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Prospective analysis of pulmonary hypertension in extremely low birth weight infants
Ramachandra Bhat1, Ariel A Salas, Chris Foster
1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama 35249-7335, USA.
Insights
Pulmonary hypertension affects at least 1 in 6 extremely low birth weight infants, often persisting until discharge. Echocardiography screening at 4 weeks identifies only a third of these cases, necessitating further research for better detection strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Pulmonary hypertension (PH) is a significant complication in extremely low birth weight (ELBW) infants, linked to bronchopulmonary dysplasia and increased mortality.
- Early identification and management of PH are crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To determine the prevalence of pulmonary hypertension in ELBW infants using screening echocardiography.
- To evaluate the outcomes of ELBW infants diagnosed with pulmonary hypertension.
Main Methods:
- Echocardiography screening for PH was performed on ELBW infants at 4 weeks of age and as clinically indicated.
- Infants were monitored until hospital discharge or pre-discharge death.
Main Results:
- 17.9% of 145 ELBW infants were diagnosed with PH, with 6.2% identified early and 11.7% later.
- Infants with PH were more likely to require oxygen at day 28 (96% vs 75%).
- Three infants with late PH died due to cor pulmonale before discharge.
Conclusions:
- Pulmonary hypertension is common in ELBW infants, affecting at least 1 in 6, and often persists.
- Routine 4-week echocardiography screening identifies only one-third of infants with PH.
- Optimal strategies for PH detection and intervention in ELBW infants require further investigation.
Objectives:
Pulmonary hypertension is associated with bronchopulmonary dysplasia in extremely low birth weight (ELBW) infants and contributes to morbidity and mortality. The objective was to determine the prevalence of pulmonary hypertension among ELBW infants by screening echocardiography and evaluate subsequent outcomes.
Methods:
All ELBW infants admitted to a regional perinatal center were evaluated for pulmonary hypertension with echocardiography at 4 weeks of age and subsequently if clinical signs suggestive of right-sided heart failure or severe lung disease were evident. Management was at discretion of the clinician, and infants were evaluated until discharge from the hospital or pre-discharge death occurred.
Results:
One hundred forty-five ELBW infants (birth weight: 755 ± 144 g; median gestational age: 26 weeks [interquartile range: 24-27]) were screened from December 2008 to February 2011. Overall, 26 (17.9%) were diagnosed with pulmonary hypertension at any time during hospitalization (birth weight: 665 ± 140 g; median gestational age: 26 weeks [interquartile range: 24-27]): 9 (6.2%) by initial screening (early pulmonary hypertension) and 17 (11.7%) who were identified later (late pulmonary hypertension). Infants with pulmonary hypertension were more likely to receive oxygen treatment on day 28 compared with those without pulmonary hypertension (96% vs 75%, P < .05). Of the 26 infants, 3 died (all in the late group because of cor pulmonale) before being discharged from the hospital.
Conclusions:
Pulmonary hypertension is relatively common, affecting at least 1 in 6 ELBW infants, and persists to discharge in most survivors. Routine screening of ELBW infants with echocardiography at 4 weeks of age identifies only one-third of the infants diagnosed with pulmonary hypertension. Further research is required to determine optimal detection and intervention strategies.
