Pulmonary Hypertension in Preterm Infants: Prevalence and Association with Bronchopulmonary Dysplasia

Mirza, Hussnain; Ziegler, James W.; Ford, Sara; Padbury, Jamés F.; Tucker, Richard; Laptook, Abbot R.

doi:10.1016/j.jpeds.2014.07.040

Cited by 130 publications

(139 citation statements)

References 34 publications

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“…PH was diagnosed as late as 232 days of age in the study by An and coworkers (40). A recent study by Mirza and coworkers described a lower incidence of PH (8% at 10-14 d of age and 4% at 36 wk PMA), but the criteria for PH diagnosis in that study was more similar to our alternate criteria-1 (41), which achieved similar rates of PH in our cohort (Figure 2). Higher death rates in preterm infants with BPD and PH compared with those without PH have been reported as well (24,40,42).…”

Section: Discussionsupporting

confidence: 66%

Early Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia

Mourani¹,

Sontag

Younoszai

et al. 2015

Am J Respir Crit Care Med

343

459

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Rationale: Pulmonary hypertension (PH) is associated with poor outcomes among preterm infants with bronchopulmonary dysplasia (BPD), but whether early signs of pulmonary vascular disease are associated with the subsequent development of BPD or PH at 36 weeks post-menstrual age (PMA) is unknown.Objectives: To prospectively evaluate the relationship of early echocardiogram signs of pulmonary vascular disease in preterm infants to the subsequent development of BPD and late PH (at 36 wk PMA).Methods: Prospectively enrolled preterm infants with birthweights 500-1,250 g underwent echocardiogram evaluations at 7 days of age (early) and 36 weeks PMA (late). Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH. Measurements and Main Results:A total of 277 preterm infants completed echocardiogram and BPD assessments at 36 weeks PMA. The median gestational age at birth and birthweight of the infants were 27 weeks and 909 g, respectively. Early PH was identified in 42% of infants, and 14% were diagnosed with late PH. Early PH was a risk factor for increased BPD severity (relative risk, 1.12; 95% confidence interval, 1.03-1.23) and late PH (relative risk, 2.85; 95% confidence interval, 1.28-6.33). Infants with late PH had greater duration of oxygen therapy and increased mortality in the first year of life (P , 0.05).Conclusions: Early pulmonary vascular disease is associated with the development of BPD and with late PH in preterm infants. Echocardiograms at 7 days of age may be a useful tool to identify infants at high risk for BPD and PH.Keywords: bronchopulmonary dysplasia; pulmonary vascular disease; pulmonary hypertension; echocardiography; prematurity At a Glance CommentaryScientific Knowledge on the Subject: Preterm infants remain at high risk for late respiratory morbidity and mortality caused by the development of bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). Early injury to the developing lung can impair angiogenesis and alveolarization and result in simplification of distal lung airspace and the clinical manifestations of BPD and PH. However, whether early signs of pulmonary vascular disease are indicative of the subsequent development of BPD or PH at 36 weeks postmenstrual age (PMA) has not been well established.What This Study Adds to the Field: This paper presents a longitudinal study identifying echocardiogram-derived risk factors at 7 days of age for the subsequent development of both BPD and PH. We also describe the incidence of PH at 36 weeks PMA and its relationship to BPD severity.

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Section: Discussionsupporting

confidence: 66%

Early Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia

Mourani¹,

Sontag

Younoszai

et al. 2015

Am J Respir Crit Care Med

343

459

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“…This study provides a comprehensive look at how the choice of echo parameters affects the incidence of PH. Using the "strictest" criteria of pulmonary artery pressure, as estimated by the tricuspid valve regurgitant jet, the authors found rates of early PH comparable to those found in other single-center prospective studies (7,23). However, rates were considerably higher when the diagnostic criteria were expanded to include any of the following: right ventricle systolic pressure higher than 40 mm Hg, right ventricle systolic pressure/systemic systolic blood pressure ratio higher than 0.5, any cardiac shunt with bidirectional or right-to-left shunting, or any degree of ventricular wall septal flattening.…”

