• MEENAKSHI M Department of Anatomy, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India.
  • JULIE CHRISTY A Department of Anatomy, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India.



Pulmonary hypertension, Umbilical cord clamping, neonatal hypoxia


Persistent pulmonary hypertension is a phenomenon with 2 in 1,000 live births. Persistent pulmonary hypertension involves defective lung parenchymal development, heart valvular defects, or may also be syndromic. It can also be idiopathic. The most common factor is improper clamping of the umbilical cord on parturition. This case report discusses the condition of a male neonate with severe tachypnea and hypoxia due to PPTH at birth. A male neonate born to anon consanguineous parents on the day of birth presented with severe tachypnea. It was normal vaginal delivery conducted in the ambulance. There was a delay in clamping the umbilical cord, it was clamped with an elastic rope. The neonate and the mother were rushed to the obstetric ward within the time duration of 20 min. The neonate presented with hypoxia, hypocalcemia, and severe tachypnea. The neonate was shifted to the intensive care unit and was supported with high flow oxygen 2 L/min. 2D echo was performed; there was no significant anomaly noted except tricuspid valvular regurgitation. The pulmonary pressure was recorded to be 76 mm/hg which gradually reduced to 26 mm/ hg on the 6th day after birth. Improper or impaired fall in pulmonary vasculature resistance that occurs after birth and increase of systemic vascular resistance is due to the removal of the placenta from circulation. Increased pulmonary vasculature with decreased or reversal of shut at the foramen ovale or ductus arteriosus leads to PPHTN. Proper clamping of the umbilical cord within 60 s becomes crucial. Delayed or improper clamping can lead to severe PPHTN.


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Teng RJ, Wu TJ. Persistent pulmonary hypertension of the newborn. J Formos Med Assoc 2013;112:177-84. doi: 10.1016/j.jfma.2012.11.007. Epub 2013 Jan 3. PMID: 23537863; PMCID: PMC3740154.

Agarwal P, Shankaran S, Laptook AR, Chowdhury D, Lakshminrusimha S, Bonifacio SL, et al. Outcomes of infants with hypoxic-ischemic encephalopathy and persistent pulmonary hypertension of the newborn: Results from three NICHD studies. J Perinatol 2021;41:502-11. doi: 10.1038/s41372-020-00905-7. Epub 2021 Jan 6. PMID: 33402707; PMCID: PMC7954876.

Valero J, Desantes D, Perales-Puchalt A, Rubio J, Almela VJ, Perales A. Effect of delayed umbilical cord clamping on blood gas analysis. Eur J Obstet Gynecol Reprod Biol 2012;162:21-3. doi: 10.1016/j. ejogrb.2012.01.020. Epub 2012 Mar 8. PMID: 22405491.

Arcilla RA, Oh W, Lind J, Gessner IH. Pulmonary arterial pressures of newborn infants born with early and late clamping of the cord. Acta Paediatr Scand 1966;55:305-15. doi: 10.1111/j.1651-2227.1966. tb17659.x. PMID: 5960343

Lakshminrusimha S, Saugstad OD. The fetal circulation, the pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates, and the role of oxygen therapy. J Perinatol 2016;36 Suppl 2:S3-11. doi: 10.1038/jp.2016.43. PMID: 27225963

Lakshminrusimha S. The pulmonary circulation in neonatal respiratory failure. Clin Perinatol 2012;39:655-83. doi: 10.1016/j.clp.2012.06.006. PMID: 22954275; PMCID: PMC3598629

Ramachandrappa A, Jain L. Elective cesarean section: Its impact on neonatal respiratory outcome. Clin Perinatol 2008;35:373-93, vii. PMID: 18456075; PMCID: PMC2453515

Lakshminrusimha S, Steinhorn RH. Pulmonary vascular biology during the neonatal transition. Clin Perinatol 1999;26:601-19. PMID: 10494467

Rasanen J, Wood DC, Weiner S, Ludomirski A, Huhta JC. Role of the pulmonary circulation in the distribution of human fetal cardiac output during the second half of pregnancy. Circulation 1996;94:1068-73. doi: 10.1161/01.cir.94.5.1068. PMID: 8790048



How to Cite

M, M., and J. C. A. “MALIGNANT PERSISTENT PULMONARY HYPERTENSION – A CASE REPORT”. Asian Journal of Pharmaceutical and Clinical Research, vol. 15, no. 5, May 2022, pp. 1-2, doi:10.22159/ajpcr.2022.v15i5.44260.



Case Study(s)