Evaluation of the Prevalence of Persistent Pulmonary Hypertension in Neonates
Evaluation of the Prevalence of Persistent Pulmonary Hypertension in Neonates
Transient Tachypnea of the Newborn (TTN) is one of the common causes of neonatal respiratory
 distress as a result of delayed clearance of fetal lung fluid.

 Neonates with TTN usually require noninvasive respiratory support (e.g. nasal cannula, nasal
 CPAP) and may need supplemental oxygen therapy to maintain normal oxygen saturation levels.
 There have also been reports of "malignant TTN," in which affected children develop
 persistent pulmonary hypertension of the newborn (PPHN).
Respiratory failure after birth is still a severe problem. Risk factors include premature
 labor and delivery by cesarean section. Despite the improvement of the quality of perinatal
 care in Poland, almost a constant percentage of premature babies has been born in Poland. The
 number of births by cesarean section is also rising - both planned and preceded by the
 attempt to vaginal delivery. TTN - Transient Tachypnea of the Newborn is one of the most
 common causes of respiratory failure in newborns. TTN occurs in approximately 10% of newborns
 born between 33 and 34 weeks of gestation, in about 5% of newborns born between 35 and 36
 weeks and less than 1% of neonates.

 At baseline of transient tachypnea of the newborn (TTN), there are disorders of absorption of
 pulmonary fluid. In the flow of water, epithelial sodium channels and Na+ / K+ -ATPase play
 an essential role. Their stimulation increases the absorption of water from the lung airspace
 and increases its transport both inside and outside the cell. In the subsequent stages of
 removal of interstitial pulmonary fluid, the vascular system and the lymphatic system are
 involved.

 TTN is usually a self-limiting process, and treatments are not defined. There are also
 reports of "malignant TTN" in which infants develop persistent pulmonary hypertension of
 newborns (PPHN) (3). TTN infants typically require non-invasive respiratory support (CPAP,
 for example) and may need higher oxygen concentrations in the respiratory mixture to maintain
 proper oxygenation. Some experts suggest that the early use of expanding pressure (nasal
 CPAP) may relieve severe forms of TTN and prevent using of mechanical ventilation, and also
 may eventually prevent the development of persistent pulmonary hypertension.

 Persistent pulmonary hypertension of newborns (PPHN) is a disorder arising at the stage of a
 physiological passage of fetal circulation into the neonatal circulation in the perinatal
 period. It is associated with a lack of decreasing pulmonary vascular resistance, which is
 influenced by increasing levels of oxygen in the blood and numerous biochemical and hormonal
 factors. From own observations and data from the literature, it is estimated that PPHN occurs
 in approximately 0.1-0.2% of newborns born term or near the term. Treatment of persistent
 pulmonary hypertension is difficult. Despite the use of mechanical ventilation, inhaled
 nitric oxide (iNO) or extracorporeal oxygenation (ECMO), the risk of death is still around
 10-15%. This percentage has declined in recent years, but it is believed that persistent
 pulmonary hypertension of newborns is one of the most challenging situations in intensive
 care of newborns. In addition, infants who have undergone PPHN are exposed to long-term
 effects in the form of neurological complications or neurodevelopmental disorders.

 Before initiating a clinical trial (intervention) with the experimental therapy, an initial
 follow-up study was conducted to assess the incidence of failure in respiratory insufficiency
 and the rate of PPHN in neonates born between 32 and 41 weeks of gestation. The failure of
 treatment will be defined as the need for invasive ventilation (intubation and mechanical
 ventilation). To accurately determine the degree of respiratory failure, a scale was
 developed that was an adaptation of the Silverman scale. PPHN will be defined by parameters
 measured in echocardiography and on changes in blood gases. Also, a comparison of parameters
 of acid-base balance and the type of treatment of respiratory failure after birth will be
 performed in the follow-up study. Based on the collected data, validation of the modified
 Silverman scale and evaluation of its clinical utility will be presented.
Inclusion Criteria:

 -  A signed form of informed consent from parents (legal guardians).

 -  32 0/7 to 41 6/7 weeks of gestation

 -  The need to support postnatal breathing, no later than 6 hours of life.

 Exclusion Criteria:

 -  The need for intubation in the after-birth procedures

 -  Age above 6 hours of age from birth

 -  Congenital heart defects

 -  Congenital diaphragmatic hernia

 -  Other severe congenital malformations and genetically determined syndromes, diagnosed
 before and after birth, associated with higher risk of respiratory failure.