Pulmonary hypertension in babies with congenital diaphragmatic hernia (CDH)

(light music) – So I’m Rachel Chapman, I’m
one of the neonatologists who takes care of babies in the
newborn intensive care unit. In infants with congenital
diaphragmatic hernia, we’ve learned a number of things. One of the things that we
know, and it’s sort of obvious, is that the lungs are underdeveloped, both on the side where the
intestines move up into the chest and on the opposite side because
everything is pushed over. One of the other things that we’ve learned over the more recent past,
is that the blood vessels in the lungs, which are what carry oxygen to the tissues, are also underdeveloped, and they’re underdeveloped
in a couple different ways. One is that there simply
can be less of them, which can be a problem. Two is that they can develop, be much thicker than normal blood vessels in the lungs in a healthy baby, and three is that they can act abnormally or squeeze too tightly in
response to medications that we normally would use, or interventions that
we would normally use to help dilate those vessels or send more blood to the tissues. This knowledge has actually helped us in terms of how we manage congenital diaphragmatic hernia babies. One, in that we from the
very beginning are thinking of the blood vessels in addition
to the lung tissue itself, and we actually use a
number of strategies, one being just providing
a good amount of oxygen to help promote dilating
those blood vessels and getting good oxygen to the tissues. We’ve also, in the more recent past, developed a number of medications that can be used to help
to lower those blood, to lower the pressure
in those blood vessels. Those medications don’t
necessarily work in all patients, and often it’s trial and error, trialing different medications
and different strategies to figure out just what’s helpful to the individual patient
with diaphragmatic hernia. There are some babies who
have such severe abnormalities with their blood vessels that we are not able to
help them with medications, but often, we are able, with trying different medication regimens, to help bring that
blood pressure net down, and help to deliver better
oxygen to the tissues. In general, with growth, if
babies are able to survive that immediate neonatal period in general, this is a problem that
gets better over time, and it’s something that doesn’t necessarily
require lifelong medications, but often can go into early infancy, and sometimes early childhood. But I think it’s been very
helpful to us as a field to understand that it’s not
just the lung tissue itself, but also the blood pressure in the lungs that can be an issue for these children, and it’s helped a lot in terms
of the different medications and interventions that we’re
able to offer for these babies.

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