The 33 Risk Factors of Neonatal Pulmonary Hypertension Guidelines

The Risk Factors of Neonatal Pulmonary Hypertension Guidelines

Neonatal pulmonary hypertension is a disease where the blood vessels carrying blood to and from the lungs of neonates or newborns are thickened and narrowed.

This leads to increased pressure which damages the nearby tissue.

Neonatal pulmonary hypertension can be caused by many different things, including birth defects, genetic disorders, or a virus that comes from the mother during pregnancy.

The symptoms of neonatal pulmonary hypertension can include a fast heart rate, shortness of breath, poor feeding and weight gain, a blue tint to skin colouration (cyanosis), and enlarged veins on the chest and on top of the head.

Treatment for this condition varies depending on its cause. Your doctor will diagnose your child with pulmonary hypertension based on their symptoms.

Image of Neonatal Pulmonary Hypertension 

1. Genetic Factors

variations in a specific gene can affect the development of a baby's lungs.

Certain genetic variations, or mutations, in the basic newborns’ genes are thought to increase the chances of developing neonatal pulmonary hypertension.

Genetic variations that increase a baby's risk for this condition are as follows:

The first sign of neonatal pulmonary hypertension is the 90-day marker.

90-day marker Pulmonary hypertension is diagnosed when a baby has at least 6 signs of pulmonary hypertension at 1 month old.

However, most of these signs are seen between 5 and 9 days after birth.

When a baby has pulmonary hypertension at less than 3 months old, it can appear very small.

2. Congenital Heart Defects in Neonates 

A heart defect is a structural problem with the heart. A congenital heart defect (CHD) is a birth defect affecting the heart. These include heart defects that may result in a hole in the heart.

These defects are often present when a baby is in the womb. They can also be acquired as an infant or a young child through infection.

When a newborn baby has a CHD, the holes in the heart allow blood to pass into the wrong parts of the heart.

This can lead to the enlargement and thickening of the walls of the heart, which can lead to a heart arrhythmia

There is no cure for congenital heart defects. However, treatments and therapies can help control the symptoms.

3. Decreased Foetal Movement During Pregnancy

Pulmonary hypertension can affect foetal movement during pregnancy. Neonatal pulmonary hypertension can cause a foetal reduction.

The foetal head must remain in a foetal position and movements of the umbilical cord and the placenta should stop.

In some cases, a pregnancy complication known as polyhydramnios may also cause this reduction in foetal movement.

4. Low Birth Weight (LBW)

Low birth weight is one of the most common risk factors for developing neonatal pulmonary hypertension

This is the result of a deficiency of oxygen to the baby's tissues, which can leave them with high pressure in the blood vessels of the lungs.

A smaller baby is also at a higher risk of developing pulmonary hypertension due to the increased pressure in the arteries of the lungs.

5. Respiratory Distress Syndrome

Respiratory Distress Syndrome (RDS) is a condition that causes a baby to have difficulty breathing.

In the womb, lungs develop with the aid of a ventilator to keep them at a healthy pressure.

When the infant is born, the ventilator is not automatically turned off, which allows the baby to struggle to breathe.

The baby can also have other problems, such as low blood oxygen levels.

6. Sepsis

Certain infections during the first month or so of life may be linked to neonatal pulmonary hypertension. For example, sepsis is a potentially life-threatening illness that affects the immune system.

There is a good chance that newborns who have had it will develop pulmonary hypertension.

7. Pulmonary Thromboembolism (Blood Clots)

Pulmonary thromboembolism can occur in the veins, lungs, arteries, and abdomen that lead to the lungs.

A blood clot can cause pressure on the veins in the lungs, causing the heart to beat abnormally.

This can lead to neonatal pulmonary hypertension. This is an emergency condition and requires emergency medical attention.

Symptoms of pulmonary thromboembolism include chest pain or shortness of breath, shortness of breath a chest wall pain that occurs around the chest, neck, or jaw.

It also is possible to have pulmonary thromboembolism without any symptoms.

8. Premature Birth

The Image of neonatal Pulmonary Hypertension

Premature birth is the most common cause of pulmonary hypertension in newborn babies.

The lungs of a baby who is born early are smaller and not fully developed, which means the blood vessels in the lungs are less flexible and are less likely to expand.

The smaller size also means that more blood is required to push oxygen-rich blood throughout the body, causing more pressure on the blood vessels in the lungs.

