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Pulmonary Hypertension in Established Bronchopulmonary Dysplasia: Physiologic Approaches to Clinical Care
Steven H Abman1, Satyan Lakshminrusimha2
1Department of Pediatrics, The Pediatric Heart Lung Center, University of Colorado Anschutz Medical Campus, Mail Stop B395, 13123 East 16th Avenue, Aurora, CO 80045, USA.
Insights
Infants born prematurely with bronchopulmonary dysplasia (BPD) often develop pulmonary hypertension (PH). Antenatal factors increase susceptibility, requiring comprehensive management including cardiac assessments and hemodynamic monitoring before targeted therapies.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants.
- Pulmonary hypertension (PH) frequently complicates BPD, increasing morbidity and mortality.
- Antenatal factors like preeclampsia and fetal growth restriction are linked to BPD-PH susceptibility.
Purpose of the Study:
- To review the link between antenatal factors and the development of BPD-PH.
- To outline diagnostic and monitoring tools for BPD-PH.
- To discuss therapeutic strategies for BPD-PH.
Main Methods:
- Review of laboratory and clinical data.
- Echocardiogram metrics for diagnosis and monitoring.
- Serial NT-proBNP assessments for clinical course evaluation.
Main Results:
- Antenatal factors significantly increase the risk of BPD-PH.
- Echocardiography and NT-proBNP are crucial for diagnosis and monitoring.
- Complicating conditions include diastolic dysfunction, shunts, and venous stenosis.
Conclusions:
- Comprehensive management of BPD-PH requires addressing lung disease, cardiac function, and hemodynamics.
- PH-targeted drug therapies should be initiated after thorough patient assessment.
- Early identification and management of risk factors are key for improved outcomes.
Abstract:
Preterm infants with bronchopulmonary dysplasia (BPD) are prone to develop pulmonary hypertension (PH). Strong laboratory and clinical data suggest that antenatal factors, such as preeclampsia, chorioamnionitis, oligohydramnios, and placental dysfunction leading to fetal growth restriction, increase susceptibility for BPD-PH after premature birth. Echocardiogram metrics and serial assessments of NT-proBNP provide useful tools to diagnose and monitor clinical course during the management of BPD-PH, as well as monitoring for such complicating conditions as left ventricular diastolic dysfunction, shunt lesions, and pulmonary vein stenosis. Therapeutic strategies should include careful assessment and management of underlying airways and lung disease, cardiac performance, and systemic hemodynamics, prior to initiation of PH-targeted drug therapies.
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