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Lung disease and pulmonary hypertension in the premature infant

Lori A Christ1, Jennifer M Sucre2, David B Frank3,4

  • 1Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.

Progress in Pediatric Cardiology
|August 25, 2020
PubMed

Insights

Premature infants often have underdeveloped lungs, increasing risks for chronic lung disease and pulmonary hypertension. Conventional treatments for pulmonary hypertension are less effective in these infants due to limited blood vessels.

Area of Science:

  • Neonatology
  • Pediatric Cardiology
  • Pulmonary Medicine

Background:

  • Premature infants face challenges adapting to extrauterine life due to incomplete lung development.
  • Bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD) impair lung structure, airway growth, and vascularization essential for respiration.
  • Deficient vascular development in the lungs can lead to elevated pulmonary vascular resistance and pulmonary hypertension (PH).

Purpose of the Study:

  • To review current knowledge on pulmonary hypertension (PH) in premature infants.
  • To discuss the unique challenges in diagnosing and treating PH in the context of developmental lung disease.
  • To highlight limitations of conventional pulmonary vasodilators for PH in this population.

Main Methods:

  • Review of recent findings on PH in premature infants.
  • Discussion of pathophysiology linking disrupted lung development to vascular deficiencies.
  • Analysis of treatment implications for developmental lung disease-associated PH.

Main Results:

  • Premature infants with BPD/CLD exhibit impaired lung vascularity, contributing to PH.
  • Conventional pulmonary vasodilators may have limited efficacy due to a reduced number of dilatable blood vessels.
  • Developmental lung disease-associated PH presents distinct challenges compared to adult or typical pediatric PH.

Conclusions:

  • Pulmonary hypertension in premature infants with disrupted lung development requires specialized consideration.
  • The limited vascular bed in these infants impacts treatment strategies for PH.
  • Further research is needed to optimize management of PH in neonates with chronic lung disease.

Keywords:
Lung developmentbronchopulmonary dysplasiachronic lung diseasepulmonary hypertension

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