This increases the risk of pulmonary hypertension in newborn babies.

Therefore, when babies are born prematurely, they are often underweight. Premature birth can cause damage to blood vessels in the lungs and lead to pulmonary hypertension.

According to the Centres for Disease Control and Prevention (CDC), one in 10 newborn babies in the U.S. are born prematurely.

This is a much higher number than many other developed countries, such as Germany, France, and the United Kingdom, which have one in 100 newborns being born prematurely.

Therefore, premature birth can cause serious damage to the blood vessels in the lungs

9. Cyanosis (Skin Blueness)

Cyanosis is often described as "blue skin". It is one of the most common symptoms of neonatal pulmonary hypertension.

It is not always possible to see how oxygen levels are affecting the bloodstream.

Doctors may try to treat an infant with oxygen and other drugs to reduce cyanosis, but this is not always successful.

In severe cases, the doctors will perform a procedure called arteriovenous access (AVA).

10. Apnoea

Apnoea is a condition that occurs when a baby stops breathing during sleep. During sleep, the lungs usually are filled with air and allow it out, which is called diaphragm breathing.

The rhythm of this breathing is called a breathing pattern. However, in newborns, the diaphragm and its breathing pattern do not develop properly.

This causes the breathing pattern to stop, as well as slowing the beating of the heart.

11. Appetite Changes in Newborns

If a newborn is fed too much or too little, the baby may not have enough food in the stomach for adequate digestion.

This condition is called dysphagia. The baby may also have a swollen tongue. These symptoms can be due to either tongue or vocal cord defects.

They both can affect swallowing and speech, and may also result in heart failure.

12. Chorioamnionitis

Chorioamnionitis is an inflammation of the amniotic sac surrounding the baby. Chorioamnionitis occurs when the amniotic sac breaks.

It usually occurs in pregnant women who had pre-existing diseases or a high-risk pregnancy.

The sac is the structure that contains the baby's amniotic fluid. If the amniotic sac breaks, the baby may become exposed to fluid such as the mother’s blood.

A breach of the amniotic sac is a risk factor for neonatal pulmonary hypertension.

13. Preeclampsia

Preeclampsia is a condition that causes high blood pressure in pregnant women. Preeclampsia is a serious complication of pregnancy.

During pregnancy, blood pressure usually remains normal.

However, in some cases, the body will not pump out enough blood or there is a problem with the placenta that prevents the placenta from giving the right amount of nutrients and oxygen to the developing baby.

When a woman has preeclampsia, her blood pressure increases to dangerously high levels.

In severe cases, preeclampsia causes a miscarriage or the foetus to have a low birth weight (a factor for neonatal pulmonary hypertension.

A possible cause of preeclampsia is having high blood pressure or protein in the urine, or both.

14. Anaemia In the Mother During Her Pregnancy

Anaemia is a medical condition that causes the blood to have low levels of iron and other nutrients.

Anaemia is one of the most common risk factors associated with developing pulmonary hypertension in a newborn baby.

When a pregnant woman is in a period of low iron levels, a number of factors can lead to a greater risk of developing blood loss in the baby.

One such factor is iron deficiency anaemia, which occurs when the body does not produce enough iron.

Low iron levels in the mother can cause blood to be more likely to clot and also affect the red blood cells. Low red blood cell counts can also be caused by a variety of other factors.

15. Mother Is a Smoker

The Image of neonatal Pulmonary Hypertension 

A woman's smoking during pregnancy can put her baby at risk of developing pulmonary hypertension in the womb.

When pregnant women smoke, the foetus’s blood vessels may be constricted.

This can cause problems in a baby's lungs, making it more likely that the baby will have pulmonary hypertension when the baby is delivered.

Many women give up smoking during pregnancy, and many others stop before they get pregnant.

However, people who are pregnant or thinking about becoming pregnant should consider quitting smoking.

Mothers with a history of smoking also have a higher risk of having a baby with pulmonary hypertension

16. Broncho Pulmonary Dysplasia

Broncho Pulmonary Dysplasia (BPD) is a condition that causes a collapse of the airway, resulting in severe obstructions.

In BPD, air and other fluid enter the chest cavity, causing the airway to swell and narrow. Making the baby have a thickened chest wall and excess fluid.

BPD usually occurs in premature babies or babies born with other complications. Early symptoms may include shortness of breath and a frequent chest infection, as well as heartburn and cough.

