Acute Vasoreactivity Testing during Cardiac Catheterization of Neonates with Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension

Frank, Benjamin S.; Schäfer, Michal; Grenolds, Alicia; Ivy, D. Dunbar; Abman, Steven H.; Darst, Jeffrey R.

doi:10.1016/j.jpeds.2018.12.004

Cited by 31 publications

(16 citation statements)

References 27 publications

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“…AVT also distinguished higher from lower risk PH in infants with BPD better than baseline pulmonary hemodynamics. 35 Others found that the severity of lung disease as assessed by impaired oxygenation at cardiac catheterization did not correlate with mortality while the presence of pulmonary vein stenosis was associated with death. 33 Biomarkers Blood biomarker concentrations contribute to tailoring longitudinal medical care of PH patients.…”

Section: Diagnosis Of Bpd and Bpd-phmentioning

confidence: 99%

Pulmonary hypertension in bronchopulmonary dysplasia

et al. 2020

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Bronchopulmonary dysplasia (BPD) is a major complication in prematurely born infants. Pulmonary hypertension (PH) associated with BPD (BPD-PH) is characterized by alveolar diffusion impairment, abnormal vascular remodeling, and rarefication of pulmonary vessels (vascular growth arrest), which lead to increased pulmonary vascular resistance and right heart failure. About 25% of infants with moderate to severe BPD develop BPD-PH that is associated with high morbidity and mortality. The recent evolution of broader PH-targeted pharmacotherapy in adults has opened up new treatment options for infants with BPD-PH. Sildenafil became the mainstay of contemporary BPD-PH therapy. Additional medications, such as endothelin receptor antagonists and prostacyclin analogs/mimetics, are increasingly being investigated in infants with PH. However, pediatric data from prospective or randomized controlled trials are still sparse. We discuss comprehensive diagnostic and therapeutic strategies for BPD-PH and briefly review the relevant differential diagnoses of parenchymal and interstitial developmental lung diseases. In addition, we provide a practical framework for the management of children with BPD-PH, incorporating the modified definition and classification of pediatric PH from the 2018 World Symposium on Pulmonary Hypertension, and the 2019 EPPVDN consensus recommendations on established and newly developed therapeutic strategies. Finally, current gaps of knowledge and future research directions are discussed.

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Section: Diagnosis Of Bpd and Bpd-phmentioning

confidence: 99%

Pulmonary hypertension in bronchopulmonary dysplasia

et al. 2020

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“…In a study on 26 BPD infants assessed by CATH, a change of ≥20% in PA pressures was noted in nine (35%) infants. This was associated with decreased subsequent mortality risk (Frank et al, 2019). However, unlike in our cohort, approximately half the cohort was already on pulmonary vasodilators.…”

Section: Discussionmentioning

confidence: 54%

“…However, unlike in our cohort, approximately half the cohort was already on pulmonary vasodilators. Use of ongoing pulmonary vasodilator therapy ranges from 33-46%, making true interpretation of response difficult (Frank et al, 2019;Steurer et al, 2019 Hill et al, 2010;Mourani et al, 2004). The dose of iNO used in pediatric cohorts has been variable (10-80 ppm).…”

Section: Discussionmentioning

confidence: 99%

“…Both drugs have been generally administered for a variable period (≥10 minutes); in many cases, O2 and iNO have been administered together (Frank et al, 2019;Khemani et al, 2007;Steurer et al, 2019). In spite of limitations, these findings contribute significantly to the clinical outlook and have prognostic significance (Barst, 1986;Douwes et al, 2016;Frank et al, 2019;Sitbon et al, 2005). CATH and bedside echocardiography are performed under very different physiological conditions.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective study, 13/20 (65%) BPD infants demonstrated such response (≥ 20% change in indexed PVR) (Steurer et al, 2019). From the clinical outlook perspective, a responsive circulation is associated with decreased short/ long-term morbidity, contributing to the clinical outlook (Barst, 1986;Douwes et al, 2016;Frank et al, 2019;Sitbon et al, 2005). However, cardiac CATH is an invasive procedure, oftentimes requiring the the transport of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography

et al. 2021

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Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Villamor,

van Westering-Kroon,

Gonzalez-Luis

et al. 2023

JAMA Netw Open

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ImportanceBronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies.ObjectiveTo explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies.Data SourcesPubMed and Embase were searched up to April 2023. Key search terms included BPD and PH.Study SelectionStudies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA.Main Outcomes and MeasuresThe primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0).ResultsA total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable.Conclusions and RelevanceIn this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.

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Acute Vasoreactivity Testing during Cardiac Catheterization of Neonates with Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension

Cited by 31 publications

References 27 publications

Pulmonary hypertension in bronchopulmonary dysplasia

Pulmonary hypertension in bronchopulmonary dysplasia

Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography

Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

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