Atención al recién nacido con hipertensión pulmonar persistente
Care of the newborn with persistent pulmonary hypertension
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Arias, D., & Narváez, C. (2016). Atención al recién nacido con hipertensión pulmonar persistente. Revista Repertorio De Medicina Y Cirugía, 25(4), 219–227. Recuperado a partir de https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/105
Publicado:
Dec 1, 2016
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Guía de Práctica Clínica
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
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Resumen
El síndrome de hipertensión pulmonar persistente del recién nacido es una entidad clínica que se presenta ante algunos factores de riesgo, condicionada por una alta presión en la arteria pulmonar de forma persistente que altera la transición de la circulación fetal a la posnatal.
Objetivo: Realizar una guía de práctica clínica para la atención de estos pacientes.
Metodología: Se siguieron las pautas definidas por el Ministerio de Protección Social de Colombia en su guía metodológica para la elaboración de guías de práctica clínica basadas en la evidencia.
Materiales y métodos: Búsqueda de la literatura en las bases Lilacs, Embase, Pubmed, Mdconsult, Cochrane, Scopus, clinicaltrials.gov y buscadores de internet, en inglés y en español.
Discusión: En el recién nacido ocurre en 1,9 por 1.000 nacidos vivos y su incidencia está estimada en el 0,2% de todos los recién nacidos vivos. Se considera un problema clínico importante en nuestra unidad de cuidado intensivo neonatal, ya que contribuye a la morbimortalidad de los a término y pretérmino. No corresponde a una patología única, y puede ser tanto primaria como secundaria. Se analizan condiciones como asfixia in útero y perinatal, infección, aspiración de meconio, síndrome de distrés respiratorio e hipoplasia pulmonar, responsables de los principales motivos de ingreso a la unidad de cuidado intensivo neonatal.
Conclusión: Es fundamental el diagnóstico temprano de la causa subyacente para iniciar el tratamiento adecuado.
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Referencias
1. Steinhorn RH, Farrow KN. Pulmonary hypertension in the neonate. NeoReviews. 2007;8:e14–21.
2. Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am. 2009;56:579–600.
3. Yoder BA, Kirsch EA, Barth WH Jr, Gordon MC. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstet Gynecol. 2002;99(5, Part 1):7–9.
4. Ramachandrappa A, Jain L. Elective cesarean section: Its impact on neonatal respiratory outcome. Clin Perinatol. 2008;35:373–93.
5. Ministerio de la Protección Social. Guía metodológica para la elaboración de guías de práctica clínica basadas en la evidencia, de evaluaciones económicas y de evaluación del impacto de la implementación de las guías en el POS y en la unidad de pago por capitación del sistema general de seguridad social en salud colombiano. Bogotá: Ministerio de la Protección Social; 2009. p. 344.
6. Oñate-Ocaña L, Ochoa-Carrillo F. Sistema GRADE para clasificar nivel de evidencia y grado de las recomendaciones para la elaboración de guías de buena práctica clínica. Cir Ciruj. 2009;77:417–9.
7. Sociedad Colombiana de Neumología Pediátrica. Guías de práctica clínica. Hipertensión arterial pulmonar en niños [consultado 22 Ago 2014]. Disponible en: http://issuu.com/acnp/docs/hipertension-arterial 20120203 005511?e=3790791/2664823
8. Puthiyachirakkal M, Mhanna MJ. Pathophysiology, management, and outcome of persistent pulmonary hypertension of the newborn: A clinical review. Front Pediatr. 2013;1:23.
9. Cabral JE, Belik J. Persistent pulmonary hypertension of the newborn: Recent advances in pathophysiology and treatment. J Pediatr (Rio J). 2013;89:226–42.
10. Klinger JR. The nitric oxide/cGMP signaling pathway in pulmonary hypertension. Clin Chest Med. 2007;28:143–67.
11. Walsh-Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: Practice variation and outcomes. Pediatrics. 2000;105 1 Pt 1:14–20.
12. Niccolls C. Persistent pulmonary hypertension of the newborn. J Neonatal Nurs. 2012;18:63–71.
13. Abdel AH, Amin AS. Risk factors and outcomes of persistent pulmonary hypertension of the newborn in neonatal intensive care unit of al-Minya University Hospital in Egypt. J Clin Neonatol. 2013;2:78–82.