Milder symptoms include a sharp increase in temperature, a change in breathing pattern, and a preference for sleeping on one side.

17. Respiratory Syncytial Virus (RSV) Infection

Respiratory Syncytial Virus (RSV) is the most common cause of respiratory illness in newborns and young children.

It is a viral infection that spreads easily in the air, and it is particularly dangerous for infants and young children.

Symptoms of RSV infection include fever, cough, runny nose, and a runny nose that tends to become red and lumpy.

A child may also be uncomfortable and seem to have a blocked nose. The symptoms may be mild or severe.

Although most children recover without treatment, some may need treatment for a week or longer.

18. Viral Bronchiolitis

Viral bronchiolitis is a severe illness that causes coughing and other symptoms such as fever, vomiting, and shortness of breath. It often leads to severe wheezing (another risk factor for pulmonary hypertension in newborn babies.

20. Pulmonary Surfactant Deficiency

Surfactant is a substance that keeps the lungs moist and helps in exchange for oxygen.

If the lungs of a baby do not have enough surfactant, they cannot function properly because a baby needs surfactant to stay healthy.

The condition where there is too little surfactant in the lungs of the baby is called pulmonary surfactant deficiency (PSD).

Babies with PSD are unable to create enough surfactant and their lungs cannot properly exchange oxygen for carbon dioxide.

Symptoms of PSD in newborns include a very short and shallow breathing rate, low blood oxygen levels, rapid heart rate, and poor or erratic growth.

A baby with PSD has a higher risk of pneumonia (another risk factor for pulmonary hypertension in newborn babies), even if the mother is breastfeeding.

21. Single Umbilical Artery

Many babies are born with one or more blockages in their umbilical arteries, which is a blood vessel that supplies oxygen and nutrients to the body from the foetus to the placenta.

If the baby is born with a single umbilical artery, it means that this artery only has one blood vessel that branches off.

This usually means that a very small blood vessel can result in a baby being born with a low blood oxygen level and shortness of breath.

Single umbilical arteries can be caused by many different health issues in the womb.

Sometimes, it can happen to babies who have a blood disorder, such as sickle cell disease, which affects the blood's ability to move oxygen around the body.

22. Prolonged Supplemental Oxygen Use

Now that I have already let know that pulmonary hypertension is caused by problems with the blood vessels of the lungs. I also need to inform you that there are certain conditions that can cause complications in newborn babies that make it harder for blood to move through the veins of the lungs.

Examples include problems with the valves in the lungs or problems with the heart or circulation in the lungs.

As long as the lungs are developing normally, the kidneys and the brain are developing properly, and the cardiovascular system is healthy, the risk of developing pulmonary hypertension is low. However, it is a very serious condition.

To prevent the formation of pulmonary hypertension, it is important for doctors to take precautions.

23. Renal Hypertension

Renal hypertension refers to high blood pressure in the kidneys, which can cause problems if it continues after birth.

If the kidneys don't work properly, it can lead to other health problems, such as cardiovascular diseases.

High blood pressure in the kidneys can damage the way that they filter waste and prevent it from entering the blood.

This can make it harder for the blood to reach the heart and body, which can cause low oxygen levels.

Symptoms of renal hypertension in newborns include very low blood pressure, less or slower breathing, blood in the urine, dangerously low blood pressure in the brain, and kidney stones If severe enough, the condition can lead to coma or death.

24. Cardiomyopathy

Now that you are aware that congenital heart defects (CHD) are the most common cause of neonatal pulmonary hypertension.

These heart defects are conditions that affect the heart, often before a person is born.

While congenital heart defects are not the only cause of neonatal pulmonary hypertension, it is usually an important one.

They are the most common cause of neonatal pulmonary hypertension, which occurs when the blood vessels in the lungs become enlarged or dilated.

The most common congenital heart defect associated with pulmonary hypertension is a pulmonary valve defect (PVVD). These are relatively common in the U.S., affecting 1 in 300 babies born.

25. Pulmonary Vein Stenosis

Pulmonary Vein Stenosis is a condition that prevents the normal flow of blood into the lungs.

This causes a reduction in the pressure of the blood in the lungs. This syndrome is a common cause of early morbidity and mortality.

It is present in about a third of newborns, and in some cases, it can be fatal. The condition is most common in newborns.

