Persistent fetal circulation
| Classification according to ICD-10 | |
|---|---|
| P29.3 | Persistent fetal circulation -
(Persistent) pulmonary hypertension in the newborn - Delayed closure of the ductus arteriosus |
| ICD-10 online (WHO version 2019) | |
The persistent fetal circulation is an abnormally long time about the time of birth also persistent fetal circulation with open remains the foramen ovale and ductus arteriosus as a right-left shunt at the only slightly perfused lung over. Inadequate lung function leads to respiratory distress syndrome in the newborn . Persistent fetal circulation is associated with pulmonary hypertension .
Synonyms are: syndrome of persistent fetal circulation; PFC Syndrome, Persistent Pulmonary Hypertension of the Newborn (PPHN)
The name was suggested in a description from 1972 by WM Gersony and colleagues.
A frequent cause is hypoxia during the birth process with subsequent acidosis and narrowing of the small pulmonary vessels. Most of them are mature and / or transferred newborns.
distribution
The frequency is given as 1 in 1,500 live births or 1 to 2 in 1,000 live births.
Classification
Depending on the underlying cause, a distinction can be made:
- Primary PFC with abnormally thickened walls of the pulmonary vessels that show increased perfusion resistance even after birth. There are no known triggering factors for this idiopathic form.
- Secondary PFC (more common) due to intrauterine hypoxia and ischemia due to lung disease such as meconium aspiration , diaphragmatic hernia , newborn respiratory distress syndrome , sepsis, and pulmonary embolism
Clinical manifestations
Clinical criteria are:
- Respiratory failure with cyanosis , labored breathing with retraction of the intercostal spaces and groaning expiration
There is an association with:
- perinatal asphyxia
- Meconium aspiration
- pneumonia
- Diaphragmatic hernia and pulmonary hypoplasia
- Hypoglycemia and hypothermia
diagnosis
In the x-ray of the lungs , the pulmonary blood flow is reduced, the inconspicuousness of the image compared to the child's condition is typical, and the right-left shunt can be seen in the echocardiography .
Differential diagnosis
The following are to be distinguished:
- congenital heart defects
- complete pulmonary vein malocclusion
- Tricuspid atresia
- Pulmonary atresia with an intact ventricular septum
- Bronchopulmonary dysplasia
- Lung sequester
- Pulmonary hypoplasia
- sepsis
- Surfactant Deficiency Syndrome
- Metabolic acidosis
therapy
Treatment consists of artificial respiration and administration of oxygen . Drugs like nitric oxide , prostacyclin, and tolazoline can cause vasodilation of the lungs.
history
The first description of the clinical picture goes back to the discoverer of the blood circulation William Harvey .
The clinical picture was only recognized much later by the French doctors S. Novelo and colleagues in 1950 and by J. Lind and C. Wegelius in 1952.
Individual evidence
- ↑ a b c Emedicine
- ↑ a b c d e f Entry on persistent fetal circulation in the Flexikon , a wiki of the DocCheck company
- ↑ WM Gersony, GV Duc, RB Dell, JC Sinclair: Oxygen method for calculation of right to left shunt: new application in presence of right to left shunting through the ductus arteriosus. In: Cardiovascular research. Vol. 6, No. 4, July 1972, pp. 423-438, PMID 5054313 .
- ↑ a b c C. D'Cunha, K. Sankaran: Persistent fetal circulation. In: Pediatrics & child health. Vol. 6, No. 10, December 2001, pp. 744–750, PMID 20084150 , PMC 2805987 (free full text)
- ↑ WA Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus In: The Classics of Medicine Library ; Birmingham, Alabama: 1978. (The Keynes English Translation of 1928)
- ^ S. Novelo, R. Limon Lason, F. Bouchard: Un nouveau syndrome avec cyanose congenitale: La persistence du canal arterial avec hypertension pulmonaire. In: ler Congres Mondial de Cardiologie ; Paris: 1950.
- ^ J. Lind, C. Wegelius: Changes in the circulation at birth . In: Acta Pediatrica 1952; Vol. 42S. 495-6.
