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PPHN – ECMO — RACP Paediatrics MCQ

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HardNeonatalPPHN – ECMORACP Paediatrics

The neonate with PPHN has failed to respond to iNO and HFOV. Oxygenation index is >40 and rising. Echocardiography confirms structurally normal heart with suprasystemic pulmonary pressures. What is the most appropriate escalation?

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Correct answer: B — ECMO

ECMO (extracorporeal membrane oxygenation) is the rescue therapy for refractory PPHN unresponsive to iNO and optimal ventilation (OI persistently >40). It provides temporary cardiopulmonary support allowing lung recovery. ECMO is available at designated tertiary neonatal centres. Gestational age ≥34 weeks and birth weight ≥2 kg are typical criteria.

Reference: RCH Melbourne – 2023 – PPHN CPG; RACP Paediatric Curriculum – Neonatology