Phenotypes of persistent pulmonary hypertension in newborns (clinical observations)

Background. Persistent Pulmonary Hypertension of the Newborn (PPHN) is a potentially life-threatening condition caused by abnormal postnatal transition from fetal to neonatal circulation. The COVID-19 pandemic and genetic syndromes, such as trisomy 21, have highlighted new challenges in its diagnosis and treatment. Aim. To analyze clinical observations of the development of persistent fetal circulation of various origins in full-term newborns, to spread awareness among the medical community regarding the features of the diagnosis of this pathological condition after birth by analyzing the causes of cardiovascular system dysfunction, the difficulties of diagnosis in modern conditions. Materials and Methods. The study was based on clinical and instrumental examinations of neonates diagnosed with PPHN in the early neonatal period. Doppler echocardiography, pulse oximetry, and standard clinical assessment were used. Two clinical cases of PPHN in a newborn from a mother with COVID-19 and in newborn with trisomy 21 were analyzed. Results and Conclusions. In the first case, maternal COVID-19 infection resulted in impaired maternal-placental circulation, fetal hypoxia, and impaired pulmonary adaptation of the newborn with severe PPHN requiring intensive support. In the second case, PPHN in a neonate with trisomy 21 was prolonged and characterized by poor response to standard therapy. The results of the study emphasize that the pathogenesis of PPHN varies depending on the etiology – infectious or genetic and is accompanied by ventricular dysfunction. An interdisciplinary approach is important for timely assessment of signs of heart failure with early echocardiographic assessment and changes in treatment. Further studies are needed to develop early diagnostic and treatment algorithms. Keywords: COVID-19, trisomy 21, fetal hypoxia, right-left shunt, echocardiography, Doppler.