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Short and long-term outcomes of chronic pulmonary hypertension in preterm infants managed using a standardized
Michelle Baczynski1, Edmond Kelly2, Patrick J McNamara3
1Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada.
Insights
A new management strategy for chronic pulmonary hypertension (cPH) in premature infants with chronic lung disease (CLD) shows promising results. Treating cPH with right-ventricular dilatation using diuretics led to symptom improvement and comparable outcomes to infants without cPH.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Pulmonology
Background:
- Limited data exists on managing chronic pulmonary hypertension (cPH) in premature infants with chronic lung disease (CLD).
- A standardized policy was implemented, treating only cPH with right-ventricular (RV) dilatation and using diuretics as first-line therapy.
- Infants with cPH but without RV dilatation were managed expectantly.
Purpose of the Study:
- To evaluate clinical outcomes of a standardized management policy for cPH in CLD of prematurity.
- To assess the efficacy of diuretics as first-line therapy for cPH with RV dilatation.
- To compare outcomes between infants with and without cPH.
Main Methods:
- Retrospective cohort study of infants with CLD.
- Infants categorized as "CLD-only" or "CLD-cPH" via echocardiography at ≥36 weeks postmenstrual age.
- Regression analysis to examine the association between cPH and death or disability at 18-24 months.
Main Results:
- Of 128 CLD infants, 48 (38%) had cPH; 29 (60%) received diuretics.
- 90% showed symptomatic improvement within 1 week of diuretic treatment.
- CLD-cPH infants had a worse in-hospital course, but similar post-discharge respiratory and neurodevelopmental outcomes compared to CLD-only infants.
- cPH was not associated with death or disability (aOR, 1.02; 95% CI, 0.32-3.27).
- Two cases (4%) progressed and were treated with sildenafil; no deaths from respiratory or RV failure occurred.
Conclusions:
- Primary treatment of CLD-cPH with diuretics, targeting RV dilatation, may improve symptoms and stabilize the disease.
- This approach can lead to post-discharge outcomes comparable to infants without cPH.
- The findings support a targeted therapeutic strategy for cPH in CLD of prematurity.
Background:
There is limited data on management strategies for chronic pulmonary hypertension (cPH) in chronic lung disease (CLD) of prematurity. Our objective was to evaluate clinical outcomes following a standardized policy, wherein only cPH with right-ventricular (RV) dilatation was treated and diuretics were employed as first-line therapy; cPH without RV-dilatation was managed expectantly.
Method:
In this retrospective cohort study, all infants with CLD were categorized as "CLD-only" or "CLD-cPH," using echocardiography at ≥36 weeks postmenstrual age. Intergroup comparison was performed. Regression analysis examined the association between cPH and primary outcome of death or disability at 18-24 months.
Results:
Of 128 CLD infants, 48 (38%) had cPH, of which 29 (60%) received diuretics. Symptomatic improvement within 1-week was recorded in 90%. Although CLD-cPH had worse in-hospital respiratory course than CLD-only, all post-discharge respiratory and neurodevelopmental outcomes were similar. cPH was not associated with death or disability (adjusted odds ratio, 1.02; 95% confidence interval, 0.32-3.27). Disease progression treated with sildenafil occurred in 2 (4%) cases. There was no death from respiratory or RV failure.
Conclusion:
Primary treatment of CLD-cPH with diuretics using RV-dilatation as therapeutic threshold, may result in symptomatic improvement, disease stabilization and post-discharge outcomes comparable to infants without cPH.
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