MALIGNANT PERSISTENT PULMONARY HYPERTENSION – A CASE REPORT

Abstract

Persistent pulmonary hypertension is a phenomenon with 2 in 1,000 live births. Persistent pulmonary hypertension involves defective lung parenchymal development, heart valvular defects, or may also be syndromic. It can also be idiopathic. The most common factor is improper clamping of the umbilical cord on parturition. This case report discusses the condition of a male neonate with severe tachypnea and hypoxia due to PPTH at birth. A male neonate born to anon consanguineous parents on the day of birth presented with severe tachypnea. It was normal vaginal delivery conducted in the ambulance. There was a delay in clamping the umbilical cord, it was clamped with an elastic rope. The neonate and the mother were rushed to the obstetric ward within the time duration of 20 min. The neonate presented with hypoxia, hypocalcemia, and severe tachypnea. The neonate was shifted to the intensive care unit and was supported with high flow oxygen 2 L/min. 2D echo was performed; there was no significant anomaly noted except tricuspid valvular regurgitation. The pulmonary pressure was recorded to be 76 mm/hg which gradually reduced to 26 mm/ hg on the 6th day after birth. Improper or impaired fall in pulmonary vasculature resistance that occurs after birth and increase of systemic vascular resistance is due to the removal of the placenta from circulation. Increased pulmonary vasculature with decreased or reversal of shut at the foramen ovale or ductus arteriosus leads to PPHTN. Proper clamping of the umbilical cord within 60 s becomes crucial. Delayed or improper clamping can lead to severe PPHTN.