14. Van Loon RL, Roofthooft MT, Hillege HL, ten Harkel AD, van Osch-Gevers M, Delhaas T, et al. Pediatric pulmonary hypertension in the Netherlands: Epidemiology and characterization during the period 1991 to 2005. Circulation. 2011;124:1755–64.
15. Razzaq A, Quddusi AI, Nizami N. Risk factors and mortality among newborns with persistent pulmonary hypertension. Pak J Med Sci. 2013;29:1099.
16. Van Marter LJ, Hernandez-Diaz 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.
17. Lapointe A, Barrington KJ. Pulmonary hypertension and the asphyxiated newborn. J Pediatr. 2011;158 2 Suppl: e19–24.
18. Bhutani VK, Chima R, Sivieri EM. Innovative neonatal ventilation and meconium aspiration syndrome. Indian J Pediatr. 2003;70:421–7.
19. Roofthooft M, Elema A, Bergman K, Berger R. Patient characteristics in persistent pulmonary hypertension of the newborn. Pulm Med. 2011:2011.
20. Baker CD, Abman SH, Mourani PM. Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Pediatr Allergy Immunol Pulmonol. 2014;27:8–16.
21. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn (PPHN). Pediatr Clin North Am. 2009;56:579–85.
22. Walsh MC, Fanaroff JM. Meconium stained fluid: Approach to the mother and the baby. Clin Perinatol. 2007;34:653–65.
23. Razzaq A, Iqbal Quddusi A, Nizami N. Risk factors and mortality among newborns with persistent pulmonary hypertension. Pak J Med Sci. 2013;29:1099–104.
24. Datin-Dorriere V, Rouzies S, Taupin P, Walter-Nicolet E, Benachi A, Sonigo P, et al. Prenatal prognosis in isolated congenital diaphragmatic hernia. Am J Obstet Gynecol. 2008;198, 80.e1-80.e5.
25. Marzo Castillejo M, Montaño Barrientos A. El sistema GRADE para la toma de decisiones clínicas y la elaboración de recomendaciones y guías de práctica clínica. Aten Primaria. 2007;39:457–60.
26. Turan S, Turan OM, Salim M, Berg C, Gembruch U, Harman CR, et al. Cardiovascular transition to extrauterine life in growth-restricted neonates: Relationship with prenatal Doppler findings. Fetal Diagn Ther. 2012;33:103–9.
27. Kadivar M, Kiani A, Kocharian A, Shabanian R, Nasehi L, Ghajarzadeh M. Echocardiography and management of sick neonates in the intensive care unit. Congenit Heart Dis. 2008;3:325–9.
28. Lawson S. Persistent pulmonary hypertension of the newborn. 2008. Revisado Mayo de 2014 [consultado 22 Ago 2014]. Disponible en: http://www.rcecs.com/MyCE/PDFDocs/course/V7041.pdf
29. Gasque G. Hipertensión pulmonar persistente del recién nacido. Rev Mex Pediatr. 2009;76:220–30.
30. Bassler D, Kreutzer K, McNamara P, Kirpalani H. Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev. 2010:11.
31. Ko SY, Chang YS, Park WS. Clinical response to inhaled nitric oxide in persistent pulmonary hypertension of the newborn. J Korean Med Sci. 1998;13:500–6.
32. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013;14: 29–36.
33. Ru-Jeng T, Tzong-Jin W. Persistent pulmonary hypertension of the newborn. J Formos Med Assoc. 2013;112:177–84.
34. Sutton J, Meyer R. Left ventricular function in persistent pulmonary hypertension of the newborn. Computer analysis of the echocardiogram. Br Heart J. 1983;50:540–9.
35. Bassler D, Kreutzer K, McNamara P, Kirpalani H. Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev. 2010:11.
36. Finer NN, Barrington KJ. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev. 2006:CD000399.
37. Swarnam K, Soraisham AS, Sivanandan S. Advances in the management of meconium aspiration syndrome. Int J Pediatr. 2012;2012:359571.
38. Porta N, Steinhorn RH. Pulmonary vasodilator therapy in the NICU: Inhaled nitric oxide, sildenafil, and other pulmonary vasodilating agents. Clin Perinatol. 2012;39:149.
39. Konduri GG, Solimano A, Sokol GM, Singer J, Ehrenkranz RA, Singhal N, et al. A randomized trial of early versus standard inhaled nitric oxide therapy in term and near-term newborn infants with hypoxic respiratory failure. Pediatrics. 2004;113:559–64. Epub 2004/03/03.
