-Pre-ductal and post-ductal pulse O2 saturation (SpO2) monitors (to detect R → L
shunting at ductus arteriosus). A difference of ≥10% suggests marked pulmonary
hypertension.
-Cardiology consultation and echocardiogram to R/O congenital heart disease.
-Other abnormalities that can elevate PVR and require treatment include: acidosis,
polycythemia, hypothermia, hypoglycemia, hypomagnesemia.
TREATMENT: Early treatment is important. The primary therapy is supplemental
oxygen. Consider intubation and mechanical ventilation in infants who have significant
respiratory distress or CO2 retention. The aim is reduction of PVR through pulmonary
vasodilator therapy, including the following as needed:
-High inspired oxygen concentration. Start with 100% O2. Maintain pre-ductal PaO2
at 90 to 100 mmHg