polycythemia. Pathology: Not applicable. [virtualpediatrichospital.org]

    Moderate systemic hypothermia and topical cooling of the head were applied for myocardial and brain protection. [synapse.koreamed.org]

    Any number of problems or situations can result in idiopathic PFC, including hypoxia, acidosis, hypothermia, hypoglycemia, etc, and some of them may not have been documented. [ncbi.nlm.nih.gov]

  • Sudden Infant Death Syndrome

    An association with sudden infant death syndrome has also been suggested ( 19 ). The underlying cause determines the prognosis ( 20 ). ETIOLOGY PFC can be primary or secondary to other factors. [ncbi.nlm.nih.gov]

Respiratoric

  • Pneumonia

    […] vascular resistance in the postnatal period Etiology, pathogenesis primary (idiopathic) — affects term infants an has no obvious pulmonary or cardiovascular causes secondary — with known etiology for example lung hypoplasia, masive meconium aspiration, pneumonia [atlases.muni.cz]

    A chest X-ray revealed pneumonia. An echocardiogram found no heart defect but rather a failure of his circulatory system to convert from the womb to the outside world. [nytimes.com]

    Pulmonary infection - eg group B beta-haemolytic streptococcal pneumonia. Pulmonary haemorrhage. Meconium aspiration pneumonia. Oxygen toxicity along with pressure or volume trauma to the lungs. [patient.info]

    Gene context of Persistent Fetal Circulation Syndrome Primary diagnoses included respiratory distress syndrome (RDS; 23), pneumonia (12), persistent fetal circulation (PFC; 6), diaphragmatic hernia /hypoplastic lungs (4) [14]. [wikigenes.org]

    The white blood cell (WBC) count and differential may help in determining whether an underlying sepsis or pneumonia is present. [emedicine.com]

Cardiovascular

  • Cyanosis

    Persistent Fetal Circulation AKA PHTN PHTN that leads to right to left shunt of the PDA and PFO No CHD Increased PAPs Cyanosis present Newborn's circulation system does not adapt to breathing outside the womb Full-term or post-term babies who have had [quizlet.com]

    The clinical appearance of these six neonates included respiratory distress, cyanosis, and/or apnea. The chest roentgenograms showed mild to moderate lung disease. All six neonates had progressive acidosis with hypoxemia. [ncbi.nlm.nih.gov]

    The newborn patient exhibits cyanosis and acidosis due to the persistence of fetal circulatory pattern of right-to-left shunting of blood through a patent ductus arteriosus (ductus arteriosus, patent) and at times a patent foramen ovale (foramen ovale [icd9data.com]

    Cyanosis unresponsive to oxygen therapy Echocardiogram X-ray to identify underlying disorders Diagnosis of persistent pulmonary hypertension of the newborn should be suspected in any near-term infant with arterial hypoxemia, cyanosis, or both, especially [merckmanuals.com]

Treatment

Early or prophylactic treatment of respiratory distress syndrome (RDS) with surfactant appears to be more effective than treatment once RDS has developed. [ncbi.nlm.nih.gov]

Make informed clinical choices for each patient, from diagnosis and treatment selection through post-treatment strategies and management of complications, with new evidence-based criteria throughout. [books.google.com]

However, basic treatment goals do exist { Fox, 1983 }, { Perkin, 1984 }. [web.archive.org]

Prognosis

Functional obstruction of pulmonary blood flow: This has a good prognosis if it is reversible. Causes include polycythemia and hyperfibrinogenemia. [en.wikipedia.org]

Poor prognosis. Secondary PFC Most commonly seen in infants with lung disease, where hypoxia and acidosis leads to pulmonary vasoconstriction and persistently elevated PVR. [openanesthesia.org]

The prognosis is much better for babies weighing over 1500 g. Prevention Antenatal corticosteroids (dexamethasone) accelerate fetal surfactant production and lung maturation. [patient.info]

Complications and Prognosis PPHN is a serious condition and intensive monitoring and treatment are critical. [chdbabies.com]

Prognosis FMH is followed by fetal anemia which has severe consequences such as neurologic injury, stillbirth, or neonatal death(3). [medichub.ro]

Etiology

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

We postulate that hypovolemia may be one factor in the etiology of persistent fetal circulation (PFC). [nature.com]

pathogenesis primary (idiopathic) — affects term infants an has no obvious pulmonary or cardiovascular causes secondary — with known etiology for example lung hypoplasia, masive meconium aspiration, pneumonia, congenital heart diseases or bronchopulmonary [atlases.muni.cz]

In our case, the etiology was unclear. [synapse.koreamed.org]

There are 3 main categories of etiologies of persistent fetal circulation (PFC) in the newborn: Congenital heart defect Any congenital heart defect which results in elevated pulmonary artery or RV pressures will have PFC in order to allow adequate cardiac [openanesthesia.org]

Epidemiology

To conduct an epidemiologic study of persistent pulmonary hypertension of the newborn ( PPHN) infant. [clinicaltrials.gov]

CONCLUSIONS: This large multicenter epidemiologic study of PPHN risk revealed no evidence to support the hypothesis that maternal consumption during pregnancy of NSAIDs overall or ibuprofen in particular is associated with PPHN risk. [pediatrics.aappublications.org]

Our study is part of a large case–control study of risk factors for PPHN, conducted within the Birth Defects Study of the Slone Epidemiology Center. [doi.org]

NCT01203423 24 NO Need to Ventilate: A Trial of Non-invasive Inhaled Nitric Oxide in Persistent Pulmonary Hypertension of the Newborn Completed NCT00139217 Not Applicable iNO 25 Risk Factors for Pulmonary Hypertension of the Newborn Completed NCT00005497 26 Epidemiology [malacards.org]

Pathophysiology

Use of this method allows not only attainment of clinically useful information but also permits better insight into the pathophysiology of the disease state. [ncbi.nlm.nih.gov]

Persistent Pulmonary Hypertension Of The Newborn Table of Contents Nomenclature Definition Changes in Pulmonary Circulation at Birth Pathophysiology Diagnosis Treatment - Discussion Treatment - Local Practice Outcome Nomenclature Persistent pulmonary [web.archive.org]

Etiology/Pathophysiology: Persistent or recurrent pulmonary artery hypertension with right to left shunting through a patent foramen ovale and patent ductus arteriosus in a patient with pulmonary disease. [virtualpediatrichospital.org]

PATHOPHYSIOLOGY Muscular pulmonary arterioles are constricted in the term fetus. [pedsinreview.aappublications.org]

Kilchemmann Fuentes C, Vallejos Vallejos C, Román Navarro A The fetal circulation, pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates, and the role of oxygen therapy. Lakshminrusimha S, Saugstad OD [medicbind.com]

Prevention

0% Emergent - ED Care Needed - Preventable/Avoidable - 0% Emergent - ED Care Needed - Not Preventable/Avoidable - 0% Primary diagnosis of injury 0% Primary diagnosis of mental health problems 0% Primary diagnosis of substance abuse 0% Primary diagnosis [medicbind.com]

However, PPHN causes an infant to revert back to fetal circulation, in which blood flow bypasses the lungs, preventing the baby from breathing. [birthinjuryguide.org]

No matter how oxygen is delivered, it should be warmed (36 to 37° C) and humidified to prevent secretions from cooling and drying and to prevent bronchospasm. [msdmanuals.com]

This condition then signals the body to direct the blood away from the infant’s lungs, which prevents the blood from becoming adequately oxygenated. [fronzutolaw.com]

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