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Published on: October 19, 2013
Pulmonary hypertension in preterm neonates with bronchopulmonary dysplasia: a meta-analysis
Dwayne Mascarenhas1,2, Marwa Al-Balushi1,2, Aida Al-Sabahi1,2
1The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pulmonary hypertension (PH) in preterm infants with bronchopulmonary dysplasia (BPD) is common and increases with BPD severity. BPD-PH is linked to higher mortality and adverse neurodevelopmental outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Knowledge gaps exist regarding the incidence and risk factors for pulmonary hypertension (PH) in preterm infants with bronchopulmonary dysplasia (BPD).
- The impact of BPD-PH on short- and long-term outcomes in this vulnerable population requires further elucidation.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of BPD-PH in preterm infants.
- To identify significant risk factors associated with the development of BPD-PH.
- To evaluate the short- and long-term outcomes for preterm infants diagnosed with BPD-PH.
Main Methods:
- A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and CINAHL was conducted.
- Studies included preterm infants (<37 weeks gestational age or <2500 g birth weight) with BPD-PH compared to BPD without PH.
- Data were extracted from inception until April 5, 2023, focusing on incidence, risk factors, and outcomes.
Main Results:
- 44 observational studies involving 7677 preterm infants were analyzed.
- PH incidence in mild, moderate, and severe BPD was 5%, 18%, and 41%, respectively.
- Significant risk factors included being small for gestational age, necrotizing enterocolitis, early PH diagnosis, and severe BPD. BPD-PH was associated with increased mortality, longer ventilation/hospitalization, and higher risk of neurodevelopmental impairment.
Conclusions:
- Pulmonary hypertension incidence rises with BPD severity in preterm infants.
- BPD-PH is a significant risk factor for increased mortality and adverse short-term and neurodevelopmental outcomes.
- These findings highlight the critical need for early identification and management of PH in preterm infants with BPD.
Context:
Knowledge gaps exist on the incidence and risk factors for developing pulmonary hypertension (PH) in preterm infants with bronchopulmonary dysplasia (BPD) and its impact on outcomes.
Objective:
To systematically review and meta-analyse the incidence, risk factors and short- and long-term outcomes of BPD-PH in preterm infants.
Design:
PubMed, Embase, Cochrane CENTRAL and CINAHL were searched for studies including infants<37 weeks gestational age (GA) or birth weight<2500 g with BPD-PH versus BPD-no PH from inception until 5 April 2023.
Main Outcome Measures:
Incidence, risk factors and short- and long-term outcomes.
Results:
44 observational studies evaluating 7677 preterm infants were included. The incidence of PH in mild, moderate and severe BPD was 5%, 18% and 41%, respectively. Small for GA (25 studies; N=5814; OR 1.8; 95% CI 1.3, 2.5), necrotising enterocolitis (22 studies; N=3387; OR 1.6; 95% CI 1.3, 2.2), early PH (four studies; N=820 OR 2.2; 95% CI 1.5, 3.3) and severe BPD (20 studies; N=2587; OR 5.4; 95% CI 3.2, 9.1) were significant risk factors for BPD-PH. Compared with BPD-no PH, the BPD-PH group had significantly higher mortality (22 studies; N=4882; OR 6.4; 95% CI 4.7, 8.6), longer duration of mechanical ventilation, oxygen supplementation, length of hospital stay, need for home oxygen and tracheostomy requirement. The BPD-PH infants also had a significantly higher risk of neurodevelopmental impairment in the motor domain.
Conclusions:
PH increases across the severity of BPD and is associated with higher odds of mortality and adverse short-term and neurodevelopmental outcomes.
Prospero Registration Number:
CRD42023413119.
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