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Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia
Peter M Mourani1, Marci K Sontag, Adel Younoszai
11 Section of Critical Care.
Insights
Early pulmonary vascular disease in preterm infants is linked to bronchopulmonary dysplasia (BPD) and later pulmonary hypertension (PH). Echocardiograms at 7 days can identify high-risk infants for BPD and PH.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Pulmonary hypertension (PH) negatively impacts preterm infants with bronchopulmonary dysplasia (BPD).
- The association between early pulmonary vascular disease signs and later BPD or PH development remains unclear.
Purpose of the Study:
- To prospectively assess the relationship between early echocardiogram findings of pulmonary vascular disease and the subsequent development of BPD and PH at 36 weeks post-menstrual age (PMA).
Main Methods:
- Preterm infants (birthweight 500-1,250 g) underwent echocardiograms at 7 days and 36 weeks PMA.
- Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH.
Main Results:
- Early PH was detected in 42% of 277 infants; 14% developed late PH.
- Early PH correlated with increased BPD severity (RR 1.12) and late PH (RR 2.85).
- Late PH was associated with longer oxygen therapy and higher first-year mortality.
Conclusions:
- Early pulmonary vascular disease in preterm infants predicts BPD and late PH.
- Early echocardiography (7 days) can identify infants at high risk for BPD and PH.
Rationale:
Pulmonary hypertension (PH) is associated with poor outcomes among preterm infants with bronchopulmonary dysplasia (BPD), but whether early signs of pulmonary vascular disease are associated with the subsequent development of BPD or PH at 36 weeks post-menstrual age (PMA) is unknown.
Objectives:
To prospectively evaluate the relationship of early echocardiogram signs of pulmonary vascular disease in preterm infants to the subsequent development of BPD and late PH (at 36 wk PMA).
Methods:
Prospectively enrolled preterm infants with birthweights 500-1,250 g underwent echocardiogram evaluations at 7 days of age (early) and 36 weeks PMA (late). Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH.
Measurements And Main Results:
A total of 277 preterm infants completed echocardiogram and BPD assessments at 36 weeks PMA. The median gestational age at birth and birthweight of the infants were 27 weeks and 909 g, respectively. Early PH was identified in 42% of infants, and 14% were diagnosed with late PH. Early PH was a risk factor for increased BPD severity (relative risk, 1.12; 95% confidence interval, 1.03-1.23) and late PH (relative risk, 2.85; 95% confidence interval, 1.28-6.33). Infants with late PH had greater duration of oxygen therapy and increased mortality in the first year of life (P < 0.05).
Conclusions:
Early pulmonary vascular disease is associated with the development of BPD and with late PH in preterm infants. Echocardiograms at 7 days of age may be a useful tool to identify infants at high risk for BPD and PH.
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