Overview of Persistent Pulmonary Hypertension of the Newborn

Persistent pulmonary hypertension of the newborn (PPHN) is a congenital heart defect (present at birth) characterized by the failure of the circulatory system of the fetus to transition properly for circulation outside the womb.  Before a child is born, it gains oxygen-laden blood directly from its mother and because its lungs are not used, very little blood is sent to the lungs of a developing fetus.  When that developing child is born and its lungs begin to breathe air, a change in blood pressure helps divert blood to the lungs for oxygenation.  In babies with PPHN, this transition does not take place and blood is not diverted to the lungs for oxygenation, thus depriving the newborn of vital oxygen in its blood.

The Children’s Hospital Colorado writes “The pulmonary artery – which, after birth, will carry blood from the heart to the lungs – instead sends blood directly back to the heart through a fetal blood vessel called the ductus arteriosus.”[1]  Normally, the increased pressure caused by air filling the lungs closes the ductus arteriosus, but in babies with PPHN, that does not occur.[2]

For babies with PPHN, “[even] though the baby is breathing, oxygen in the breathed air will not reach the bloodstream. Because the blood returning from the body is unable to enter the lungs properly – and instead flows through the still-open ductus arteriosus – it returns to the heart in an oxygen-poor state.”


Signs Your Child May Have PPHN

Signs of persistent pulmonary hypertension of the newborn include, but may not be limited to:

  • “ rapid breathing (also called tachypnea)
  • rapid heart rate
  • respiratory distress, including signs such as flaring nostrils and grunting
  • cyanosis (when the skin has a bluish tinge), even while the baby is receiving extra oxygen to breathe
  • Sometimes when examining a baby with PPHN, the doctor will hear a heart murmur (an extra or abnormal heart sound). With PPHN, a baby may also continue to have low oxygen levels in the blood while receiving 100% oxygen.”


Treatment for PPHN

The most important first aim of PPHN treatment is to maximize oxygen levels in the baby’s blood.  This often requires immediate transfer to a neonatal intensive care unit, where through a hole cut into the baby’s trachea, pure oxygen is delivered to the lungs though a tube powered by a mechanical ventilator.[3]

Most often, use of a mechanical ventilator and medication are enough to treat PPHN in a child,[4] but, “if other methods can’t reverse the PPHN and raise the baby’s oxygen levels to the necessary range, a type of intensive procedure called extracorporeal membrane oxygenation (ECMO) may be needed. ECMO requires major surgery, is complicated to monitor, and has potentially serious side effects associated with it. It is reserved for the sickest babies who are not responding to other forms of treatment.

The ECMO machine acts as an artificial heart and lung for the baby for several days while the baby’s lungs heal and recover. Although ECMO is very successful in treating PPHN, fewer than 100 hospitals (mostly children’s hospitals) in the United States have facilities that can provide this treatment.”[5]


Complications of PPHN

Persistent pulmonary hypertension of the newborn is a very serious ailment.  Even if it is observed and treated early, lack of oxygen to vital organs can cause major, permanent damage, such as “shock, heart failure, brain hemorrhage, seizures, kidney failure, multiple organ damage, and possibly even death.”[6]  Sometimes PPHN manifests as a symptom of another disease which can be treated, thus curing the PPHN, but other times it remains untreatable.[7]

Other complications of PPHN include feeding problems in the first few weeks of life and hearing problems that may be long-term.


Link between PPHN and Maternal Use of SSRI Drugs

In 2006, it was documented that maternal use of SSRI antidepressant drugs during pregnancy dramatically raises the risk of a child being born with persistent pulmonary hypertension of the newborn.  “SSRI” stands for selective serotonin reuptake inhibitor, and refers to a new class of psychiatric medications that regulate levels of a chemical called serotonin between brain cells.  It has long been known that serotonin plays a role in mood, appetite, and sleep regulation, but recent research by T.W. Sadler has shown that serotonin may also play a key role in fetal development.

The 2006 study documenting the link between maternal use of SSRI drugs during pregnancy and PPHN was published by Christina Chambers et al. and concluded that infants born to mothers who used SSRI drugs after the 20th week of gestation were 6.1 times more likely to be born with PPHN than were children born to mothers who had not used SSRIs during pregnancy.[8]


We Are Here to Help

Because the manufacturers of SSRI drugs such as Zoloft®, Paxil®, Celexa®, and Prozac® do not warn users of these medications of the elevated risk at which developing children are placed for being born with congenital malformations, the manufacturers of these medications may be held liable for injury incurred by users or newborn children of users.  If you used Paxil®, Zoloft®, or another SSRI during pregnancy and your child was born with PPHN, please do not hesitate to contact our team of SSRI birth defect lawyers for a free, no obligation case consultation at (855) 452-5529 or by e-mail at justinian@dangerousdrugs.us.

We have the experience and resources needed to win compensation from even the largest of pharmaceutical companies and secure the justice your family deserves.

[1] “Persistent Pulmonary Hypertension of the Newborn (PPHN) – Children’s Hospital Colorado-Denver Area, Rocky Mountain Region” Children’s Hospital Colorado. © 1995-2008 The Nemours Foundation/KidsHealth. Available at <http://www.childrenscolorado.org/wellness/info/parents/20830.aspx> Reviewed December 2001, Accessed 5 February 2013.

[2] Ibid.

[3] Ibid.

[4] Ibid.

[5] Ibid.

[6] Ibid.

[7] Ibid.

[8] Chambers, C. et al. (2006) “Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn” The New England Journal of Medicine Vol. 354, No. 6; pp. 579-587