Clinical Utility of Echocardiography for the Diagnosis and Management of Pulmonary Vascular Disease in Young Children With Chronic Lung Disease

Mourani, Peter M.; Sontag, Marci K.; Younoszai, Adel K.; Ivy, D. Dunbar; Abman, Steven H.

doi:10.1542/peds.2007-1583

Cited by 284 publications

(282 citation statements)

References 25 publications

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“…Our results suggest that serial echocardiography may be of limited utility because this modality may substantially underestimate the extent of PH and in no way can help determine PVR or pulmonary blood flow. This finding is consistent with other studies that have shown that echocardiography for assessment of PH in the pediatric population may have variable utility (18). We suggest that closer follow-up, possibly including cardiac catheterization, may be necessary in any patient who deviates from the expected clinical course.…”

Section: Pulmonary Hypertension In Cdhsupporting

confidence: 91%

Pulmonary vascular resistance in repaired congenital diaphragmatic hernia vs. age-matched controls

et al. 2012

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Section: Pulmonary Hypertension In Cdhsupporting

confidence: 91%

Pulmonary vascular resistance in repaired congenital diaphragmatic hernia vs. age-matched controls

et al. 2012

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“…10,33 Although some authors suggest that PH should be confirmed with cardiac catheterization before initiating sildenafil therapy, .95% of our cohort did not undergo catheterization, suggesting that clinicians are relying on echocardiography in the diagnosis of PH. Because of the poor correlation between standard echocardiography and cardiac catheterization, 35 clinicians are left to balance the limitations of echocardiography with the risks associated with cardiac catheterization. 36 Given the difficulties in accurately diagnosing PH and the relatively infrequent nature of BPD-PH in the pediatric population, efforts to promote regionalization of care in this unique subgroup of patients will be an important first step in better characterizing disease phenotype, natural history, and response to sildenafil administration.…”

Section: Discussionmentioning

confidence: 99%

Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Backes

Reagan

Smith

et al. 2016

Hospital Pediatrics

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OBJECTIVE: This study had 2 goals: (1) to identify clinical and demographic characteristics associated with sildenafil exposure for infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH); and (2) to characterize hospital-specific treatment frequency, age at first administration, and length of sildenafil treatment. METHODS: This retrospective cohort study used data from the Pediatric Health Information System to determine variables associated with sildenafil exposure and between-hospital variations in sildenafil utilization patterns. The study included infants with BPD-PH who were discharged between January 1, 2006, and December 31, 2013. RESULTS: Within 36 US pediatric hospitals, 3720 infants were diagnosed with BPD, of whom 598 (16%) also had a diagnosis of PH (BPD-PH). Among infants with BPD-PH, 104 infants (17%) received sildenafil. The odds for sildenafil treatment among infants born between 25 and 26 weeks’ gestational age (GA) and <24 weeks’ GA, respectively, were 2.26 (95% confidence interval [CI]: 1.20–4.24) and 3.21 (95% CI: 1.66–6.21) times those of infants born at 27 to 28 weeks’ GA. Severity of BPD correlated with sildenafil exposure, with adjusted odds ratios (ORs) for moderate BPD (OR: 3.03 [95% CI: 1.03–8.93]) and severe BPD (OR: 7.56 [95% CI: 2.50–22.88]), compared with mild BPD. Greater rates of sildenafil exposure were observed among small for GA neonates (OR: 2.32 [95% CI: 1.21–4.46]). The proportion of infants with BPD-PH exposed to sildenafil varied according to hospital (median: 15%; 25th–75th percentile: 0%–25%), as did the median duration of therapy (52 days; 25th–75th percentile: 28–109 days). CONCLUSIONS: The odds of sildenafil treatment were greatest among the most premature infants with severe forms of BPD. The frequency and duration of sildenafil exposure varied markedly according to institution. Patient-centered trials for infants with BPD-PH are needed to develop evidence-based practices.

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“…1,8 A tricuspid regurgitation jet was measured to calculate estimated right ventricular peak systolic pressure using the Bernoulli equation and then adding the assumed right atrial pressures. 11,12 When a tricuspid regurgitation jet was not visualized, then degree of septal flattening and presence of bidirectional shunting was felt to be consistent with PH. 13 Echocardiographic assessment for PH occurred routinely in infants with BPD, still requiring fractional percentage of inhaled oxygen (FiO 2 ) >0.4 or assisted ventilation by 34 weeks postmenstrual age.…”

Section: Diagnosis Of Phmentioning

confidence: 99%

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

et al. 2011

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Objective: The objective of this study is to determine the effects that sildenafil citrate has on gas exchange in infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH).Study Design: A retrospective review was performed from 2005 to 2009. Infants treated with sildenafil citrate for greater than 48 h were included. Standard patient data was collected, including echocardiogram, inspired oxygen and systemic blood pressure, before and during administration of sildenafil citrate.Result: Sildenafil citrate was used in 21 preterm infants with BPDassociated PH. A significant reduction in estimated right ventricular peak systolic pressure was seen after initiation of sildenafil citrate, with the majority of infants showing no improvement in gas exchange at 48 h of treatment. Four infants died during treatment. Conclusion:Sildenafil citrate reduced estimated pulmonary artery pressures, but this reduction was not reflected in improved gas exchange within the first 48 h.

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Clinical Utility of Echocardiography for the Diagnosis and Management of Pulmonary Vascular Disease in Young Children With Chronic Lung Disease

Cited by 284 publications

References 25 publications

Pulmonary vascular resistance in repaired congenital diaphragmatic hernia vs. age-matched controls

Pulmonary vascular resistance in repaired congenital diaphragmatic hernia vs. age-matched controls

Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

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