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Early Echocardiographic Indicators of Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary
Valentina Gava Chakr1, Rita C Silveira1, Lívia da Rosa Pauletto1
1Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Newborn Section, Hospital de Clínicas de Porto Alegre, Rua Silva Jardim 1155 # 701, Porto Alegre, RS, 90450-071, Brazil.
Insights
Early echocardiography can detect subclinical pulmonary vascular remodeling in premature infants with bronchopulmonary dysplasia (BPD). Pulmonary artery acceleration time (PAAT) is lower in neonates who develop BPD, indicating early disease.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Pulmonary Medicine
Background:
- Premature infants, especially those with bronchopulmonary dysplasia (BPD), face risks of pulmonary vascular disease (PVD) due to impaired pulmonary vascular development.
- Early identification of subclinical changes is crucial for managing PVD in this vulnerable population.
Purpose of the Study:
- To identify early subclinical echocardiographic changes in pulmonary hemodynamics and right ventricular (RV) function in neonates who develop BPD or die before 36 weeks postmenstrual age (PMA).
- To assess late echocardiographic changes at 36-40 weeks PMA in infants with BPD.
- To compare these indices between neonates with and without BPD.
Main Methods:
- A prospective cohort study involving preterm infants (<33 weeks gestation) undergoing serial echocardiography.
- Evaluation of pulmonary hemodynamics and RV function using pulmonary artery acceleration time (PAAT) and tricuspid annular plane systolic excursion (TAPSE).
- Comparison of echocardiographic indices at 7-10 days (T0) and 36-40 weeks PMA (T1).
Main Results:
- Among 104 infants, 22 developed BPD. No infants met criteria for pulmonary hypertension via tricuspid regurgitation jet velocity (TRJV).
- At T0, infants who developed BPD or died before 36 weeks PMA had significantly lower PAAT (52.8 ms) compared to controls (67.0 ms).
- By T1, PAAT and TAPSE were similar between groups, but both groups showed significant maturation-related increases in PAAT, TAPSE, and s' from T0 to T1.
Conclusions:
- Early echocardiographic assessment, particularly of PAAT, can identify subclinical pulmonary vascular remodeling in preterm infants who develop BPD.
- A multiparametric echocardiographic approach may enhance early detection of pulmonary vascular remodeling, especially when TRJV is inconclusive.
Abstract:
Premature infants, particularly those with bronchopulmonary dysplasia (BPD), experience significant disruptions in pulmonary vascular development, increasing their risk of pulmonary vascular disease (PVD). Objectives were to identify early subclinical changes in echocardiographic indices of pulmonary hemodynamics and right ventricular (RV) function at 7-10 days of age (T0) in neonates who develop BPD or die before 36 weeks postmenstrual age (PMA), compared to neonates without BPD. Additionally, to determine whether late changes in echocardiographic are present at 36-40 weeks PMA (T1) in those with BPD. In this prospective cohort study, preterm infants less than 33 weeks of gestation underwent serial echocardiography to evaluate indices of pulmonary hemodynamics and RV function, including pulmonary artery acceleration time (PAAT) and tricuspid annular plane systolic excursion (TAPSE). Among 104 preterm infants, 22 developed BPD. None met echocardiographic criteria for pulmonary hypertension based on tricuspid regurgitation jet velocity (TRJV). At T0, infants with BPD or who died before 36 weeks PMA had significantly lower PAAT values after adjustment for gestational age and birth weight (52.8 vs. 67.0 milliseconds). By T1, PAAT and TAPSE were similar between groups. However, paired comparisons from T0 to T1 revealed significant increases in PAAT, TAPSE, and s' values in both groups as they matured. Early echocardiographic assessment of pulmonary hemodynamics and RV function can identify subclinical pulmonary vascular remodeling in infants with BPD. A multiparametric approach may improve early identification of pulmonary vascular remodeling, especially when TRJV is inconclusive.
