Persistent pulmonary hypertensin of the newborn (PPHN), a major clinical problem in the neonatal intensive care unit, can contribute significantly to morbidity and mortality in both term and preterm infants. Hypoxemic respiratory failure or PPHN can place newborns at risk for death, neurologic injury, and other morbidities. PPHN is categorized into parenchymal lung disease (meconium aspiration syndrome, respiratory distress syndrome, sepsis), idiopathic (or “black-lung”), and pulmonary hypoplasia (as seen in congenital diaphragmatic hernia). Treatment involves correction of factors that may promote vasoconstriction, mechanical ventilation to achieve optimal lung volume that may include high-frequency oscillatory ventilation, medical optimization of cardiac output and left ventricular function, and inhaled nitric oxide. A number of alternative and emerging pulmonary vasodilators are being investigated.

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