Natural History of Postnatal Cardiopulmonary Adaptation in Infants Born Extremely Preterm and Risk for Death or Bronchopulmonary Dysplasia

Still puzzling about a clear definition of pulmonary arterial hypertension in newborns

“…This article is focused on describing the state of the art and future perspectives in paediatric PAH, as formulated by the recent Paediatric Task Force of the 6th World Symposium on Pulmonary Hypertension. They are quite similar to the report of the 5th World Symposium (Nice 2013), in which the unique features of paediatric PAH were highlighted for the first time, but decidedly different from the classification proposed by the Pulmonary Vascular Research Institute Taskforce (Panama 2011) [2,3].…”

“…Normal perinatal transition has been previously defined with regard to echocardiogram-derived pulmonary artery pressure over time in the first days of life. Recently, a study of serial changes in estimated levels of pulmonary hypertension describes several different patterns of the transition in preterm infants, demonstrating striking changes in delayed pulmonary vascular transition being associated with degree of prematurity [2]. Of note, those preterm infants with delayed pulmonary vascular transition had the highest risk for late deaths and the subsequent development of bronchopulmonary dysplasia.…”

Just Say No to iNO in Preterms—Really?

“…In infants born extremely preterm, however, delayed vascular transition with persistent elevation of PVR is more common than in subjects born at term, especially in the setting of HRF. 7 Infants born preterm with evidence of sustained PH at 7-14 days of postnatal age were more likely to have greater mortality, to have a prolonged need for mechanical ventilation and NICU admission, or to subsequently develop the diagnosis of BPD or BPD with late PH at 36 weeks of PMA. 18,19 Kinsella et al evaluated the ontogeny of the pulmonary vascular response to iNO and oxygen in lambs.…”

“…Clinical data have shown that PPHN occurs and can contribute to hypoxemia in a subgroup of infants born preterm with severe HRF, especially in the setting of oligohydramnios and preterm prolonged rupture of membranes (preterm, prelabor rupture of membranes [PPROM]s). 6,7 Multiple clinical series have shown acute improvements in oxygenation in this subgroup of infants born preterm with HRF and proven pulmonary hypertension (PH), [8][9][10][11][12] but randomized controlled trial (RCT) data are lacking. 9 Unfortunately, clinical evidence supporting the use of alternative drug therapies for severe PPHN management in infants born preterm is extremely limited, especially in comparison with the number of published clinical observations and experience with the use of iNO therapy in the NICU setting.…”

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

“…Left ventricular failure leads to an increase in pressure and volume in the left atrium of the heart and pulmonary veins. Secondary right ventricular failure develops and when the hydrostatic pressure exceeds the colloid osmotic pressure in the blood, fluid enters the pulmonary parenchyma, which results in pulmonary oedema and lung stretch, and susceptibility are reduced [5,39,40]. In order to prevent iatrogenic overhydration in premature newborns, it is currently recommended to supply liquids in a volume of 60-80 ml/kg b.w./day on the first day of life of the newborn, which should be increased by about 20 ml/kg b.w./day up to a maximum value of 150 ml/kg b.w./day [41].…”