Developmental outcomes of preterm infants with bronchopulmonary dysplasia-associated pulmonary hypertension at 18–24 months of corrected age

Abstract

BackgroundOwing to advances in the critical care of premature infants with bronchopulmonary dysplasia (BPD), BPD-associated pulmonary hypertension (PH) is becoming a growing concern. However, only few investigations were available on neurodevelopmental outcomes in preterm infants with PH. Therefore, this study aimed to identify the impact of PH on growth and neurodevelopment at 18–24 months of corrected age (CA).MethodsWe retrospectively analyzed the medical records of 394 infants (aged < 28 weeks of gestation) admitted to the neonatal intensive care unit between 2005 and 2014. Among the surviving infants, 123 returned for follow-up evaluations including the Bayley Scales of Infant and Toddler Development, third Edition (Bayley-III) screening tests and growth assessment at 18–24 months of CA. Among the 81 infants with moderate or severe BPD, 20 met the criteria for PH. Baseline characteristics and outcomes were compared in infants who developed BPD-associated PH (PH group, n = 20) and moderate or severe BPD infants who did not develop PH (non-PH group, n = 61).ResultsCompared to the non-PH group, the PH group showed significantly lower cognitive (85 vs. 95, p = 0.004), language (81 vs. 89, p = 0.040), and motor (88 vs. 94, p = 0.010) scores of the Bayley-III at 18–24 months of CA. Cognitive delay was found in 45.0% (9/20) of PH infants. In addition, z-scores of weight (− 1.4 ± 1.3 vs. -0.6 ± 1.1%, p = 0.011) and HC (− 1.2 ± 1.8 vs. 0.53 ± 1.0%, p = 0.035) were significantly lower in the BPD with PH group. With the subgroup analysis in infants with severe BPD only, the cognitive score was consistently lower and poorer and weight gain after discharge was identified in infants with PH and severe BPD.ConclusionPH was a worsening factor of non-optimal growth and poor neurodevelopmental outcome in preterm infants with BPD at 18–24 months of CA. Our findings suggest the importance of close developmental follow-up and recognition of that risk to help optimize the outcome of preterm infants with PH.

Bronchopulmonary Dysplasia: a Multidisciplinary Approach to Management

“…It has been associated with significant morbidity, notably increased duration of mechanical ventilation, need for tracheostomy, and prolonged hospitalization, and it carries a significant risk of mortality. Infants with severe BPD and PH are more likely to have neurodevelopmental impairment at 18-24 months compared with BPD survivors without PH [36]. In one cohort of infants with BPD-associated PH, the mortality rate was as high at 28% [37].…”

Pulmonary hypertension in bronchopulmonary dysplasia

“…About 25% of infants with moderate to severe BPD develop PH 3,4 that affects heart and lungs, greatly increasing mortality (47% of BPD infants die 2 years after diagnosis of PH). [5][6][7] Compared to BPD without PH, BPD-PH is associated with suboptimal somatic growth and neurodevelopmental outcome, 8,9 and higher rates of tracheostomy, increased use of supplemental oxygen, feeding problems, and frequent hospital admissions. 10 Young adults born preterm (very low birth weight ≤1500 g; average gestational age 28 weeks) are at increased risk for PVD, PH, and right ventricular (RV) dysfunction.…”

Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia: A Review

“…Neurodevelopmental outcomes (cognitive, language, and motor)—and quality of life for PH-BPD infants have been reported to be significantly abnormal, with delays persisting to the early toddler years. 10,58…”