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Extremely premature infants born at 23-25 weeks gestation are at substantial risk for pulmonary hypertension

Hannes Sallmon1,2,3, Martin Koestenberger4,5, Alexander Avian6

  • 1Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany. sallmon@dhzb.de.

Journal of Perinatology : Official Journal of the California Perinatal Association
|April 2, 2022
PubMed

Insights

Pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH) affects 44% of extremely low gestational age newborns (ELGANs). Pharmacotherapy improved hemodynamics in most infants by 12 months.

Area of Science:

  • Neonatal Medicine
  • Pediatric Cardiology
  • Respiratory Medicine

Background:

  • Extremely low gestational age newborns (ELGANs) are a highly vulnerable population.
  • Bronchopulmonary dysplasia (BPD) is a common complication in ELGANs, often associated with pulmonary hypertension (BPD-PH).
  • Understanding the incidence and management of BPD-PH in the most immature infants is critical.

Purpose of the Study:

  • To determine the incidence and severity of BPD-PH in extremely immature ELGANs (230/6-256/7 weeks gestational age).
  • To assess the efficacy of pharmacologic treatment for BPD-PH in this population.

Main Methods:

  • Prospective observational cohort study.
  • Echocardiography markers and serum NT-proBNP levels were used to assess BPD-PH at 3 and 12 months chronological age.
  • Incidence and efficacy of pharmacologic treatment were analyzed.

Main Results:

  • At 3 months, 44% (15/34) of ELGANs showed echocardiographic evidence of BPD-PH.
  • At 12 months, 6/34 infants still had pulmonary hypertension.
  • PH-targeted therapy, including sildenafil and dual oral combination therapy, was administered to all affected infants.

Conclusions:

  • Nearly half of extremely immature ELGANs develop BPD-PH.
  • Pharmacotherapy led to hemodynamic improvements in most infants by 12 months of age.
  • Early intervention with PH-targeted therapy is effective in managing BPD-PH in ELGANs.
Abstract

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