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Neonatal outcomes of preterm infants with pulmonary hypertension: clustering based on prenatal risk factors

Seong Phil Bae1,2, Sung Shin Kim3,4, Jungha Yun5

  • 1Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.

Pediatric Research
|May 11, 2024
PubMed

Insights

Prenatal risk factors like histologic chorioamnionitis and small-for-gestational-age impact preterm infant outcomes. Understanding these clusters aids in managing pulmonary hypertension (PH) and improving neonatal care.

Area of Science:

  • Neonatal Medicine
  • Perinatal Epidemiology
  • Pediatric Cardiology

Background:

  • Pulmonary hypertension (PH) is a significant concern in preterm infants, often presenting as hypoxic respiratory failure.
  • The etiologies of PH in this population are complex and multifactorial.
  • Few studies have classified preterm infants based on distinct prenatal risk factor profiles for PH.

Purpose of the Study:

  • To investigate the association between specific prenatal risk factors and neonatal outcomes in preterm infants diagnosed with pulmonary hypertension (PH).
  • To classify very-low-birth-weight infants based on a combination of gestational age, small-for-gestational-age status, and prenatal exposures.
  • To identify distinct clusters of infants with similar prenatal conditions and predict their neonatal outcomes.

Main Methods:

  • A prospective cohort study included very-low-birth-weight infants (22-29 weeks' gestation) requiring PH-specific treatment.
  • Infants were categorized into six clusters using a two-step cluster analysis.
  • Key classification factors included gestational age, small-for-gestational-age (SGA), antenatal corticosteroid (ACS) exposure, histologic chorioamnionitis (HCA), and oligohydramnios.

Main Results:

  • Six distinct infant clusters were identified based on prenatal factors: HCA (Cluster A), oligohydramnios (Cluster B), SGA (Cluster C), no ACS (Cluster D), no dominant parameter (Cluster E), and HCA with oligohydramnios (Cluster F).
  • Cluster C (SGA) showed a significantly higher risk of in-hospital mortality compared to the reference group (Cluster A).
  • Clusters B (oligohydramnios), D (no ACS), and F (HCA and oligohydramnios) exhibited increased risks of requiring PH-specific treatment within the first week of life.

Conclusions:

  • The identified clusters reveal distinct patterns of prenatal conditions and associated neonatal outcomes in preterm infants with PH.
  • This classification provides a better understanding of how specific prenatal risk factors contribute to the development of PH.
  • These findings can inform targeted interventions and improve the management of pulmonary hypertension in vulnerable preterm populations.
Abstract

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