PULMONARY HYPERTENSION IN PEDIATRICS: DIAGNOSTIC AND THERAPEUTIC CHALLENGES FOR REDUCING MORBIDITY AND MORTALITY

Abstract

Introduction: Pulmonary hypertension is a rare, progressive, and potentially fatal condition characterized by increased pulmonary arterial pressure and right ventricular overload. In pediatrics, the disease is particularly complex due to its association with congenital heart defects, chronic lung diseases, and neonatal conditions that impair postnatal circulatory adaptation. Early diagnosis is often hindered by the nonspecific nature of symptoms such as dyspnea and fatigue, leading to therapeutic delays that increase morbidity and mortality. Transthoracic echocardiography plays a central role in screening and follow-up, whereas right heart catheterization remains the gold standard for diagnosis. Recent therapeutic advances, including the use of specific vasodilators, inhaled nitric oxide, and advanced ventilatory support, have improved prognosis, although challenges persist regarding the standardization of pediatric protocols and access to specialized care. Objective: To analyze pediatric pulmonary hypertension, focusing on its causes, clinical manifestations, and therapeutic approaches, aiming to contribute to early diagnosis and the reduction of infant morbidity and mortality. Methodology: This is a descriptive literature review with a qualitative approach, based on the analysis of scientific publications from 2017 to 2025. Results and Discussion: Pediatric pulmonary hypertension has multiple etiologies, mainly congenital heart diseases and chronic pulmonary disorders. Early diagnosis remains challenging due to nonspecific symptoms, with echocardiography as the main screening tool and cardiac catheterization as the confirmatory method. Therapeutic approaches have evolved with the use of pulmonary vasodilators such as sildenafil, bosentan, and prostacyclins, in addition to inhaled nitric oxide in acute cases. The importance of multidisciplinary management and individualized treatment according to clinical severity and available resources was also highlighted. Conclusion: Despite diagnostic and therapeutic advances, challenges remain regarding access to specialized centers and the standardization of clinical protocols. Strengthening public health policies, investing in research, and training healthcare teams are essential to improving prognosis and the quality of life of children with pulmonary hypertension.