Echocardiography evaluation of bronchopulmonary dysplasia-associated pulmonary hypertension: a retrospective observational cohort study

Abstract

Background: Echocardiography has poor accuracy in grading the severity of pulmonary hypertension (PH) compared to cardiac catheterization. However, the relationship between degree of PH and prognostic outcomes remains uncertain. Our primary objective was to determine whether echocardiogram-assessed PH severity is associated with mortality and hospital readmission in the first year of life.Methods: A retrospective cohort study of infants born less than 32 weeks of gestational age with bronchopulmonary dysplasia (BPD) underwent echocardiography was performed. Echocardiograms were performed at 36-38 weeks postmenstrual age. Data during hospitalization and post-discharge collected at 1-year age were analyzed with cox regression models and logistic regression models to identify the association of PH severity with mortality and readmission. Area under curve (AUC) was calculated to examine the accuracy of these models to reflect the likelihood of outcomes.Results: Fifty-six of 237 (23.6%) infants were diagnosed as PH. Moderate and severe PH was significantly associated with mortality during the first one year of life (moderate PH vs. none HR =26.58, 95% CI: 4.40-160.78, P<0.001; severe PH vs. none HR =36.49, 95% CI: 5.65-235.84, P<0.001). Male, preeclampsia and inhaled nitric oxide were also associated with mortality. Mild PH was significantly associated with readmission (OR =2.42, 95% CI: 1.12-5.26, P=0.025), but not associated with mortality (HR =2.09, 95% CI: 0.43-10.18, P=0.36). The PH severity model based on echocardiography accurately informed mortality (AUC 0.79).Conclusions: Echocardiogram-assessed PH severity is associated with prognostic outcomes, including mortality and readmission in very preterm infants with BPD. The severity of PH based on echocardiography is a potential predictor of mortality in the first year of life.

Pulmonary hypertension with bronchopulmonary dysplasia: Aichi cohort study

“…Du et al reported that the number of patients with mild PH was threefold higher than the number of patients with moderate to severe PH in their study. 12 They also noted that patients with moderate to severe PH accounted for an estimated 5.9% of all patients, similar to the present results.…”

“…In addition, pulmonary hypertension (PH) associated with BPD is considered important, because more severe preterm newborns have been saved by the recent advanced intensive neonatal management 7–9 . There have been some studies about PH associated with BPD, but they were based on patient data from a single or small number of institutions 4,10–15 . To determine the actual incidence of PH associated with BPD in VLBWIs, a cohort survey is needed.…”

“…[7][8][9] There have been some studies about PH associated with BPD, but they were based on patient data from a single or small number of institutions. 4,[10][11][12][13][14][15] To determine the actual incidence of PH associated with BPD in VLBWIs, a cohort survey is needed.…”

Multi-dose enteral L-citrulline administration in premature infants at risk of developing pulmonary hypertension associated with bronchopulmonary dysplasia

“…It has been estimated that between 8-42% of infants with BPD have evidence of PH 1,2,3,4,6 . Mortality rates for infants with BPD-PH have been reported to be as high as 47% 3,4,6,7,8 . In addition, there is a growing appreciation that the individual and societal costs associated with BPD-PH are substantial 9,10 .…”

“…Premature infants with chronic lung disease of prematurity, bronchopulmonary dysplasia (BPD), are at risk of developing pulmonary hypertension (PH) 1,2,3,4,5,6 . It has been estimated that between 8-42% of infants with BPD have evidence of PH 1,2,3,4,6 . Mortality rates for infants with BPD-PH have been reported to be as high as 47% 3,4,6,7,8 .…”