medigraphic.com
ISSN 0035-0052 (Impreso)

2014, Número 5

<< Anterior Siguiente >>

Rev Mex Pediatr 2014; 81 (5)


Hipertensión pulmonar persistente en niños recién nacidos. Conceptos recientes

Gasque GJJ

Idioma: Español
Referencias bibliográficas: 50
Paginas: 183-193
Archivo PDF: 162.78 Kb.


RESUMEN

La hipertensión pulmonar persistente de los recién nacidos (HPPRN) es una emergencia médica en la etapa neonatal con una alta morboletalidad, debido a una falla en la transición de la circulación fetal a la postnatal, que ocurre en los neonatos a término o próximos a esta etapa en 2 a 6 de cada 1,000 nacidos vivos, aunque en ocasiones puede encontrarse en neonatos prematuros con SDR o DBP. La causa más frecuente de la HPPRN es secundaria al síndrome de aspiración de meconio (SAM), la asfixia perinatal, la neumonía intrauterina, la sepsis y la hernia diafragmática congénita (HDC). En esta contribución se revisan los progresos en el conocimiento de la fisiopatología de la HPPRN y se discuten las evidencias de terapias comunes como la ventilación mecánica, el óxido nítrico y la oxigenación por membrana extracorpórea, así como también se informa del empleo racional y promisorio de los vasodilatadores pulmonares, entre los que se incluyen los inhibidores de fosfodiesterasa y nuevos medicamentos que actúan sobre substancias reactivas al oxígeno. En la última década, con los avances logrados, la mortalidad ha disminuido, lo que parece depender de un diagnóstico y tratamiento temprano de la causa desencadenante y la referencia oportuna a un centro hospitalario que tenga OMEC. El seguimiento neurológico a largo plazo es esencial, pues 20-25% de los sobrevivientes presentan anormalidades en su neurodesarrollo y de 10 a 25% problemas de audición.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Gasque-Góngora JJ. Hipertensión pulmonar persistente del recién nacido. Rev Mex Pediatr. 2009; 76(5): 220-230.

  2. Steinhorn RH. Neonatal pulmonary hypertension. Pediatr Crit Care Med. 2010; 11(2 Suppl.): S79-S84.

  3. Puthiyachirakkal M, Mhanna MJ. Pathophysiology, management, and outcome of persistent pulmonary hypertension of the newborn: a clinical review. Front Pediatrics. 2013; 1(23): 1-6.

  4. Teng RJ, Wu TJ. Persistent pulmonary hypertension of the newborn. J Formos Med Assoc. 2013; 112: 177-184.

  5. Nair J, Lakshminrusimha S. Update on PPHN: mechanisms and treatment. Semin Perinatol. 2014; 38: 78-91.

  6. Hernández-Díaz S, Van Marter LJ, Werler MM, Louik C, Mitchell AA. Risk factors for persistent pulmonary hypertension of the newborn. Pediatrics. 2007; 120: e272-e282.

  7. Delaney C, Cornfield DN. Risk factors for persistent pulmonary hypertension of the newborn. Pulmonary Circulation. 2012; 2(1): 15-20.

  8. Van Marter LJ, Hernández-Díaz S, Werler MM, Louik C, Mitchell AA. Nonsteroidal antiinflammatory drugs in late pregnancy and persistent pulmonary hypertension of the newborn. Pediatrics. 2013; 131: 79-87.

  9. Byers HM, Dagle JM, Klein JM, Ryckman KK, McDonald EL, Murray JC et al. Variations in CRHR1 are associated with persistent pulmonary hypertension of the newborn. Pediatr Res. 2012; 71(2): 162-167.

  10. Andrade SE, McPhillips H, Loren D, Raebel MA, Lane K, Livingston J et al. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009; 18(3): 246-252.

  11. Ornoy A, Koren G. Selective serotonin reuptake inhibitors in human pregnancy: on the way to resolving the controversy. Semin Fetal Neonatal Med. 2014; 19: 188-194.

  12. Swarnam K, Soraisham AS, Sivanandan S. Advances in the management of meconium aspiration syndrome. Inter J Pediatr. 2012; 7: 1-7.

