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Pulmonary artery pressure: early predictor of chronic lung disease in preterm infants
N V Subhedar1, A H Hamdan, S W Ryan
1Department of Child Health, University of Liverpool.
Insights
Pulmonary artery pressure (PAP) in preterm infants is linked to chronic lung disease (CLD). Early PAP assessment using AT:RVET(c) can help predict CLD development in ventilated infants.
Area of Science:
- Neonatal respiratory medicine
- Pediatric cardiology
- Pulmonary hypertension research
Background:
- Chronic lung disease (CLD) is a significant concern in preterm infants.
- Pulmonary artery pressure (PAP) is a potential marker for respiratory complications.
- Early identification of risk factors for CLD is crucial for timely intervention.
Purpose of the Study:
- To investigate the independent association between PAP and CLD in ventilated preterm infants.
- To evaluate the prognostic value of early PAP assessment for predicting CLD.
- To develop and validate a predictive score for CLD.
Main Methods:
- Studied two cohorts of preterm infants (development n=55, validation n=28) at 24 hours of age.
- Assessed PAP non-invasively using the AT:RVET(c) ratio from pulmonary artery Doppler waveforms.
- Employed logistic regression and receiver operating characteristic (ROC) curves to develop and assess a predictive score for CLD.
Main Results:
- Birthweight, inspired oxygen concentration, and AT:RVET(c) were independently associated with CLD.
- The predictive score, including AT:RVET(c), demonstrated high accuracy (ROC AUC 0.96 development, 0.89 validation).
- Excluding AT:RVET(c) significantly reduced the predictive accuracy of the score.
Conclusions:
- Early non-invasive assessment of PAP via AT:RVET(c) is independently associated with CLD development.
- An early PAP assessment can serve as a valuable component in a multifactorial scoring system for predicting CLD in preterm infants.
- This approach offers potential for earlier identification and management of CLD risk.
Aim:
To determine if pulmonary artery pressure (PAP) in ventilated preterm infants is independently associated with the development of chronic lung disease (CLD) and whether early assessment has any prognostic value.
Methods:
Two cohorts (development n = 55; and validation n = 28) of preterm infants were studied at 24 hours of age. PAP was assessed non-invasively using its inverse correlation with the corrected acceleration time to right ventricular ejection time ratio (AT:RVET(c)), calculated from the pulmonary artery Doppler waveform. Clinical and respiratory variables were also collected. Using logistic regression analysis to identify factors independently associated with CLD, a prognostic score was developed to predict CLD. The ability of the score to predict CLD was described using receiver operating characteristic (ROC) curves.
Results:
Birthweight, inspired oxygen concentration, and AT:RVET(c) were independently predictive of CLD. The area under the ROC curve was 0.96 for the development and 0.89 for the validation cohort. Exclusion of AT:RVET(c) resulted in a reduction to 0.88 and 0.73, respectively.
Conclusion:
PAP is independently associated with CLD. An early assessment of PAP using AT:RVET(c) may permit the early prediction of CLD as part of a multifactorial scoring system.