Mortality in infants with bronchopulmonary dysplasia: Data from cardiac catheterization

Abstract

Rationale Pulmonary hypertension (PH) is relatively common in infants with severe bronchopulmonary dysplasia (BPD), however, hemodynamic data and factors associated with mortality in this patient group are sparsely described in the literature. Objectives To characterize the hemodynamics of former preterm infants with BPD and PH, as measured at cardiac catheterization, and to identify respiratory and cardiovascular predictors of mortality. Methods Single‐center, retrospective cohort study, including, 30 patients born at less than 32‐week gestational age (GA), who had an oxygen requirement at 36 weeks postmenstrual age and underwent cardiac catheterization between July 2014 and December 2017. Results Median GA at birth was 25 5/7 weeks (interquartile range [IQR], 24 4/7‐26 6/7 weeks). Median birth weight was 620 g (IQR, 530‐700 g). With a median of 23 months of follow up (IQR, 11‐39 months), mortality as of July 2018 was 27% (8 of 30). The alveolar‐arterial oxygen gradient as a measure of lung disease did not correlate with mortality (log‐rank test P = 0.28). However, indexed pulmonary vascular resistance (PVR) of greater than 3 Woods units × m 2 showed a trend toward increased mortality (log‐rank test P = 0.12). Pulmonary vein stenosis was the only predictor significantly associated with mortality (log‐rank test P = 0.005). Conclusions In this cohort, the severity of lung disease as assessed by impaired oxygenation at cardiac catheterization did not correlate with mortality. The only factor significantly associated with mortality was the presence of pulmonary vein stenosis on cardiac catheterization, although PVR may also be an important factor.

Pulmonary hypertension in bronchopulmonary dysplasia

“…1). 13 Additional indications include concern for vascular abnormalities (e.g., pulmonary vein stenosis), 33 other features of an atypical response to therapy, and/or failure to thrive. 34 A systematic cardiac catheterization protocol for pediatric PH is available.…”

“…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. 12 Brain natriuretic peptide (BNP) and its N-terminal cleavage product (NT-proBNP) are secreted by cardiomyocytes in response to ventricular wall stress due to pressure overload and/or volume expansion.…”

Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography

“…The dose of iNO used in pediatric cohorts has been variable (10-80 ppm). 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).…”

“…A decline in pulmonary artery (PA) pressure and pulmonary vascular resistance (PVR) indicates a reactive component to PH (Khemani et al, 2007). 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).…”

Pathophysiological mechanisms and pharmacological methods of prevention and treatment of bronchopulmonary dysplasia in preterm infants

“…Despite the significant development of neonatology and constantly developing methods of BPD prophylaxis, its mortality is estimated at about 10% -20% in the first year of life. The risk of death increases in direct proportion to the duration of oxygen therapy and the advancement of ventilation methods and parameters [5,109,110].…”