Is Persistent Pulmonary Hypertension of the Newborn Caused by Medical Negligence?

Persistent Pulmonary Hypertension of the Newborn (PPHN) is a complex condition with multiple potential causes. Determining whether PPHN is caused by medical negligence involves understanding both the medical background of the condition and the specifics of the care provided.

What is PPHN?

PPHN is a serious condition that affects newborn babies. It causes high blood pressure in the lungs’ arteries that prevents normal blood flow and oxygen delivery. After birth, a baby’s blood vessels will open up immediately to allow blood to flow into the lungs. However, in a baby with PPHN, the blood vessels do not open correctly and the child is unable to breathe independently.

Certain babies are at a higher risk for developing PPHN due to neonatal, maternal, and environmental factors. Some of the known causes and risk factors for PPHN include:

• Birth asphyxia: Lack of oxygen before or during birth may lead to PPHN because it can cause significant stress and damage to the baby’s cardiovascular system.
• Congenital diaphragmatic hernia (CDH): A birth defect where there is an abnormal opening in the diaphragm, leading to improper lung development and increased risk for PPHN.
• Meconium Aspiration Syndrome (MAS): Babies who inhale meconium-stained amniotic fluid during delivery are at increased risk for PPHN due to inflammation and blockage of the airways.
• Pulmonary Hypoplasia: Underdeveloped lungs can lead to insufficient oxygenation and increased pulmonary vascular resistance, contributing to PPHN.
• Respiratory Distress Syndrome: Common in premature babies with underdeveloped lungs.
• Infections: Infants with infections such as pneumonia or sepsis are more likely to develop PPHN due to the inflammatory response and resulting lung injury.
• Maternal factors: Diabetes, obesity, smoking, cesarean section delivery, and the use of certain medications during pregnancy can increase the risk of PPHN.
• Environmental factors: High altitude, problems with the normal physiological changes that should occur after birth, and genetic factors can increase the risk of PPHN in babies.

PPHN can be fatal. Even if a PPHN diagnosis of PPHN is made within the first 72 hours after birth, the chances of survival are between 10-50%. More than 50% of newborns with a pneumothorax requiring a chest tube will go on to develop PPHN.

Establishing medical negligence in a PPHN case

To prove medical negligence, the plaintiff must prove that the healthcare provider failed to meet the standard of care, and this failure was the proximate cause of the PPHN. Some potential types of negligence that could lead to a PPHN lawsuit include:

• Failure to monitor and respond to fetal distress: Inadequate monitoring of the baby’s heart rate and oxygen levels during labor or a delay in performing a necessary cesarean section in response to signs of fetal distress can lead to PPHN.
• Improper management of birth complications: PPHN can result from the mismanagement of meconium-stained amniotic fluid or the failure to promptly treat respiratory distress or other complications immediately after birth.
• Improper use of ventilation: Incorrect ventilator settings or the failure to provide adequate respiratory support can lead to further lung damage and hypoxemia.
• Inappropriate medication: Using drugs that are not suitable for treating PPHN or failing to use necessary medications, e.g., nitric oxide, can worsen the condition.
• Inadequate prenatal care: Failure to identify and manage maternal conditions that could contribute to PPHN or a lack of proper counseling on the risks of certain medications or substances during pregnancy can result in PPHN.
• Postnatal care failures: A delay in diagnosing and treating infections or  inadequate respiratory support or inappropriate ventilation strategies could lead to PPHN.

Here are the four key elements that need to be proven in a medical malpractice case involving improper treatment of PPHN:

Duty of Care

The healthcare provider had a duty to provide care to the patient. To meet this element, the doctor-patient relationship must be established, showing that the doctor was responsible for treating the child.

Breach of Duty

The healthcare provider failed to meet the standard of care expected in the medical community. This involves showing that the doctor’s treatment of the child with PPHN was improper, either through incorrect diagnosis, inappropriate treatment methods, delay in treatment, or failure to follow established medical guidelines for managing PPHN.

Causation

The breach of duty was the proximate cause of harm to the patient. There must be a clear link between the doctor’s improper treatment and the child’s worsening condition or additional injuries. This often requires expert medical testimony to explain how the improper treatment led to harm.

Damages

The patient suffered actual harm or injury as a result of the breach of duty. This means the child must have experienced physical, emotional, or financial harm due to the improper treatment. This could include worsening of the PPHN, additional medical complications, or long-term health issues.

Proving medical negligence in a PPHN case typically requires the following evidence:

• Medical records: Comprehensive review of prenatal, labor, delivery, and postnatal care records
• Expert testimony: Testimony from medical experts to establish the standard of care and how it was breached
• Causation evidence: A clear connection between the medical negligence and the development of PPHN

While PPHN can occur despite appropriate medical care, medical negligence may be a contributing factor in some cases. If a doctor improperly treats a child diagnosed with PPHN, and this improper treatment can be shown to have caused harm to the child, it may constitute medical malpractice. To pursue a malpractice claim, it is essential to consult with a legal expert specializing in medical malpractice to evaluate the specifics of the case, gather necessary evidence, and navigate the legal process.

At Plaxen Adler Muncy, P.A., our Maryland medical malpractice lawyers offer comprehensive counsel to the victims of medical malpractice. We always put the needs of clients above everything else. Our reputation as formidable litigators has helped our attorneys secure millions of dollars in settlements and verdicts for personal injury and medical malpractice victims throughout the state of Maryland.

If you suspect that your child suffered PPHN as a result of medical negligence, we can help. Call us on complete our contact form to set up a free initial consultation with our experienced Maryland medical malpractice attorneys today.