Bronchopulmonary dysplasia – associated pulmonary hypertension: An updated review

Long-term impact of late pulmonary hypertension requiring medication in extremely preterm infants with severe bronchopulmonary dysplasia

“…Since echocardiography is the gold standard for diagnosing PH and a screening echocardiogram would be conducted in most units, especially in severe BPD cases 9 , 32 – 35 , the initiation of PH medication was based on the attending clinician’s decision, guided by echocardiographic results. The PH medications mainly used in our study (sildenafil, inhaled NO, and bosentan) are generally used in clinical practice 7 , 9 . Therefore, these diagnostic criteria in the present study are valuable as real-world data.…”

“…BPD-associated late pulmonary hypertension (PH) is a cardiorespiratory complication of BPD, typically evident after a corrected age (CA) of 36 weeks 7 – 9 . Late PH emerges as a significant challenge for EPIs with severe BPD owing to its strong correlation with BPD severity 10 , 11 .…”

Genetic Ablation of Pyruvate Dehydrogenase Kinase Isoform 4 Gene Enhances Recovery from Hyperoxic Lung Injury: Insights into Antioxidant and Inflammatory Mechanisms

“…PDK4 demonstrates heightened expression in both cardiac and skeletal muscle tissues. Considering the well-documented associations between cardiovascular irregularities and ailments like pulmonary hypertension, which are frequently associated with BPD [40,41], one could reasonably speculate that heightened oxygen exposure may influence blood vessel development in both pulmonary and cardiac domains. Nevertheless, it is crucial to acknowledge that the lack of histopathological scrutiny of the vascular system in our present study presents a constraint, urging further inquiry to comprehensively elucidate the underlying mechanisms.…”

Navigating Diagnostic and Treatment Challenges of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia

“…Using positive airway pressure to prevent alveolar derecruitment and ventilation–perfusion mismatch–related hypoxemia is a management tool for the BPD-PH population that cannot be overstated. Often, the timing for shifting the focus from BPD prevention strategies such as low PEEP, a higher respiratory rate, and a low inspiratory time to the management of established BPD to provide sufficient ventilatory support to facilitate growth and development is unclear and often needs a continuous assessment of the patient through a dedicated team with a multidisciplinary approach [ 9 , 61 , 68 ]. In some instances, tracheostomy may be needed to adequately meet the infant’s respiratory needs, while still allowing for adequate participation in therapies and promoting interaction and neurodevelopment of the infant at a critical stage of maturation.…”

“…The diagnosis of BPD-PH represents a negative prognostic factor for mortality in the premature population, especially within the initial two years of life [ 7 ]. This disease, which is characterized by elevated pulmonary vascular resistance resulting from increased constriction, muscular vascular thickening, reduced vascular territory, heightened pulmonary reactivity, ventilation–perfusion mismatch, and potentially adverse venous drainage and remodeling [ 9 , 10 , 11 ], represents a heterogeneous lung disorder influenced by immature repair mechanisms, pulmonary inflammation, and fibrosis. The physiological complexities are further compounded by factors like shunt physiology through persistent systemic-to-pulmonary connections such as patent ductus arteriosus (PDA), which increase pulmonary blood flow, leading to reactive constriction and exposing the pulmonary vasculature to systemic pressures.…”