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Long-term follow-up of bronchopulmonary dysplasia
Insights
Children with severe bronchopulmonary dysplasia often have poor long-term outcomes, including ongoing respiratory issues and developmental delays. Some patients show improved pulmonary artery pressure and resistance after recatheterization and oxygen therapy.
Area of Science:
- Pediatrics
- Cardiology
- Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants.
- Long-term outcomes for children with severe BPD are not well-defined.
Purpose of the Study:
- To evaluate the long-term clinical course and outcomes of children with severe bronchopulmonary dysplasia.
Main Methods:
- Cardiac catheterization and pulmonary wedge angiography were performed initially and in some cases, repeated.
- Pulmonary function was assessed using spirometry.
- Patients were followed for an average of 4.4 years.
Main Results:
- Most children experienced ongoing respiratory abnormalities and developmental delays.
- Four patients underwent recatheterization, showing reduced pulmonary artery pressure and resistance, especially with oxygen administration.
- Initial studies missed significant left-to-right shunts in two patients.
Conclusions:
- The long-term outlook for children with severe BPD is guarded and diverse.
- Recatheterization and oxygen therapy may improve pulmonary hemodynamics.
- Further investigation is needed for patients with BPD and associated cardiac findings.
Abstract:
We observed 10 children with bronchopulmonary dysplasia, evaluated initially by cardiac catheterization (mean age 18 months), for an average of 4.4 years. Age at last evaluation averaged 5.8 years; subjects reside in and around Albuquerque, N.M. (altitude 5000 ft). At initial cardiac catheterization, mean pulmonary artery pressure was 40 mm Hg, pulmonary vascular resistance index 8.9 units, and intrapulmonary shunt fraction was high; pulmonary wedge angiograms were normal. Over the period of follow-up the group has done poorly. Four of the 10 continue to receive home oxygen therapy, but none requires inotropic or diuretic therapy; four children have marked developmental or motor delays. Nine of 10 patients have abnormalities of respiratory function on spirometric testing. Four patients underwent recatheterization because of clinical indications; two had large atrial level left-to-right shunts not found on initial study. Reductions in pulmonary artery pressure (55 to 37 mm Hg) and pulmonary vascular resistance (11.9 to 7.8 units) occurred between the two studies in these four patients (average study interval 4.0 years); the still elevated levels of pressure and resistance fell further in response to 40% O2 administration. Pulmonary wedge angiograms were abnormal in each restudied patient. Although not uniformly bleak, the long-term outlook for children with severe bronchopulmonary dysplasia is diverse and guarded.