Which of the following should be considered to treat an infant with persistent pulmonary hypertension?

• A. ECMO and NO therapy
• B. NO therapy and vasoconstrictors
• C. ECMO and vasoconstrictors
• D. ECMO, NO therapy, and hyperventilation

Answer: (D)

Managing persistent pulmonary hypertension in the newborn aims to lower the high pulmonary vascular resistance and improve oxygenation while supporting the infant’s cardiopulmonary function. Inhaled nitric oxide provides a selective pulmonary vasodilator effect, reducing PVR without causing systemic hypotension. When the infant is severely ill or unresponsive to initial therapies, extracorporeal membrane oxygenation offers temporary cardiopulmonary support to allow the lungs to recover. Additionally, careful hyperventilation can decrease CO2 and raise pH, which helps lower PVR further. Using all three approaches together addresses vascular tone, oxygenation, and time for recovery. Vasoconstrictors would worsen pulmonary resistance and are not aligned with this situation, which is why they are not part of the optimal approach.