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Changes in pulmonary arterial pressure in preterm infants with chronic lung disease
1Neonatal Intensive Care Unit, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK. n.v.subhedar_lwh@yahoo.com
Insights
Pulmonary arterial pressure remains high in infants with chronic lung disease throughout their first year. This study tracked pulmonary hypertension in these infants using Doppler echocardiography.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Elevated pulmonary arterial pressure (PAP) is common in preterm infants with respiratory distress syndrome who develop chronic lung disease.
- The long-term progression of pulmonary hypertension in this vulnerable population is not well understood.
Purpose of the Study:
- To assess changes in pulmonary arterial pressure (PAP) non-invasively using Doppler echocardiography.
- To investigate the natural history of PAP in infants with chronic lung disease during their first year of life.
Main Methods:
- Serial Doppler echocardiography examinations were conducted in infants with and without chronic lung disease.
- The acceleration time to right ventricular ejection time ratio (AT/RVET) was calculated from pulmonary artery velocity waveforms.
Main Results:
- Infants with chronic lung disease had a significantly lower median AT/RVET compared to healthy preterm infants.
- AT/RVET correlated with corrected age in both groups but showed no significant difference in the rate of change.
- Multivariate analysis indicated AT/RVET was independently associated with age and inversely with oxygen duration in infants with chronic lung disease.
Conclusions:
- Pulmonary arterial pressure decreases with age in both groups but stays persistently elevated in infants with chronic lung disease up to 52 weeks corrected age.
- Non-invasive Doppler assessment provides valuable insights into pulmonary hypertension trends in infants with chronic lung disease.
Background:
Pulmonary arterial pressure (PAP) is raised in preterm infants with respiratory distress syndrome who subsequently develop chronic lung disease. The natural history of pulmonary hypertension in infants with chronic lung disease is unknown.
Objectives:
To investigate changes in PAP, assessed non-invasively using Doppler echocardiography, in infants with chronic lung disease during the 1st year of life.
Methods:
Serial examinations were performed in infants with chronic lung disease and healthy preterm infants. The Doppler derived acceleration time to right ventricular ejection time ratio (AT/RVET) was calculated from measurements made from the pulmonary artery velocity waveform.
Results:
A total of 248 examinations were performed in 54 infants with chronic lung disease and 44 healthy preterm infants. The median AT/RVET was significantly lower in infants with chronic lung disease than in healthy preterm infants (0.31 v 0.37). AT/RVET significantly correlated with age corrected for prematurity in both infants with chronic lung disease (r = 0.67) and healthy infants (r = 0.55). There was no significant difference between the rate of change in AT/RVET between the two groups. In infants with chronic lung disease, multivariate analysis showed that AT/RVET was significantly independently associated with age and inversely with duration of supplemental oxygen treatment. Median AT/RVET was significantly lower in infants with chronic lung disease until 40-52 weeks of age corrected for prematurity.
Conclusions:
Although PAP falls with increasing age in both infants with chronic lung disease and healthy preterm infants, it remains persistently raised in infants with chronic lung disease until the end of the 1st year of life.