At first, the baby may have a fast heart rate and take longer than usual to breathe. This will resolve in the first few days after birth.

Symptoms of pulmonary vein stenosis include low oxygen levels, shortness of breath, and rapid heart rate.

26. Arachnoiditis

Arachnoiditis is an inflammation in the cerebrospinal fluid (CSF). This can cause decreased circulation in the brain, which can lead to swelling in the brainstem, known as meningitis (another factor for pulmonary hypertension in newborn babies.

27. Idiopathic Pulmonary Arterial Hypertension

Idiopathic pulmonary arterial hypertension (IPAH) is the term for a condition that is currently not known to have a known cause.

IPAH develops slowly over time and affects less than one in 1,000 newborns. In many cases, it is found during a routine blood test called a chorionic villus sampling.

Having a number of birth defects increase a baby's risk of developing IPAH. It can also be a risk factor for pulmonary hypertension in neonates.

28. Atrial Septal Defect

An atrial septal defect (ASD) is a hole in the septum between the upper two chambers of the heart.

This can occur as a result of oxygen deprivation to the heart. A neonate is more at risk of pulmonary hypertension if the hole is large, which is more likely if it is close to the back of the heart.

As addressed earlier that congenital heart defects (CHD) are the most common birth defects that can cause a hole in the heart.

Children born with congenital heart defects have a higher chance of developing pulmonary hypertension and other heart problems.

29. Blood Vessel Damage

When the valves between the blood vessels in the heart do not function correctly, blood that is pumped to the body is less evenly distributed. The underproduction of oxygen can damage blood vessels resulting in pulmonary hypertension in the baby.

30. Congenital Heart Disease

The term congenital refers to the disorder that is present at birth. In other words, congenital heart disease is not inherited.

Congenital heart disease (CHD) can cause problems in a baby's heart and lungs. CHD is the most common type of birth defect in the United States.

The common causes of congenital heart disease include a heart problem and a problem with the lungs.

Other conditions such as sudden infant death syndrome (SIDS) also can cause pulmonary hypertension.

SIDS is usually caused by a genetic problem with the connection between the heart and the lungs.

SIDS affects about 2 in 5,000 babies in the United States. Toxic Brain Injury during or after birth, the baby can have a stroke.

The Image of neonatal Pulmonary Hypertension

31. Blood Group (AOB) Incompatibility Between Mother & Infant

In about half of babies, the blood in their blood vessels is incompatible with the mother's blood vessels, meaning that the two types of blood are not compatible.

This condition is also called an avascular mismatch. If the blood in the blood vessels of the baby's body is incompatible with the mother's blood vessels, this can lead to the build-up of extra blood pressure.

32. Severe Respiratory Distress Syndrome (RDS) / Hyaline Membrane

In severe cases of RDS, babies might have their blood oxygen levels drop so low that they are unable to breathe.

They have a very high risk of death, and severe damage to their lungs will occur if they survive.

Drs. Zweifel and Golding note that there are two main types of RDS. In milder cases, the baby might not be able to breathe well enough to clear mucus from the lungs and keep them moist.

But in severe cases, the child will not be able to breathe and will need a ventilator to support breathing.

Babies with severe cases of RDS are very likely to have severe pulmonary hypertension, and they may also have a condition called critical congenital heart disease.

33. Haemangiomas

Haemangiomas can develop in one of the layers of the foetal vessels. Haemangiomas are uncommon and often cause no symptoms.

They are most commonly found in the layers of the foetal vessels that connect the heart with the lungs.

When a vessel becomes affected by a haemangioma, it forms a lump. The cysts can be as small as a pea, or as large as an orange.

Doctors can usually identify the cause of a haemangioma by examining the ultrasound images.

If they find two or more blood vessels affected by a haemangioma, then this could indicate that the pulmonary artery is narrowed and that the baby has pulmonary hypertension. 

Conclusion

We hope you enjoyed reading our article about Neonatal Pulmonary Hypertension. 

With this knowledge, we know that you can make the most of your child’s health by understanding the risk factors of neonatal pulmonary hypertension.   

If you have any questions regarding Pulmonary Hypertension, please leave a comment in the comment box below anytime. 

Thank you for reading, we are always excited when one of our posts is able to provide useful information on a topic like this! 

Remember to always check back as our next article will be on the symptoms of neonatal pulmonary hypertension.