Treatment of the infant with persistent pulmonary hypertension may include which of the fol-lowing? 1. ECMO 2. High-frequency ventilation 3. Nitric oxide 4. Caffeine citrate
a. 1 and 3 only
b. 1, 2, and 3 only
c. 3 and 4 only
d. 2, 3, and 4 only
ANS: B
Initial therapy for PPHN is removal of the underlying cause, such as administration of oxygen for hypoxemia, surfactant for RDS, glucose for hypoglycemia, and inotropic agents for low cardiac output and systemic hypotension. If correction of the underlying problem does not correct the hypoxemia, the infant needs intubation and mechanical ventilation. Because pain and anxiety may contribute to PPHN, the infant may need sedation and, frequently, paralysis. If these measures do not improve oxygenation, the next step is HFV. This mode of ventilation allows a higher FRC without a large tidal volume. Inhaled nitric oxide is now considered the next inter-vention. Should all of these modalities fail to improve oxygenation, the infant may be a candi-date for extracorporeal membrane oxygenation (ECMO).
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