PRIMARY PULMONARY HYPERTENSION


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Persistent pulmonary hypertension of the newborn (PPHN) is a birth defect defined as the failure of the normal circulatory transition occurring after birth. The syndrome is characterized by pulmonary hypertension that causes hypoxemia. Infant survivors of PPHN birth injury are at risk of serious developmental disabilities—long-term cognitive problems such as a learning disability, autism, or ADHD.

PPHN affects normal breathing, which presents obvious risks. The longer an infant is deprived of oxygen, the more hypoxic the baby’s blood becomes. Oxygen deprivation can cause the victim’s brain to react adversely, leading to death or severe injuries.

Joe Lyon is a highly-rated Ohio attorney representing plaintiffs nationwide in a wide variety of civil litigation claims against pharmaceutical companies, and medical professionals responsible for children born with injuries. 


SSRI Drugs & Other Risk Factors


PPHN, or persistent fetal circulation syndrome, usually occurs in full-term babies or babies who were born at 34 weeks or more. These babies often have other types of breathing conditions.

During pregnancy, babies get oxygen from their mother and the placenta. PPHN occurs when the blood vessels do not open up enough, and there is a limit on how much oxygen is sent to the brain and organs. There is a suspected increased risk of PPHN birth injury if the mother is taking selective serotonin reuptake inhibitors (SSRIs) during the last trimester of pregnancy.

Untreated depression in pregnant women can pose serious risks, though the alternative of taking selective serotonin reuptake inhibitors (SSRIs) may increase the risk of PPHN and other birth defects of the heart and abdominal cavity.

A report in a 2006 edition of the New England Journal of Medicine describes a link between the maternal use of SSRIs (including Paxil) and PPHN. The U.S. Food and Drug Administration (FDA) revised its warnings on SSRI drugs accordingly. Other factors that may increase the infant’s risk of developing PPHN include:

  • Meconium aspiration—this happens when the baby breathes in its own meconium
  • Infection
  • Respiratory distress syndrome (RDS)—this breathing difficulty happens in infants who do not have fully developed lungs
  • Lack of oxygen before or during birth

Common Symptoms of PPHN


Symptoms of PPHN may include the following:

  • Rapid or slow breathing, grunting, and retracting
  • Bluish color to the skin
  • Hands and feet cool to the touch
  • Low blood pressure throughout the body
  • Low blood oxygen levels
  • Asphyxia
  • Tachypnea, respiratory distress
  • Respiratory acidosis
  • Loud, single second heart sound or a harsh systolic murmur
  • Low Apgar scores
  • Meconium staining
  • Poor cardiac function and perfusion
  • Systemic hypotension
  • Symptoms of shock
  • Acute perinatal distress

Treatment & Management of PPHN


PPHN is most often recognized in term or near-term neonates, but it can occur in premature newborns. In contrast to adult primary pulmonary hypertension, the newborn condition is not defined by a specific pressure of the pulmonary circulation. The diagnosis is confirmed regardless of the pulmonary arterial pressure, as long as it is accompanied by a right-to-left shunt and absence of congenital heart disease.

The treatment strategy for PPHN is aimed at maintaining adequate systemic blood pressure, decreasing pulmonary vascular resistance, ensuring oxygen release to tissues, and minimizing lesions induced by high levels of inspired oxygen and ventilator high pressure settings. General management principles include the following:

  • Continuous monitoring of oxygenation, blood pressure, and perfusion
  • Maintaining a normal body temperature
  • Correction of electrolytes and glucose abnormalities and metabolic acidosis
  • Nutritional support
  • Minimal stimulation and handling of the newborn
  • Minimal use of invasive procedures
  • Medical therapy

Compensation Following PPHN Birth Injury


Birth defects take a significant toll on the health industry and on families across the country. The out-of-pocket medical costs for an infant with any birth defect can be enormous and families can be faced with huge lifestyle changes, lost wages, and long-term personal care costs for disabled children.