40. Turanlahti MI, Laitinen PO, Sarna SJ, Pesonen E. Nitric oxide, oxygen, and prostacyclin in children with pulmonary hypertension. Heart. 1998;79:169–74.
41. Nair J, Orie J, Lakshminrusimha S. Successful treatment of a neonate with idiopathic persistent pulmonary hypertension with inhaled nitric oxide via nasal cannula without mechanical ventilation. AJP Rep. 2012;2:29–32.
42. Hosono S, Ohno T, Kimoto H, Shimizu M, Takahashi S, Harada K. Inhaled nitric oxide therapy might reduce the need for hyperventilation therapy in infants with persistent pulmonary hypertension of the newborn. J Perinat Med. 2006;34:333–7.
43. Keszler M. High-frequency ventilation: Evidence-based practice and specific clinical indications. NeoReviews. 2006;7:e234–49.
44. Clark RH, Kueser TJ, Walker MW, Southgate WM, Huckaby JL, Perez JA, et al., Clinical Inhaled Nitric Oxide Research Group. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. N Engl J Med. 2000;342:469–74.
45. Recomendaciones sobre ventilación de alta frecuencia en el recién nacido.Pérez Rodríguez J, editor. Anales de Pediatría. Elsevier; 2002.
46. Ovalle O, Colmenares A. Ventilación de alta frecuencia. 2009. Revisado Mayo de 2014 [consultado 22 Ago 2014]. Disponible en: file:///C:/Users/Jossedela/Downloads/VENTILACION%20ALTA%20impreso%20junio%2009.pdf.
47. Turanlahti M, Laitinen P, Sarna S, Pesonen E. Nitric oxide, oxygen, and prostacyclin in children with pulmonary hypertension. Heart. 1998;79:169–74.
48. Bartlett RH, Gazzaniga AB, Huxtable RF, Schippers HC, O’Connor MJ, Jefferies MR. Extracorporeal circulation (ECMO) in neonatal respiratory failure. J Thorac Cardiovasc Surg. 1977;74:826–33. Epub 1977/12/01.
49. UK Collaborative ECMO Trail Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet. 1996;348:75–82.
50. Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev. 200
51. Van Berkel S, Binkhorst M, van Heijst AF, Wijnen MH, Liem KD. Adapted ECMO criteria for newborns with persistent pulmonary hypertension after inhaled nitric oxide and/or high-frequency oscillatory ventilation. Intensive Care Med. 2013;39:1113–20.
52. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database of Systematic Reviews. 2011;(Issue 8).
53. Paradisis M1, Jiang X, McLachlan AJ, Evans N, Kluckow M, Osborn D. Population pharmacokinetics and dosing regimen design of milrinone in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2007;92:F204–9.
54. Rieg AD, Suleiman S, Perez-Bouza A, Braunschweig T, Spillner JW, Schröder T, et al. Milrinone relaxes pulmonary veins in guinea pigs and humans. PLoS One. 2014;9.
55. Steinhorn RH, Kinsella JP, Pierce C, Butrous G, Dilleen M, Oakes M, et al. Intravenous sildenafil in the treatment of neonates with persistent pulmonary hypertension. J Pediatr. 2009;155, 841.e1-847.e1.
2. Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am. 2009;56:579–600.
3. Yoder BA, Kirsch EA, Barth WH Jr, Gordon MC. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstet Gynecol. 2002;99(5, Part 1):7–9.
4. Ramachandrappa A, Jain L. Elective cesarean section: Its impact on neonatal respiratory outcome. Clin Perinatol. 2008;35:373–93.
5. Ministerio de la Protección Social. Guía metodológica para la elaboración de guías de práctica clínica basadas en la evidencia, de evaluaciones económicas y de evaluación del impacto de la implementación de las guías en el POS y en la unidad de pago por capitación del sistema general de seguridad social en salud colombiano. Bogotá: Ministerio de la Protección Social; 2009. p. 344.
6. Oñate-Ocaña L, Ochoa-Carrillo F. Sistema GRADE para clasificar nivel de evidencia y grado de las recomendaciones para la elaboración de guías de buena práctica clínica. Cir Ciruj. 2009;77:417–9.