  13. Hintz SR, Benitz WE, Halamek LP, Van Meurs KP, Rhine WD. Secondary infection presenting as recurrent pulmonary hypertension. J Perinatol. 2000; 20(4): 262-264.

  14. El-Sayed M, Sherif L, Said RN, El-Wakkad AS, El-Refay A, Aly H. Endothelin-1 and L-arginine in preterm infants with respiratory distress. Am J Perinatol. 2011; 28: 129-136.

  15. Mourani PM, Abman SH. Pulmonary vascular disease in bronchopulmonary dysplasia: pulmonary hypertension and beyond. Curr Opin Pediatr. 2013; 25(3): 329-337.

  16. Lapointe A, Barrington KJ. Pulmonary hypertension and the asphyxiated newborn. J Pediatr. 2011; 158: 19-24.

  17. Benjamín JR, Bizzarro MJ, Cotten M. Congenital diaphragmatic hernia: updates and outcomes. Neo Reviews. 2011; 12; e439-e452.

  18. Storm L, Aubry E, Rakza T, Houeijeh A, Debar, Tourneux P et al. Congenital diaphragmatic hernia study group. Pathophysiology of persistent pulmonary hypertension of the newborn: impact of the perinatal environment. Arch Cardiol Dis. 2013; 106: 169-177.

  19. Roofthooft MTR, Bergman EKA, and Berger RMF. Patient characteristics in persistent pulmonary hypertension of the newborn. Pulmonary Med. 2011; 858154. doi: 10.1155/2011/858154.

  20. Walsh MC, Stork EK. Persistent pulmonary hypertension of the newborn. Rational therapy based on pathophysiology. Clin Perinatol. 2001; 28(3): 609-627.

  21. Konduri GG, Kim O. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn (PPHN). Pediatr Clin North Am. 2009; 56(3): 579-600.

  22. Cabral JEB, Belik J. Persistent pulmonary hypertension of the newborn: recent advances in pathophysiology and treatment. J Paediatr (Rio J). 2013; 89: 226-242.

  23. Teixeira-Mendonca C, Henriques-Coeiho T. Pathophysiology of pulmonary hypertension in newborns: therapeutic indications. Port J Cardiol. 2013; 1: 105-112.

  24. Agrawal A, Agrawal R. Persistent pulmonary hypertension of the newborn. Recent advances in the management. Int J Clin Pediatr. 2013; 2(1): 1-11.

  25. Inhaled nitric oxide in full-term and nearly full-term infants with hypoxemic respiratory failure. The Neonatal Inhaled Nitric Oxide Study Group. N Engl J Med. 1997; 336(9): 597-604.

  26. Davidson D, Barefield ES, Kattwinkel J, Dudell G, Damask M, Straube R et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double masked, placebo controlled, dose response, multicenter study. The INO/PPHN Study Group. Pediatrics. 1998; 10: 325-334.

  27. Sadiq HF, Mantych G, Benawra RS, Devaskar UP, Hocker JR. Inhaled nitric oxide in the treatment of moderate persistent pulmonary hypertension of the newborn: a randomized controlled, multicenter trial. J Perinatol. 2003; 23(2): 98-103.

  28. Finer NN, Barrington KJ. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev. 2006; 18(4): CD000399.

  29. Gonzales A, Fabres J, D’Apremont I, Urcelay G, Avaca M, Gandolfi C et al. Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with moderate respiratory failure and pulmonary hypertension. J Perinatol. 2010; 30(6): 420-424.

  30. Ehlen M, Wiebe B. Iloprost in persistent pulmonary hypertension of the newborn. Cardiol Young. 2003; 13(4): 361-363.

  31. Chotigeat U, Jaratwashirakul S. Inhaled iloprost for severe persistent pulmonary hypertension of the newborn. J Med Assoc Thai. 2007; 90(1): 167-170.

  32. Nakwan N, Wannaro J. Persistent pulmonary hypertension of the newborn successfully treated with beraprost sodium: a retrospective review. Neonatology. 2011; 99(1): 32-37.