Section: Sharpening the Tools Of Detectionsupporting

confidence: 53%

Pulmonary Hypertension in Premature Infants. Sharpening the Tools of Detection

Farrow

Steinhorn

2015

Am J Respir Crit Care Med

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measurements, as well as acceptable measurements in more than 1,000 children aged 5-12 years. A comparison of children living in a range of locations in India with those of Indian heritage who were living in London in the United Kingdom revealed significantly higher FEV 1 and FVC (per z-scores relative to reference values derived from Indian populations) in the London residents. However, when the India-resident children were subgrouped into urban, semiurban, and rural areas of residence, it was discovered that the urban-residing children from India had spirometric measures that were indistinguishable from those measured in the London contingent. In contrast, the rural-residing Indian children had FEV 1 and FVC measures that were 0.9 z-scores lower, and the semiurban Indian group had measures 0.5 z-scores lower, than the India urban and London groups. Assuming that the genetically determined physical characteristics relating predicted lung volumes to height, age, and sex are relatively constant for the general population of India, these results suggest strongly that differences in living conditions among these subpopulations have a significant effect on lung development or lung function. This is useful information, as it identifies a population that could hold clues to mechanisms by which environmental conditions may affect lung development in utero or in early life and that may benefit from interventions to improve lung health.The authors also report that the z-FEV 1 /FVC was not significantly different among the subpopulations, suggesting a restrictive (reduced lung size), rather than obstructive, pattern in the nonurban residents. This needs to be confirmed with a measure of total lung capacity (TLC), which would not be possible for population screening but could be attempted in a representative sample of participants. In persons with normal respiratory systems, the primary determinant of FEV 1 is FVC, the primary determinant of FVC is TLC, and the primary determinant of TLC is thoracic volume, which relates to height and chest dimensions. Thus, the surrogate measures (height, age, sex, ethnic heritage) that are used to compute reference ranges for spirometry mostly function as an estimate of TLC. If the actual TLC is significantly different from the expected TLC, this will affect the z-FEV 1 and z-FVC but will not affect the z-FEV 1 /FVC unless the TLC is altered by a process that also affects airway integrity or lung elastic recoil. The alternative scenario that may cause a proportional decrease of FEV 1 and FVC is premature airway closure during forced expiration (2), although this is unlikely in the absence of chronic respiratory symptoms.The authors employed a multivariate model that included family affluence score, exposure to household tobacco smoke, exposure to indoor biomass smoke, z-body weight, and z-body mass index, but these variables were nearly qualitatively associated with place of residence, so none emerged as strong correlates with the spirometric measures. Specific data regarding maternal to...

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“…28 Recently, there have been some reports that placental pathologic changes of maternal vascular underperfusion in BPD are associated with increased risk of pulmonary hyper tension, 29 and after a systematic review and metaanalysis, oligohydramnios and SGA were shown as significant risk fac tors of pulmonary hypertension in infants with BPD. 30 Addi tionally, in our study, SGAP was a significant risk factor of pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Pregnancy Disorders Causing Preterm Delivery on In-Hospital Outcomes in Preterm Infants at Less than 32 Weeks of Gestation

et al. 2017

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Objective:We assessed the influence of small for gestational age (GA) with placental disorders (SGAP) and histologic chorioamnionitis (HCA) on the inhospital outcomes of preterm infants. Methods: Preterm infants with a GA <32 weeks born at Seoul National University Hospital between 2007 and 2014 were included and divided into 4 groups according to the presence of SGAP and HCA: group 1, SGAP only; group 2, HCA only; group 3, both SGAP and HCA; and group 4, no SGAP or HCA. Multivariate logistic regression was done to compare neonatal outcomes including death, moderate to severe bronchopulmonary dysplasia (BPD) or death, patent ductus arteriosus with treat ment, sepsis, necrotizing enterocolitis ≥stage 2b, and intraventricular hemorrhage ≥grade 3. Results: A total of 572 infants were included. There were 77 patients (13.5%) in group 1, 226 patients (39.5%) in group 2, and 24 patients (4.2%) in group 3. After adjusting for GA, cesarean section, 5 minute Apgar score, multiple pregnancy, premature rupture of membrane before 18 hours prior to delivery, and preeclampsia, group 1 showed higher risks of mortality (adjusted odds ratio [aOR] 3.15, 95% confidence interval [CI] 1.138.80), moderate to severe BPD or death (aOR 9.12, 95% CI 3.98 20.90), sepsis (aOR 2.12, CI 1.014.46), and pulmonary hypertension (aOR 3.26, 95% CI 1.159.22) compared with group 4. There were no significant differences in mortality and inhospital outcomes between groups 2 and 4 or between groups 3 and 4. Conclusion: Close monitoring and early intervention are suggested in SGAP infants.

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Pulmonary Hypertension in Preterm Infants: Prevalence and Association with Bronchopulmonary Dysplasia

Cited by 130 publications

References 34 publications

Early Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia

Early Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia

Pulmonary Hypertension in Premature Infants. Sharpening the Tools of Detection

The Influence of Pregnancy Disorders Causing Preterm Delivery on In-Hospital Outcomes in Preterm Infants at Less than 32 Weeks of Gestation

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