7. Sociedad Colombiana de Neumología Pediátrica. Guías de práctica clínica. Hipertensión arterial pulmonar en niños [consultado 22 Ago 2014]. Disponible en: http://issuu.com/acnp/docs/hipertension-arterial 20120203 005511?e=3790791/2664823
8. Puthiyachirakkal M, Mhanna MJ. Pathophysiology, management, and outcome of persistent pulmonary hypertension of the newborn: A clinical review. Front Pediatr. 2013;1:23.
9. Cabral JE, Belik J. Persistent pulmonary hypertension of the newborn: Recent advances in pathophysiology and treatment. J Pediatr (Rio J). 2013;89:226–42.
10. Klinger JR. The nitric oxide/cGMP signaling pathway in pulmonary hypertension. Clin Chest Med. 2007;28:143–67.
11. Walsh-Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: Practice variation and outcomes. Pediatrics. 2000;105 1 Pt 1:14–20.
12. Niccolls C. Persistent pulmonary hypertension of the newborn. J Neonatal Nurs. 2012;18:63–71.
13. Abdel AH, Amin AS. Risk factors and outcomes of persistent pulmonary hypertension of the newborn in neonatal intensive care unit of al-Minya University Hospital in Egypt. J Clin Neonatol. 2013;2:78–82.
14. Van Loon RL, Roofthooft MT, Hillege HL, ten Harkel AD, van Osch-Gevers M, Delhaas T, et al. Pediatric pulmonary hypertension in the Netherlands: Epidemiology and characterization during the period 1991 to 2005. Circulation. 2011;124:1755–64.
15. Razzaq A, Quddusi AI, Nizami N. Risk factors and mortality among newborns with persistent pulmonary hypertension. Pak J Med Sci. 2013;29:1099.
16. Van Marter LJ, Hernandez-Diaz 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.
17. Lapointe A, Barrington KJ. Pulmonary hypertension and the asphyxiated newborn. J Pediatr. 2011;158 2 Suppl: e19–24.
18. Bhutani VK, Chima R, Sivieri EM. Innovative neonatal ventilation and meconium aspiration syndrome. Indian J Pediatr. 2003;70:421–7.
19. Roofthooft M, Elema A, Bergman K, Berger R. Patient characteristics in persistent pulmonary hypertension of the newborn. Pulm Med. 2011:2011.
20. Baker CD, Abman SH, Mourani PM. Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Pediatr Allergy Immunol Pulmonol. 2014;27:8–16.
21. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn (PPHN). Pediatr Clin North Am. 2009;56:579–85.
22. Walsh MC, Fanaroff JM. Meconium stained fluid: Approach to the mother and the baby. Clin Perinatol. 2007;34:653–65.
23. Razzaq A, Iqbal Quddusi A, Nizami N. Risk factors and mortality among newborns with persistent pulmonary hypertension. Pak J Med Sci. 2013;29:1099–104.
24. Datin-Dorriere V, Rouzies S, Taupin P, Walter-Nicolet E, Benachi A, Sonigo P, et al. Prenatal prognosis in isolated congenital diaphragmatic hernia. Am J Obstet Gynecol. 2008;198, 80.e1-80.e5.
25. Marzo Castillejo M, Montaño Barrientos A. El sistema GRADE para la toma de decisiones clínicas y la elaboración de recomendaciones y guías de práctica clínica. Aten Primaria. 2007;39:457–60.
26. Turan S, Turan OM, Salim M, Berg C, Gembruch U, Harman CR, et al. Cardiovascular transition to extrauterine life in growth-restricted neonates: Relationship with prenatal Doppler findings. Fetal Diagn Ther. 2012;33:103–9.
27. Kadivar M, Kiani A, Kocharian A, Shabanian R, Nasehi L, Ghajarzadeh M. Echocardiography and management of sick neonates in the intensive care unit. Congenit Heart Dis. 2008;3:325–9.
28. Lawson S. Persistent pulmonary hypertension of the newborn. 2008. Revisado Mayo de 2014 [consultado 22 Ago 2014]. Disponible en: http://www.rcecs.com/MyCE/PDFDocs/course/V7041.pdf
29. Gasque G. Hipertensión pulmonar persistente del recién nacido. Rev Mex Pediatr. 2009;76:220–30.
30. Bassler D, Kreutzer K, McNamara P, Kirpalani H. Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev. 2010:11.
31. Ko SY, Chang YS, Park WS. Clinical response to inhaled nitric oxide in persistent pulmonary hypertension of the newborn. J Korean Med Sci. 1998;13:500–6.
32. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013;14: 29–36.
