Figure 5.

Management of acute persistent pulmonary hypertension of the newborn (PPHN) (suggested guidelines as recommended by the authors are shown in this figure): (1) minimal stimulation with the use of eye covers and ear muffs; (2) sedation and analgesia with a narcotic agent and a benzodiazepine (avoid muscle paralysis if possible); (3) maintain preductal oxygen saturation in the low to mid-90s and postductal saturations above 70% as long as metabolic acidosis, lactic acidosis, and/or oliguria are not present; (4) lung recruitment with adequate positive end-expiratory pressure (PEEP) or mean airway pressure and/or surfactant to maintain 8- to 9-rib expansion during inspiration; and (5) maintain adequate blood pressure and avoid supraphysiological systemic pressure. See text for details.

HFOV = high frequency oscillatory ventilation; MAS = meconium aspiration syndrome; OI = oxygenation index; PIP = peak inspiratory pressure.

Modified from Nair and Lakshminrusimha. (15) Copyright Satyan Lakshminrusimha.