If your child has suffered PPHN that may be linked to the use of a prescribed drug, you may seek compensation and may have a rightful claim against the drug makers or healthcare professionals responsible. The Lyon Firm is committed to recovering medical costs and proper compensation for the suffering and emotional pain that comes from birth defects and birth injuries.

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Why are these cases important?

 When management or individuals fail to provide a sufficient level of care, victims may seek legal recourse and file suit against the negligent parties. Medical malpractice lawsuits improve the quality of healthcare by holding physicians and hospitals responsible when they fall below a professional standard of care. 

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Questions about Medical Malpractice

Can I File A Lawsuit?

Each birth injury case and instance of hospital negligence is different and must be investigated. Medical records and testimony can provide insights into the root cause of a birth injury. The Lyon Firm works with medical experts to bring legal action when necessary.

If you have been injured in a childbirth injury or your child has suffered, The Lyon Firm will review your case. Once your medical goals have been discussed following a birth injury, it is crucial to set up a plan to help pay for the medical costs associated with the birth injury in question.

Obtaining a settlement is not an easy task but an experienced attorney can assist you in a big way. Once the lawsuit is filed, an attorney can present your case with evidence and testimony in the discovery phase, which will begin the settlement process.

What is an Apgar Score?

Apgar tests are performed on infants one minute after birth and five minutes after birth. The first test is done to examine how the child handled the birthing process, whereas the second test is done to see how the child is fairing outside of the mother’s womb.

The minimum score a baby can obtain is a zero and the maximum is ten; the test consists of five categories and the baby is ranked 0-2 for each category (zero for negative results and two for excellent results). The five categories measure:

  • breathing effort;
  • heart rate;
  • muscle tone;
  • reflex/grimace response;
  • skin color.

Initially, the Apgar test was assumed to be independent of a child’s future health; the tests were mere indications of how an infant was getting acclimated with surviving on his own and whether or not any appropriate medical procedures needed to be ordered.

However, a recent study and article produced by the New England Journal of Medicine (NEJM) indicates that a lower Apgar score during the five-minute test is related to higher death rates for neonatal infants (immediate post birth) and post-neonatal infants (one month to one year after birth).

Specifically, it was found that infants who scored 0-3 on their five-minute Apgar test had a 35 percent chance of death within the first week after birth, a 3 percent chance of death between 7-28 days of birth, and a 5 percent chance of death within one year of birth. Deaths were typically a result of anoxia or asphyxia (types of suffocation).

The study produced by the NEJM was conducted in Scotland and consisted of one million births between 1992 and 2010. Another study produced in 2013 by the Public Library of Science (PLoS) revealed similar implications.

According to this study, within one month of birth, 58% of babies who scored a one on the Apgar did not survive, 33 percent of babies who scored a two on the Apgar did not survive, and 19% of all babies who scored a three on the Apgar did not survive.  The mortality rate for babies who initially received low Apgar scores, but lived past one month of life decreased astoundingly.

After surviving past one month, only 3 percent of babies who scored a one did not survive over a year, 3% of babies who scored a two did not survive over a year, and 4% of babies who scored a three did not survive.

These results are analogous with those from the NEJM; while the mortality rate is high within the first month of birth for infants with low Apgar scores, it decreases significantly after the first month.

What is Bradycardia?

Bradycardia is the slowing of the heart rate below for a ten minute period. If a baby has severe bradycardia, their brain may not be getting enough oxygen. Brain damage begins within 10 minutes.

The variability in oxygen deprivation will vary, depending on the fetal reserve. If an infant has a full fetal oxygen reserve, it will take a longer bradycardia to result in a brain injury or birth injury. Generally, if a baby can be delivered within 10 minutes after a bradycardia, the child will not suffer birth injury.

What is Tachycardia?

Tachycardia is the opposite of bradycardia, and describes when a heart rate is greater than 150-160 beats per minute. A sustained heart rate above 150 can suggest the possibility of fetal distress because a primary cause of tachycardia is oxygen deprivation. A normal fetal heart rate is somewhere between 115 and 150.

What Are Declarations?

Decelerations are drops in the fetal heart rate. Some decelerations are considered normal, but still the fetus loses oxygen during each deceleration. Repeated decelerations may lead to acidosis, hypoxia, and ischemia, and ultimately birth injury.