33. Ru-Jeng T, Tzong-Jin W. Persistent pulmonary hypertension of the newborn. J Formos Med Assoc. 2013;112:177–84.
34. Sutton J, Meyer R. Left ventricular function in persistent pulmonary hypertension of the newborn. Computer analysis of the echocardiogram. Br Heart J. 1983;50:540–9.
35. Bassler D, Kreutzer K, McNamara P, Kirpalani H. Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev. 2010:11.
36. Finer NN, Barrington KJ. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev. 2006:CD000399.
37. Swarnam K, Soraisham AS, Sivanandan S. Advances in the management of meconium aspiration syndrome. Int J Pediatr. 2012;2012:359571.
38. Porta N, Steinhorn RH. Pulmonary vasodilator therapy in the NICU: Inhaled nitric oxide, sildenafil, and other pulmonary vasodilating agents. Clin Perinatol. 2012;39:149.
39. Konduri GG, Solimano A, Sokol GM, Singer J, Ehrenkranz RA, Singhal N, et al. A randomized trial of early versus standard inhaled nitric oxide therapy in term and near-term newborn infants with hypoxic respiratory failure. Pediatrics. 2004;113:559–64. Epub 2004/03/03.
40. Turanlahti MI, Laitinen PO, Sarna SJ, Pesonen E. Nitric oxide, oxygen, and prostacyclin in children with pulmonary hypertension. Heart. 1998;79:169–74.
41. Nair J, Orie J, Lakshminrusimha S. Successful treatment of a neonate with idiopathic persistent pulmonary hypertension with inhaled nitric oxide via nasal cannula without mechanical ventilation. AJP Rep. 2012;2:29–32.
42. Hosono S, Ohno T, Kimoto H, Shimizu M, Takahashi S, Harada K. Inhaled nitric oxide therapy might reduce the need for hyperventilation therapy in infants with persistent pulmonary hypertension of the newborn. J Perinat Med. 2006;34:333–7.
43. Keszler M. High-frequency ventilation: Evidence-based practice and specific clinical indications. NeoReviews. 2006;7:e234–49.
44. Clark RH, Kueser TJ, Walker MW, Southgate WM, Huckaby JL, Perez JA, et al., Clinical Inhaled Nitric Oxide Research Group. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. N Engl J Med. 2000;342:469–74.
45. Recomendaciones sobre ventilación de alta frecuencia en el recién nacido.Pérez Rodríguez J, editor. Anales de Pediatría. Elsevier; 2002.
46. Ovalle O, Colmenares A. Ventilación de alta frecuencia. 2009. Revisado Mayo de 2014 [consultado 22 Ago 2014]. Disponible en: file:///C:/Users/Jossedela/Downloads/VENTILACION%20ALTA%20impreso%20junio%2009.pdf.
47. Turanlahti M, Laitinen P, Sarna S, Pesonen E. Nitric oxide, oxygen, and prostacyclin in children with pulmonary hypertension. Heart. 1998;79:169–74.
48. Bartlett RH, Gazzaniga AB, Huxtable RF, Schippers HC, O’Connor MJ, Jefferies MR. Extracorporeal circulation (ECMO) in neonatal respiratory failure. J Thorac Cardiovasc Surg. 1977;74:826–33. Epub 1977/12/01.
49. UK Collaborative ECMO Trail Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet. 1996;348:75–82.
50. Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev. 200
51. Van Berkel S, Binkhorst M, van Heijst AF, Wijnen MH, Liem KD. Adapted ECMO criteria for newborns with persistent pulmonary hypertension after inhaled nitric oxide and/or high-frequency oscillatory ventilation. Intensive Care Med. 2013;39:1113–20.
52. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database of Systematic Reviews. 2011;(Issue 8).
53. Paradisis M1, Jiang X, McLachlan AJ, Evans N, Kluckow M, Osborn D. Population pharmacokinetics and dosing regimen design of milrinone in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2007;92:F204–9.
54. Rieg AD, Suleiman S, Perez-Bouza A, Braunschweig T, Spillner JW, Schröder T, et al. Milrinone relaxes pulmonary veins in guinea pigs and humans. PLoS One. 2014;9.
55. Steinhorn RH, Kinsella JP, Pierce C, Butrous G, Dilleen M, Oakes M, et al. Intravenous sildenafil in the treatment of neonates with persistent pulmonary hypertension. J Pediatr. 2009;155, 841.e1-847.e1.