需要体外生命支持的新生儿甲状腺毒症并持续肺动脉高压

• 作 者: Oden J. Cheifetz I.M. 刘莉
• 机 构: Division of Pediatric Endocrinology and Diabetes Box 3080 Duke Children's Hospital Durham NC 27710
• 出 处: 世界核心医学期刊文摘(儿科学分册)
• 发表日期: 2006年05期
• 关键词: 持续肺动脉高压 甲状腺毒症 生命支持 新生儿 甲状腺功能亢进 表面活性物质 脓毒症 舒血管物质 肺血管 肺动脉高压

We report a case of neonatal Graves’disease involving an infant with severe persistent pulmonary hypertension (PPHN) associated with neonatal thyrotoxicosis that necessitated extracorporeal membrane oxygenation. Hyperthyroidism, although uncommon in the newborn period, has been associated with pulmonary hypertension among adults. The exact mechanisms responsible for this effect on pulmonary vascular pressure are not well understood. Recent studies have provided evidence that thyrotoxicosis has direct and indirect effects on pulmonary vascular maturation, metabolism of endogenous pulmonary vasodilators, oxygen economy, vascular smooth muscle reactivity, and surfactant production, all of which may contribute to the pathophysiologic development of PPHN. Therefore, because PPHN is a signifi cant clinical entity among term newborns and the symptoms of hyperthyroidism may be confused initially with those of other underlying disorders associated with PPHN (eg, sepsis), it would be prudent to perform screening for hyperthyroidism among affected newborns.

We report a case of neonatal Graves’ disease involving only infant with severe persistent pulmonary hypertension (PPHN) associated with neonatal thyrotoxicosis that necessitated extracorporeal membrane oxygenation. Although the uncommon in the newborn period, has been associated with pulmonary hypertension among adults. The exact mechanisms responsible for this effect on pulmonary vascular pressure are not well understood. recent studies have provided evidence that thyrotoxicosis has direct and indirect effects on pulmonary vascular maturation, metabolism of endogenous pulmonary vasodilators, oxygen economy, vascular smooth muscle reactivity, and surfactant production of may contribute to the pathophysiologic development of PPHN. therefore, because PPHN is a signifi cant clinical entity among term newborns and the symptoms of hyperthyroidism may be confused initially with those of other underlying disorders associated with PPHN (eg, sepsis), it would be prudent to perform screening for hyperthyroidism among affected newborns.