  33. Amadu EJ, Abbad F. Severe persistent pulmonary hypertension of the newborn in a setting where limited resources exclude the use of inhaled nitric oxide: successful treatment with sildenafil. Eur J Pediatr. 2005; 164: 626-629.

  34. Herrera TR, Concha GP, Heberto CJ, Loera GR, Rodríguez BI. Sildenafil oral como alternativa en el tratamiento de recién nacidos con hipertensión pulmonar persistente. Rev Mex Pediatr. 2006; 73(4): 159-163.

  35. Baquero H, Soliz A, Neira F, Venegas ME, Sola A. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn. A pilot randomized blinded study. Pediatrics. 2006; 117(4): 1077-1083.

  36. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Data-base Syst Rev. 2011; 10(8): CD005494.

  37. Bassler D, Choong K, McNamara P, Kirpalini H. Neonatal persistent pulmonary hypertension treated with milrinona: four case reports. Biol Neonate. 2006; 89: 1-5.

  38. Kinsella JP, Ivy DD, Abman SH. Pulmonary vasodilator therapy in congenital diaphragmatic hernia: acute, late, and chronic pulmonary hypertension. Semin Perinatol. 2005; 29: 123-128.

  39. Bassler D, Kreutzer K, McNamara P, Kirpalani H. Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev. 2010; (11): CD007802.

  40. McNamara PJ, Shivananda SP, Shani M, Freeman D, Taddio A. Pharmacology of milrinona in neonates with persistent pulmonary hypertension of the newborn and suboptimal response to inhaled nitric oxide. Pediatr Crit Care Med. 2013; 14(1): 74-84.

  41. Porta NF, Steinhorn RH. Pulmonary vasodilator therapy in the NICU: inhaled nitric oxide, sildenafil and other pulmonary vasodilating agents. Clin Perinatol. 2012; 39(1): 149-164.

  42. Radicioni M, Bruni A, Camerini P. Combination therapy for life-threatening pulmonary hypertension in a premature infant: first report on bosentán use. Eur J Pediatr. 2011; 170: 1075-1078.

  43. Mohamed WA, Ismail M. A randomized double-blind, placebo-controlled, prospective study of bosentán for the treatment of persistent pulmonary hypertension of the new-born. J Perinatol. 2012; 32(8): 608-613.

  44. Lazar DA, Olutoye OO, Cass DL, Fernandes CJ, Welty SE, Johnson KE et al. The use of ECMO for persistent pulmonary hypertension of the newborn: a decade of experience. J Surg Res. 2012; 177(2): 263-267.

  45. Bifano EM, Pfannenstiel A. Duration of hyperventilation and outcome in infants with persistent pulmonary hypertension. Pediatrics. 1988; 81: 657-661.

  46. Lipkin PH, Davidson D, Spivak L, Straube R, Rhines J, Chang CT. Neurodevelopmental and medical outcomes of persistent pulmonary hypertension in term newborns treated with nitric oxide. J Pediatr. 2002; 140(3): 306-310.

  47. Konduri G, Vohr B, Robertson C, Sokol GM, Solimano A, Singer J et al. Early inhaled nitric oxide therapy for term and near-term newborns infants with hypoxic respiratory failure: neurodevelopmental follow-up. J Pediatr. 2007; 150(3): 235-240.

  48. Eriksen V, Nielsen LH, Klokker M, Greisen G. Follow up of 5 to 11 year-old children treated for persistent pulmonary hypertension of the newborn. Acta Pediatr. 2009; 98(2): 304-309.

  49. Rosenberg AA, Lee NR, Vaver KN, Werner D, Fashaw L, Hale K et al. School-age outcomes of newborns treated for persistent pulmonary hypertension. J Perinatol. 2010; 30(2): 127-134.

  50. Berti A, Janes A, Furlan R, Macagno F. High prevalence of minor neurologic deficits in a long-term neurodevelopmental follow-up of children with severe persistent pulmonary hypertension of the newborn: a cohort study. Italian J Pediatr. 2010; 36(45): 1-5.




2020     |     www.medigraphic.com