Early Pulmonary Hypertension in Preterm Infants

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Isolation of Pulmonary Artery Smooth Muscle Cells from Neonatal Mice
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Isolation of Pulmonary Artery Smooth Muscle Cells from Neonatal Mice

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Srinivasan Mani1, Hussnain Mirza2, James Ziegler3

  • 1Section of Neonatology, Department of Pediatrics, The University of Toledo/ ProMedica Russell J. Ebeid Children's Hospital, Toledo, OH 43606, USA.

Clinics in Perinatology
|February 7, 2024
PubMed

Insights

Pulmonary hypertension (PH) in preterm neonates stems from lung injury and abnormal vascular development. Management strategies and the use of pulmonary vasodilators remain debated topics in neonatal care.

Area of Science:

  • Neonatology
  • Pediatric Cardiology
  • Respiratory Medicine

Background:

  • Pulmonary hypertension (PH) in preterm neonates presents unique multifactorial pathogenesis.
  • Premature lungs are susceptible to injury from ventilation and oxygen, leading to diverse PH phenotypes.
  • Early PH prevalence varies significantly, affecting 8-55% of extremely preterm infants.

Purpose of the Study:

  • To review the characteristics and pathogenesis of PH in preterm neonates.
  • To discuss the variable prevalence and contributing factors of early PH.
  • To highlight the controversies surrounding the management of PH and vasodilator use in this population.

Main Methods:

  • Literature review of studies on neonatal pulmonary hypertension.
  • Analysis of factors contributing to lung injury and vascular dysfunction in preterm infants.
  • Synthesis of current evidence on PH management strategies.

Main Results:

  • Preterm infants experience lung injury from positive pressure ventilation and high oxygen concentrations.
  • Disrupted lung development and vascular signaling pathways contribute to abnormal pulmonary vascular transition.
  • The prevalence of PH in extremely preterm infants is highly variable.

Conclusions:

  • PH in preterm neonates is characterized by multifactorial causes and unique presentations.
  • Abnormal pulmonary vascular transition is linked to disrupted lung development and signaling.
  • Current management approaches for early PH, including off-label vasodilator use, require further investigation and consensus.

Keywords:
Chronic lung diseasePreterm infantsPulmonary hypertension

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