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Screening Echocardiography Identifies Risk Factors for Pulmonary Hypertension at Discharge in Premature Infants with
B A Madden1, M R Conaway2, S A Zanelli3
1Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA. bmadden@luriechildrens.org.
Insights
Echocardiograms at 36 weeks post-menstrual age (PMA) can identify premature infants with bronchopulmonary dysplasia (BPD) at high risk for pulmonary hypertension (PH) at discharge, especially when atrial septal defects, right ventricular dilation, or impaired function are present.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Pulmonary Medicine
Background:
- Premature infants with bronchopulmonary dysplasia (BPD) face an elevated risk of developing secondary pulmonary hypertension (BPD-PH).
- Previous research on the effectiveness of echocardiographic screening at 36 weeks post-menstrual age (PMA) for BPD-PH has produced conflicting results.
- This study aimed to evaluate early echocardiographic findings at the time of BPD diagnosis to predict BPD-PH at discharge.
Purpose of the Study:
- To determine if echocardiographic screening at 36 weeks PMA can identify premature infants with BPD who are at higher risk for BPD-PH at discharge.
- To identify specific echocardiographic markers and clinical factors associated with an increased likelihood of BPD-PH at discharge.
Main Methods:
- A retrospective cohort analysis was conducted on clinical and demographic data, along with screening echocardiograms from infants diagnosed with BPD.
- Infants were categorized based on the presence or absence of BPD-PH at discharge, confirmed by echocardiography.
- Screening echocardiograms at 36 weeks PMA and associated clinical data were analyzed to identify predictors of BPD-PH at discharge using multivariable models.
Main Results:
- Out of 64 infants with severe BPD, 34% (22/64) had BPD-PH at discharge.
- No significant clinical differences were observed between infants at the 36-week PMA screening.
- Pulmonary hypertension identified during screening was not a strong predictor of PH at discharge, with 49% of cases resolving. However, the presence of an atrial septal defect (ASD), right ventricular (RV) dilation, hypertrophy, or reduced RV function on screening, particularly in combination, was associated with BPD-PH at discharge.
Conclusions:
- In premature infants with BPD, echocardiographic screening at 36 weeks PMA can identify those at increased risk for BPD-PH at discharge, especially when ASD, RVH, or impaired RV function are detected.
- These findings suggest that specific echocardiographic markers may aid in risk stratification for BPD-PH.
- Larger prospective studies are recommended to validate these predictive factors.
Hypothesis:
Premature infants with bronchopulmonary dysplasia (BPD) are at increased risk of secondary pulmonary hypertension (BPD-PH). Prior studies yielded mixed results on the utility of echocardiographic screening at 36 weeks post-menstrual age (PMA). We present our experience using echocardiographic screening at the time of BPD diagnosis to identify infants at highest risk of BPD-PH at discharge.
Materials And Methods:
Retrospective cohort analysis of clinical/ demographic data and screening echocardiograms in patients with BPD. Discharge echocardiograms identified infants with or without BPD-PH at discharge. 36 weeks PMA screening echocardiograms and clinical data were then reviewed to identify which factors were associated with increased odds of BPD-PH at discharge. Associations between echocardiographic findings were evaluated with 2- and 3-variable models to predict increased risk of BPD-PH at discharge.
Results:
In our cohort of 64 infants with severe BPD, BPD-PH was present in 22/64 (34%) infants at discharge. There were no clinical differences at time of 36 weeks PMA screening evaluation (mean PMA 36.6 ± 2.9 weeks). PH at screening was poorly predictive of PH at discharge as PH at screening resolved in 49% of patients. However, having an ASD, RV dilation, hypertrophy, or reduced function on screening, especially in combination, were associated with BPD-PH at discharge.
Conclusion:
In our cohort of premature infants with BPD, 36 weeks PMA screening echocardiogram identified patients at increased risk for BPD-PH at discharge when ASD, RVH, or impaired RV function were present. Larger prospective studies are indicated to validate these findings.
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