The 18 Recommended Diagnostic Tests for Infant Pulmonary Hypertension
DIAGNOSES OF INFANT PULMONARY HYPERTENSION
Many newborns are
born with pulmonary hypertension and they are unable to breathe on their own
upon arrival at the hospital.
This is particularly
a problem for preemies since they're often born several weeks before full
gestation, which means they may not have enough lung development to absorb
enough oxygen even after receiving treatment.
While there isn't
much that parents can do about genetic causes of the disease, steps can be
taken to manage a newborn's case of pulmonary hypertension.
If your child has
increased heart rate, shortness of breath, and cyanosis, you should consult
your doctor.
Your doctor may
perform tests to diagnose the condition. If your child does have pulmonary
hypertension, your doctor will find the best diagnosis and treatment methods
for your baby.
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In our previous
article, we did a comprehensive walkthrough on the risk factors and symptoms
of pulmonary hypertension. If you missed that, you can always get it here.
However, we do suggest
you go through the risk factors and symptoms of an infant's pulmonary hypertension first before reading about its possible diagnoses in this
article.
Now, let’s see
what we have for you.
THE COMMON DIAGNOSES FOR INFANT PULMONARY HYPERTENSION
Below are a number
of diagnoses for infant pulmonary Hypertension depending on the symptoms.
1. Ventriculography
Ventriculography
(VNG) is a diagnostic tool that measures the pressure in the blood vessels in
the lungs.
VNG is often used
in the early stages of pulmonary hypertension to determine whether an infant's
blood flow is affected.
VNG can help
diagnose the following: pulmonary artery prolapses, ventricular septal defect, and
gallbladder disease.
VNG testing
requires that the infant remain still while the doctor uses a catheter to
insert a tiny camera into the lungs.
Once the camera is
in place, the doctor measures the pressure and flow of blood through the lungs
with the help of ultrasound.
2. Determine the Presence of VSD or PDA
VSD is a hole in the heart, which can be as small as 1 mm, or
as large as 4 mm. VSD is often seen in preterm babies, and it is present in
babies with trisomy 21, also known as Down syndrome.
PDA is a hole in the wall between the two lower chambers of
the heart. It can be present at birth, or it may develop later, often due to
heart defects or surgical complications.
If there are any
problems with the heart's natural pumping ability, it will cause the heart to
pump blood very slowly or not at all.
This can cause the
blood pressure to rise in the lungs and cause the blood vessels to narrow.
3. Chest Radiograph
A chest x-ray is
the best way to diagnose Infant Pulmonary Hypertension. A chest x-ray is the
best way to diagnose infant pulmonary hypertension.
Doctors can
perform a chest x-ray if they suspect that a newborn has pulmonary
hypertension.
This can be done
during a routine hospital check-up or in response to any of the following
symptoms: a small raised, red mark on the baby's skin, chest discomfort
lethargy, an abnormally rapid heartbeat, and fever.
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A doctor may use
an ultrasound scan to see blood vessels. The doctor may be able to tell that a
baby has pulmonary hypertension if they have an electrocardiogram (also called
an echocardiogram) after they are born.
An echocardiogram
takes pictures of the heart, which shows a specialized image of the blood flow
in the baby's heart.
This can be used
to see that the heart has narrowed and thickened, or that the valves in the
heart has widened.
Echocardiograms
are usually performed within two days after a baby is born. This will help the
doctor determine the cause of Infant Pulmonary Hypertension.
5. Pulse Oximeter
To measure the
levels of oxygen and carbon dioxide in the blood, a pulse oximeter is used.
In some cases, the doctor may advise a person to take their pulse at a different time of day to
see if this different measure can help them identify the cause of their high
blood pressure.
A person can also
have high blood pressure while they are asleep and the morning blood pressure
is normal.
A blood pressure
reading in a doctor's office may not be accurate. Typically, the doctor will
send a blood pressure reading to a laboratory for analysis.
For diagnosis, the
blood pressure levels must be confirmed by a doctor.
