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Published on: October 19, 2013
Pulmonary hypertension in preterm infants: prevalence and association with bronchopulmonary dysplasia
Hussnain Mirza1, James Ziegler2, Sara Ford2
1Department of Pediatrics, Women & Infants Hospital/The Alpert Medical School of Brown University, Providence, RI.
Insights
Early pulmonary hypertension (PH) in preterm infants is linked to bronchopulmonary dysplasia (BPD). This finding highlights the importance of monitoring PH in high-risk newborns to improve outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants.
- Pulmonary hypertension (PH) is increasingly recognized in neonates, but its early impact is not well understood.
- Identifying early markers for BPD severity is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between early pulmonary hypertension (PH) detected in the first two weeks of life and the development of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA).
Main Methods:
- A prospective observational cohort study included preterm infants born before 28 weeks' gestation.
- Echocardiograms were performed at 10-14 days and 36 weeks' PMA to assess for PH.
- BPD severity was classified at 36 weeks' PMA according to the National Institutes of Health workshop definition.
Main Results:
- Early PH was detected in 8% of enrolled infants (n=120).
- Infants with early PH required higher fraction of inspired oxygen by day 10.
- A significantly higher rate of moderate/severe BPD or death was observed in infants with early PH (90%) compared to those without (47%).
Conclusions:
- Early detection of pulmonary hypertension in preterm infants is associated with an increased risk of developing moderate to severe bronchopulmonary dysplasia or death.
- These findings underscore the clinical significance of early PH as a predictor of adverse respiratory outcomes in extremely preterm infants.
Objective:
To determine whether early pulmonary hypertension (PH) at 10-14 days of life in preterm infants is associated with bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA).
Study Design:
This was a prospective observational cohort study of infants <28 weeks' gestation. Exclusion criteria were any major anomaly, genetic syndrome, or death before the initial echocardiogram. Echocardiograms were performed between 10 and 14 days of life and at 36 weeks' PMA to assess PH. BPD and its severity were determined at 36 weeks PMA by the National Institutes of Health workshop definition.
Results:
From March 2011 to April 2013, of 146 consecutively admitted infants <28 weeks, 120 were enrolled. One infant was excluded, 17 did not consent, and 8 died before undergoing a study echocardiogram. At 10-14 days of life, 10 infants had early PH (8%). Male sex (56% vs 40%), gestational age (26(+2) ± 1(+2) vs 25(+6) ± 1(+4) weeks), birth weight (837 ± 205 g vs 763 ± 182 g), and small for gestational age (14% vs 20%) were not significantly different among infants with no PH and early PH, respectively. Infants with early PH required >0.3 fraction of inspired oxygen by day 10 of life (70% vs 27%, P < .01). Moderate/severe BPD or death was greater among infants with early PH (90%) compared with no PH (47%, relative risk 1.9, 95% CI 1.43-2.53).
Conclusion:
In this prospective, single-center cohort, early PH was associated with moderate/severe BPD or death at 36 weeks' PMA.
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