What Prescriptions Are Linked with Birth Defects?

Children are incredibly vulnerable to dangerous prescription drugs while developing in a mother’s womb. Unfortunately, several medications may interfere with proper development and contribute to various types of physical and mental birth defects. Some of these medications include the following:

  • •    SSRIs: antidepressants including Paxil, Lexapro, Effexor, Prozac, and Zoloft
    •    PPIs (prescription antacids): include Prilosec, Nexium and Prevacid
    •    Accutane
    •    Cholesterol-controlling statins: Crestor
    •    Depakote
    •    Topamax (topiramate)
Why hire the Lyon Firm?

Our Firm will help you find the answers.  The Firm has the experience, resources and dedication to take on difficult and emotional cases and help our clients obtain the justice for the wrong they have suffered. 

 Experience:  Joe Lyon is an experienced Cincinnati Medical Malpractice Lawyer. The Lyon Firm has 17 years of experience and success representing individuals and plaintiffs in all fifty states, and in a variety of complex civil litigation matters. Medical malpractice lawsuits can be complex and require industry experts to determine the root cause of an accident or injury. Mr. Lyon has worked with experts nationwide to assist individuals understand why an injury occurred and what can be done to improve their lives in the future. Some cases may go to a jury trial, though many others can be settled out of court.

Resources/Dedication: Mr. Lyon has worked with experts in the fields of accident reconstruction, biomechanics, epidemiology, metallurgy, pharmacology, toxicology, human factors, workplace safety, life care planning, economics, and virtually every medical discipline in successfully representing Plaintiffs across numerous areas of law. The Lyon Firm is dedicated to building the strongest cases possible for clients and their critical interests.

Results:  Mr. Lyon has obtained numerous seven and six figure results in personal injury,  automotive product liability, medical Negligence, construction accidents, and auto dealership negligence cases.  The cases have involved successfully litigating against some of  the largest companies in the world

Your Right to Safe healthcare

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A recently published study titled, A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care, estimated that 210,000 hospital patients die each year from medical mistakes that could have been prevented.

This places medical malpractice as the third leading cause of death in the United States after heart disease and cancer. Further, the Office of The Inspector General estimated 180,000 deaths per year are due to medical mistakes. And a Study from Journal of Patient Safety estimated that the number of preventable deaths is between 210,000 and 440,000.

Incredibly, the Wrong Site Surgery Project Study found that national incidence of wrong site surgeries, which includes wrong patient, wrong procedure, wrong site and wrong side surgeries, may be as high as 40 per week. 

Our Victories

The Lyon Firm aggressively, professionally, and passionately advocates for injured individuals and families against companies due to a defective product or recalled product to obtain just compensation under the law. 

FAILURE TO DIAGNOSE BOWEL OBSTRUCTION

WRONGFUL DEATH

(Cincinnati, Ohio):  Confidential settlement for a family due to a wrongful death. An emergency room physician failed to recognize the common symptoms associated with bowel obstruction and prescribed a contraindicated medicine of GoLytley.  The patient died at home the day of discharge after taking the medication. The case against the emergency room physician was resolved by settlement following extensive discovery. The settlement was paid to the spouse and surviving adult children for the loss of their mother. While no amount of money could bring back their mother, the case provided answers and held the hospital accountable.

FAILURE TO DIAGNOSE BREAST CANCER

$910,000 Settlement.

(Cincinnati, Ohio):   Joe Lyon was second chair in a case involving the failure of a physician to promptly communicate a positive breast cancer result to a patient. As a result of the delay, the cancer progressed from in situ carcinoma to stage 3B with lymph node involvement. The treatment required mastectomy and radiation/ chemotherapy rather than a simple excision. The case settled after extensive discovery. The defense argued: “the patient should have called the physician.” The settlement provided recovery for suffering through a misdiagnosis and the loss of a spouse and a mother. While the settlement cannot bring this wonderful woman back, it helped her family move forward with life’s challenges and encouraged  future accountability.

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