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6. Chest CT-Scan
Most cases of infant
pulmonary hypertension is detected in the hospital or clinic settings.
At birth, the
lungs of the newborn are small and immature. They are difficult to examine and
diagnose, as they cannot produce adequate amounts of new blood vessels or
capillaries to carry oxygen around the lungs and bloodstream.
As a result, it is
possible for the lungs to be unable to properly oxygenate the blood.
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An outpatient workup will not always be required for the diagnosis of infant pulmonary Hypertension.
However, it is
important to rule out some possible causes of the condition.
It may be possible
to use an outpatient workup to check for a different cause of the blood
pressure, such as subglottic stenosis or bronchiectasis.
In the outpatient
workup, the doctor will ask the parents about any recent illnesses or if the
baby had undergone any kind of surgery.
8. Aortic Arch Measurement by Magnetic Resonance Imaging
The aortic arch is
the bony opening in the heart that is formed by the aortic valve. It is located
in the upper left chest, right below the collarbone.
The diagnosis of infant
pulmonary Hypertension is usually made by measuring the aortic arch length in
the chest.
The measurement
typically shows abnormalities in the aortic arch that can indicate an infant
pulmonary Hypertension.
Doctors can use magnetic resonance imaging (MRI) to measure the aortic arch.
Magnetic resonance
imaging (MRI) is a type of diagnostic imaging that uses strong magnetic fields
to produce images of body parts. MRI can provide images of the aortic arch.
Before MRI, doctors typically perform an echocardiogram or an ultrasound of the
heart.
9. Health History of the Parents and Siblings
A newborn's
medical history, blood tests, and physical exams are vital for diagnosing
pulmonary hypertension.
The following
medical histories are available when looking for Infant Pulmonary Hypertension:
When doctors
examine the newborn, they may ask about any medical conditions the baby might
have or if there are any family members or relatives with similar problems.
Doctors will also
ask about the health history of the baby's parents and siblings.
By knowing a
newborn's medical history, doctors can rule out other health problems and
figure out the cause of the condition.
10. Genetics Counselling
Only around 4% of babies are affected by this condition, but up to 8% of cases are hereditary
since the cause of infants' pulmonary hypertension is not yet fully understood.
Genetic
counselling and medical genetic testing can help a doctor determine if there is
a genetic link to this condition.
The main genetic
risk factors for this condition are: red blood cell disorders, congenital
diaphragmatic hernia, multifocal leukoencephalopathy (MLH), and autosomal
dominant red cell disorders.
11. Electrocardiography (ECG)
Auscultation and
electrocardiography is the main diagnostic tool for infant pulmonary hypertension.
ECG will be
carried out on an infant who has a possible case of pulmonary hypertension, to
check for abnormalities.
An
electrocardiogram (ECG) uses the heart and electrical signals to check the
heart's movement. This allows the doctors to check for abnormal heart rhythms.
Although auscultation
is a less accurate tool, it is easier to perform. It is used to check for a
problem, rather than to diagnose a problem.
Auscultation is
often used to rule out or confirm a diagnosis of other conditions, such as
sepsis.
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A stress test
involves placing the baby on a stretcher and giving the baby small doses of a substance that causes the baby's heart to beat faster and faster until it
collapses.
This is to see if
there is an underlying heart defect. Once a baby has been diagnosed with
pulmonary hypertension, a doctor will prescribe the appropriate medications and
ask about the lifestyle and family history of the mother and child.
Doctors typically
recommend that newborns be put on medications that will help the heart keep a healthy
blood flow to the lungs.
Once a baby is
stable on the medications, the doctor will monitor them closely to make sure
that they are keeping the heart healthy and in a normal rhythm.
13. Arterial Blood Gas Analysis
A medical device
called a blood gas test can help diagnose infant pulmonary hypertension.
An arterial blood
gas (ABG) is a test that measures the function of the lungs. The test
identifies if the flow of blood to the lungs is sufficient to allow oxygen to
be carried through the bloodstream.
A good ABG will
show a low oxygen saturation, which may indicate pulmonary hypertension.
