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Pulmonary Artery Pressures in School-Age Children Born Prematurely
Sanja Zivanovic1, Kuberan Pushparajah2, Sandy Calvert3
1Division of Asthma, Allergy and Lung Biology, Medical Research Council Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.
Insights
School-aged children born extremely premature have higher pulmonary artery pressures than term-born peers. Bronchopulmonary dysplasia further elevates these pressures, but neonatal ventilation mode shows no significant impact.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Pulmonary Hypertension
Background:
- Extremely premature birth is associated with long-term respiratory morbidities.
- Pulmonary hypertension is a known complication in premature infants, but its persistence into school age requires further investigation.
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease that can affect pulmonary artery pressures.
Purpose of the Study:
- To determine if school-aged children born extremely premature have higher pulmonary artery pressures compared to term-born children.
- To assess the impact of bronchopulmonary dysplasia (BPD) on pulmonary artery pressures in extremely premature survivors.
- To evaluate the influence of different neonatal ventilation modes on pulmonary artery pressures in this cohort.
Main Methods:
- Transthoracic echocardiography was used to measure pulmonary artery pressures in 11-14 year olds.
- Tricuspid regurgitation velocity was assessed via continuous-wave Doppler to estimate right-ventricular-to-right-atrial systolic pressure.
- The study included 193 extremely premature children (106 with BPD) and 110 term-born children.
Main Results:
- Children born extremely premature exhibited significantly higher peak tricuspid regurgitation velocity (2.21 m/s) compared to term-born children (1.95 m/s).
- Extremely premature children who developed BPD had higher peak tricuspid regurgitation velocity than those without BPD (P=.023).
- No significant differences in pulmonary artery pressures were found based on neonatal ventilation mode (high-frequency oscillation vs. conventional ventilation).
Conclusions:
- School-aged children born extremely prematurely have elevated pulmonary artery pressures compared to their term-born counterparts.
- The presence of bronchopulmonary dysplasia in extremely premature children is associated with increased pulmonary artery pressures.
- Neonatal ventilation strategies did not appear to significantly influence long-term pulmonary artery pressures in this study population.
Objectives:
To test the hypothesis that pulmonary artery pressures were higher in school aged children born extremely premature than those born at term. We also wanted to assess whether pulmonary artery pressures differed between children born prematurely with or without bronchopulmonary dysplasia (BPD) or between those randomized in the neonatal period to different ventilation modes.
Study Design:
Transthoracic echocardiography was performed on 193 children born extremely premature (106 had BPD) and 110 children born at term when they were 11-14 years of age. Ninety-nine children born extremely premature had been supported by high-frequency oscillation and 94 by conventional ventilation. Tricuspid regurgitation was assessed in the apical 4-chamber and modified parasternal long-axis views. Continuous-wave Doppler of the peak regurgitant jet velocity was used to estimate the right-ventricular-to-right-atrial systolic pressure gradient.
Results:
Tricuspid regurgitation was measurable in 71% (137/193) of the children born preterm and 75% (83/110) of the children born at term (P .23). The children born prematurely compared with the children born at term had a greater peak tricuspid regurgitation velocity (2.21 vs 1.95 m/s, P < .001) and the children born prematurely who had BPD vs those without BPD had a greater peak tricuspid regurgitation velocity (P = .023). There were no significant differences in pulmonary artery pressures according to neonatal ventilation mode.
Conclusions:
Pulmonary artery pressures were estimated to be greater in 11- to 14-year-old children born extremely prematurely compared with those born at term and in those born prematurely who developed BPD compared with those who did not but did not differ significantly by neonatal ventilation mode.
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