Primary Pulmonary Hypertension (PPH) in Newborns

You take the drugs your doctor prescribes in order to improve your health and well-being. When you are pregnant, you must trust that those medications will not harm you or your baby. If your infant has been diagnosed with Persistent Pulmonary Hypertension of the Newborn (PPHN), a rare but serious condition that has been associated with common drugs used to treat depression as well as medications used to treat pain and inflammation, you’ll want to know how your baby’s condition may be linked to the medications you have taken. You’ll want to know what you can do. Call us at the Monsour Law Firm. We will help.

Information about Persistent Pulmonary Hypertension of the Newborn (PPHN)

What is Persistent Pulmonary Hypertension of the Newborn (PPHN)?

How is Persistent Pulmonary Hypertension of the Newborn (PPHN treated?

What are the causes of Persistent Pulmonary Hypertension of the Newborn (PPHN)?

Are there any long-term effects of Persistent Pulmonary Hypertension of the Newborn (PPHN)?

What is Persistent Pulmonary Hypertension of the Newborn (PPHN)?

Persistent Pulmonary Hypertension of the Newborn (PPHN) is a relatively rare but serious disorder that occurs at birth but can result in both immediate and long-term health problems. In the womb, oxygen is acquired through the placenta and goes directly from the placenta to other organs through a special blood vessel in the umbilical cord, called the ductus arteriosus. Before birth, your baby’s blood circulation bypasses the lungs.

At birth, the the ductus arteriosus should close, and the baby’s system should switch to receive oxygen from the lungs. With PPHN, this switch does not occur. The baby's circulation system continues to bypass the lungs, attempting to maintain the prenatal circulation pattern even though the placenta is no longer there to provide desperately needed oxygen. The oxygen in the air your baby breathes into his lungs is not carried to the body’s other organs and the baby’s system cannot adapt to life outside the womb. PPHN occurs in approximately one in 700 births.

How is Persistent Pulmonary Hypertension of the Newborn (PPHN treated?

Treatment for newborns with PPHN may involve:

• Supplemental oxygen.
• Assisted ventilation with mechanical ventilators.
• Nitric oxide to relax contracted lung blood vessels and improve blood flow to the lungs.
• Additional drug therapy to assist in these treatments.
• Management of fluid and electrolyte levels, particularly calcium.
• Extracorporeal Membrane Oxygenation (ECMO), a modified heart-lung bypass and that requires surgery. Relatively few hospitals in the U.S. (mostly children’s hospitals) have the facilities to provide ECMO treatment to a newborn with PPHN.

The care of infants with Persistent Pulmonary Hypertension of the Newborn (PPHN) requires meticulous care and continuous monitoring of breathing rates, blood-oxygen levels and heart rate. Babies with PPHN often have problems feeding for several days or weeks, and may require a feeding tube until they are able to begin breast or bottle-feeding on their own.

It is important for the infant to have a complete examination by a neurologist or a developmental pediatrician after recovery, since the incidence of significant neurological developmental impairment is 25%. The prevalence of hearing loss is also high, and the baby should have a hearing test before discharge.

What are the causes of Persistent Pulmonary Hypertension of the Newborn (PPHN)?

All the factors that produce PPHN are not completely understood. Genetic factors may increase susceptibility. PPHN may be caused by fetal stress associated with the medical condition of the mother, include diabetes, anemia and high blood pressure. Post-term labor and delivery (after 40 weeks) may increase the risk that a newborn will have PPHN, and complications that occur during labor and delivery are also associated with the condition.

Some medications, including anti-inflammatory and pain medications, as well as certain anti-depressant drugs, have been associated with Persistent Pulmonary Hypertension of the Newborn (PPHN). The National Institutes of Health published an analysis whose authors confirmed that “ the use of NSAIDs during pregnancy, particularly aspirin, ibuprofen, and naproxen …is significantly associated with PPHN. Thus, the easy access to over-the-counter NSAIDs of pregnant women should be reevaluated, and the potential dangers of these drugs to the newborn infant should be more effectively promoted.”

Another reported association with PPHN is maternal use of SSRIs, (a class of anti- depressants called selective serotonin re-uptake inhibitors from the way in which they affect brain chemistry), particularly when these drugs are taken during the second trimester. A New England Journal of Medicine study found that infants born to women who had taken SSRIs after the 20th week of pregnancy experienced a sixfold increase in the risk of PPHN.

SSRI anti-depressants include:

• Paxil, Paxil CR, and Pexeva (paroxetine)
• Zoloft (sertraline)
• Prozac (fluoxetine)
• Celexa (citalopram)
• Lexapro, Cipralex and Seroplex (escitalopram)
• Luvox (fluvoxamine maleate)

Are there any long-term effects of Persistent Pulmonary Hypertension of the Newborn (PPHN)?

Prolonged hyperventilation (rapid or deep breathing), typical of PPHN, is associated with an increased prevalence of neurological developmental consequences, especially sensorineural (involving the inner ear) hearing loss. Infants should be monitored closely for the first two years of life, preferably in a specialty follow-up clinic, and assessed for developmental problems. Children who have suffered from PPHN should also be evaluated prior to entering school to determine if they have any subtle deficits or learning disabilities. Delayed sensorineural hearing loss has also been reported in a high percentage of PPHN patients.

PPHN Lawsuits

If your infant has been diagnosed with Persistent Pulmonary Hypertension of the Newborn (PPHN), you need to understand your rights and protect your family’s future. An experienced Monsour Law Firm attorney will evaluate your case and assure that you get appropriate compensation.

What are the grounds for a PPH lawsuit?

There are many possible grounds for a PPHN lawsuit including failure to warn, wrongful death, and negligence. Litigation may seek both compensatory and punitive damages.

Do you have a case?

The cost of treating PPHN can be extremely expensive. In addition to medical costs, PPHN can have a devastating impact on every aspect of your life and the lives of your loved ones. Even if you have not contemplated litigation before, if your infant has suffered from PPHN, you should consider seeking compensation.

What are the next steps to take?