This diagnosis can
be further helped by testing for infectious diseases in the blood or tissues.
Common infectious
diseases like Pertussis. this disease is caused by the bacterium Bordetella
pertussis. It is transmitted through the air and usually affects infants.
14. Right Heart Catheterisation
This procedure
involves threading a catheter through an artery, vein, or vein in the groin to
the right side of the heart.
The catheter then
leads to a vein at the chest that feeds the right side of the heart with blood,
which the right ventricle (the heart's main pumping chamber) uses to produce
pressure to circulate the blood around the body.
This helps keep
the blood oxygenated. When a blood vessel collapses, as is the case with
pulmonary hypertension, the right ventricle is unable to pump blood around the
body.
In a right heart
catheterization, a doctor will make a small hole at the entrance of the right
ventricle to allow blood to drain away from the lungs.
Then, they will
insert a tube into the right ventricle and guide it to the pulmonary artery.
15. Pulmonary Function Tests
Pulmonary function
tests are used to monitor the health of the lungs in newborns. All babies are
born with a low amount of blood in the lungs.
The amount of
blood in the lungs affects how well they breathe. When a baby is born, the
lungs can respond to the hormone Oxytocin.
Oxytocin causes
more blood to enter the lungs, and this helps them adjust to the changes in air
pressure that occur when a baby is born.
During the first
several hours after birth, the lungs continue to adapt to their new
environment.
16. Liver and Renal Function Test
A doctor may
diagnose a medical condition in a newborn based on their blood tests.
An early sign of infant
pulmonary Hypertension is when they have severe jaundice or an elevated
liver-to-kidney ratio.
They may also have
low levels of oxygen and blood pressure. As the blood flows through the baby's
body, it is clear that the baby has low blood volume.
These low levels
of blood mean that the tissues in the body do not get enough oxygen.
Early diagnosis of
a pulmonary hypertension condition in newborns can help doctors prevent damage
to the lungs and blood vessels.
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An oximeter is a
small device that measures oxygen saturation in the blood. It can be used to
help diagnose infant pulmonary hypertension.
The oximeter may
be used in combination with a bronchopulmonary reflex test, also known as the
hyperoxia test.
The test is
usually carried out on a neonate who is being checked for anaemia or the
presence of any additional illnesses.
The idea behind
the test is that the oximeter allows a doctor to see the amount of oxygen that
is being delivered to the bloodstream.
The test is
carried out in a neonatal intensive care unit (NICU).
18. Foetal Echo Diagnosis
The foetal echo is
a prenatal blood test used to detect diseases. It is a special blood test that
is carried out to detect diseases, especially congenital heart disease.
This test is
usually carried out in the second and third trimesters of pregnancy. The foetus
can be examined with an ultrasound machine to make sure that it has a healthy
heart structure.
This scan will
tell the doctor how well the baby's heart is functioning and how well the baby
is growing.
If a foetus has a
serious disease, doctors may perform an amniocentesis to get a diagnosis.
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The
development of Infant pulmonary hypertension is ongoing and it's a complicated process that is still not understood.
As with
any disease, it is important for you to know everything about the disease and
the symptoms, as well as the prognosis and the correct diagnosis of the
disease.
The first step towards getting the right diagnosis is to take your baby to the
doctor to get it checked.
The doctor will listen to the baby's chest with a stethoscope to check for
congestion, wheezing or crackling sounds, and other abnormal pulmonary sounds.
The doctor may also take the baby's blood pressure to check if it's high and as
well may take an echocardiogram of the baby's heart to check for heart defects.
Sometimes
the doctor may also take the baby's chest X-ray or CT scan to get a better look
at the lungs.
If your
baby is diagnosed with pulmonary hypertension, then the doctor will treat it
with medications or recommend that you consult a specialist like a cardiologist
or a pulmonologist who will be able to attend to your case.
We hope
that the information we provided in this blog post has been helpful for you,
and we wish you the best with your infant pulmonary hypertension.
Remember
to check back as we shall soon bring out the best treatment options for this disease.
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