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Identification of gaps in the current knowledge on pulmonary hypertension in extremely preterm infants: A systematic
Sanne Arjaans1, Elvira A H Zwart1, Mark-Jan Ploegstra1
1Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Insights
Pulmonary hypertension is common in extremely preterm infants with bronchopulmonary dysplasia (BPD), increasing mortality risk. More research is needed to understand its prevalence and risk factors in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Pulmonary hypertension (PH) is a known complication in extremely preterm infants, often linked to bronchopulmonary dysplasia (BPD).
- Current understanding of PH prevalence, risk factors, and outcomes in this population remains limited.
- This study addresses the need for an updated overview of PH in extremely preterm infants.
Purpose of the Study:
- To systematically review and meta-analyze existing data on the prevalence of PH in extremely preterm infants.
- To identify key risk factors associated with PH in this cohort.
- To evaluate the impact of PH on mortality and other outcomes.
Main Methods:
- A systematic literature search was conducted across Medline, EMBASE, and Cochrane Library databases up to July 2017.
- Two independent reviewers screened titles, abstracts, and full-text articles for eligibility.
- Meta-analyses were performed on comparable study samples, focusing on infants with and without BPD.
Main Results:
- Pulmonary hypertension was identified in 20% of infants with BPD and 2% without BPD.
- Severe BPD significantly increased the risk of PH (RR 2.7).
- Infants with PH faced a substantially higher risk of mortality (RR 4.7).
Conclusions:
- Pulmonary hypertension is prevalent in extremely preterm infants, especially those with severe BPD, and is associated with increased mortality.
- Limitations in study populations, PH definitions, and assessment timing hinder accurate prevalence and outcome determination.
- Prospective studies with standardized methods are crucial for a comprehensive understanding of PH in this population.
Background:
Pulmonary hypertension complicates the clinical course of extremely preterm infants and is associated with bronchopulmonary dysplasia (BPD). However, prevalence, risk factors, and outcome of pulmonary hypertension in these infants are insufficiently known. This systematic review and meta-analysis aims to provide an up-to-date overview of available data on prevalence, risk factors, and outcome of pulmonary hypertension and to identify current knowledge gaps.
Methods:
Medline, EMBASE, and the Cochrane Library databases were searched in July 2017. Two authors reviewed titles/abstracts and full-texts. Eligible studies reported prevalence, patient characteristics or mortality of infants with/without pulmonary hypertension. Studies were excluded if they did not include extremely preterm infants. Only similar study samples (selected infants with BPD or infants both with/without BPD) were compared in the meta-analyses.
Results:
Of 1829 unique articles identified, 25 were eligible for inclusion. Pulmonary hypertension was observed in infants with BPD (20%, 95% confidence interval [CI] 14, 25), but also in those without BPD (2%, 95% CI 0, 8). Infants with severe BPD were most at risk of pulmonary hypertension (risk ratio [RR] 2.7, 95% CI 1.7, 4.2). Infants with pulmonary hypertension were more at risk of mortality (RR 4.7, 95% CI 2.7, 8.3).
Conclusions:
Pulmonary hypertension occurs in particularly in infants with severe BPD, and increases risk of mortality. Due to selected study populations, heterogeneous pulmonary hypertension-definitions and poorly reported timing of pulmonary hypertension assessments, however, data available in current reports are insufficient to allow accurate assessment of true prevalence, risk factors, and time-related outcome. Prospective studies, with standardised methodology and follow-up are needed to determine these factors.
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