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Practices and Outcomes from a Prospective, Multicenter Registry for Preterm Newborns with Pulmonary Hypertension
Nicolle Fernández Dyess1, Claire Palmer1, Roger F Soll2
1Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO.
Insights
Preterm infants with hypoxemic respiratory failure and pulmonary hypertension face high mortality and bronchopulmonary dysplasia risks. PH-targeted treatments, like inhaled nitric oxide, are common but did not show improved outcomes in this study.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Early-onset hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) are critical conditions in preterm infants.
- These conditions are associated with significant mortality and long-term respiratory morbidity, such as bronchopulmonary dysplasia.
- Current treatment practices for HRF and PH in this vulnerable population require detailed description and outcome analysis.
Purpose of the Study:
- To document current treatment strategies for preterm infants experiencing early HRF and PH.
- To investigate the association between PH-targeted treatments and patient outcomes, including mortality and major morbidities.
- To identify factors influencing outcomes in this high-risk neonatal cohort.
Main Methods:
- A prospective, observational, multicenter clinical registry was established.
- The registry included preterm newborns (<34 weeks' gestation) with clinical or echocardiographic evidence of HRF and PH within 72 hours of birth.
- Data were collected from 28 US neonatal intensive care units between 2017 and 2022, with mortality and major morbidities as primary and secondary endpoints, respectively.
Main Results:
- The study analyzed 224 preterm infants; 84% received PH-targeted treatment, predominantly inhaled nitric oxide (iNO).
- High early mortality (33%) and bronchopulmonary dysplasia rates (77% among survivors) were observed.
- Infants receiving PH-targeted treatment had higher initial oxygenation indices, but patient outcomes did not significantly differ compared to untreated infants.
Conclusions:
- Early-onset HRF with PH in preterm infants carries a substantial risk of early mortality and bronchopulmonary dysplasia.
- Inhaled nitric oxide is frequently used for early PH treatment in preterm infants with HRF.
- While iNO may potentially mitigate poorer outcomes in severe PH compared to untreated infants with lower oxygenation indices, this study found no significant difference in overall patient outcomes.
Objective:
To describe current treatment practices of preterm infants with early hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) and their association with patient outcomes.
Study Design:
We developed a prospective, observational, multicenter clinical registry of preterm newborns <34 weeks' gestation with HRF and PH, based on either clinical or echocardiographic evidence during the first 72 hours of life, from 28 neonatal intensive care units in the US from 2017 through 2022. The primary end point was mortality among those who did or did not receive PH-targeted treatment, and the secondary end points included comparisons of major morbidities. Variables were compared using t tests, Wilcoxon rank-sum tests, Fisher exact tests, and χ² tests.
Results:
We analyzed the results of 224 preterm infants enrolled in the registry. Of which, 84% (188/224) received PH-targeted treatment, most commonly inhaled nitric oxide (iNO). Early mortality in this cohort was high, as 33% (71/224) of this sample died in the first month of life, and 77% of survivors (105/137) developed bronchopulmonary dysplasia. Infants who received PH-targeted treatment had higher oxygenation indices at the time of enrollment (28.16 [IQR: 13.94, 42.5] vs 15.46 [IQR: 11.94, 26.15]; P = .0064). Patient outcomes did not differ between those who did or did not receive PH-targeted therapy.
Conclusions:
Early-onset HRF with PH in preterm infants is associated with a high early mortality and a high risk of developing bronchopulmonary dysplasia. iNO is commonly used to treat early-onset PH in preterm infants with HRF. In comparison with untreated infants with lower oxygenation indices, iNO treatment in severe PH may prevent poorer outcomes.
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