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Tailoring Therapy to Bronchopulmonary Dysplasia Phenotype: A Ten-Year Experience in Precision Medicine

Arvind Sehgal1,2, Samuel Menahem3

  • 1Monash Newborn, Monash Children's Hospital, Melbourne, VIC 3168, Australia.

Children (Basel, Switzerland)
|February 27, 2026
PubMed

Insights

Systemic afterload reduction with captopril improved cardiorespiratory health in preterm infants with severe bronchopulmonary dysplasia (BPD), systemic hypertension, and left heart dysfunction (LHD). This treatment significantly reduced oxygen needs and enhanced cardiac function in this vulnerable population.

Area of Science:

  • Neonatal Cardiology
  • Pediatric Pulmonology
  • Critical Care Medicine

Background:

  • Severe bronchopulmonary dysplasia (BPD) in extremely preterm infants can lead to systemic hypertension and left heart dysfunction (LHD).
  • This complex phenotype poses significant cardiorespiratory challenges, often requiring novel therapeutic approaches.
  • The potential benefits of afterload reduction in this specific infant population remain incompletely understood.

Purpose of the Study:

  • To evaluate the efficacy of systemic afterload reduction using captopril in infants with severe BPD, systemic hypertension, and LHD.
  • To assess the impact of this intervention on cardiorespiratory parameters, including oxygenation and echocardiographic measures of LHD.

Main Methods:

  • Prospective analysis of ten-year data from extremely preterm infants diagnosed with severe BPD-systemic hypertension-LHD.
  • Treatment involved systemic afterload reduction with captopril initiated at a corrected gestation of approximately 40 weeks.
  • Primary outcome measures included changes in oxygen requirements, pCO2 levels, and echocardiographic assessments of cardiac function.

Main Results:

  • Captopril treatment led to significant reductions in oxygen requirements (43% to 26%) and pCO2 levels (64 to 53 mm Hg) after five weeks.
  • Echocardiographic analysis revealed significant improvements in diastolic indices (E/A ratio, isovolumic relaxation time) and systolic function (velocity of circumferential fiber shortening, left ventricular output).
  • A notable improvement in aortic pulsatility was also observed, indicating enhanced systemic circulation.

Conclusions:

  • The combination of systemic hypertension and LHD may be an under-recognized complication in infants with severe BPD.
  • Systemic afterload reduction with captopril demonstrates significant physiological benefits and improved cardiorespiratory outcomes in a subset of these infants.
  • This therapeutic strategy appears well-suited for managing the complex cardiorespiratory profile associated with severe BPD and associated hypertension/LHD.
Abstract

Keywords:
ACE inhibitioncaptoprilchronic lung diseasepulmonary hypertension

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