Pulmonary Hypertension in Preterm Infants With Bronchopulmonary Dysplasia

Abstract

Background and ObjectivesWith the increasing survival of preterm infants, pulmonary hypertension (PH) related to bronchopulmonary dysplasia (BPD) has become an important complication. The aim of this study was to investigate the characteristics and outcome of PH in preterm infants with BPD and to identify the risk factors for PH.Subjects and MethodsWe reviewed the records of 116 preterm infants with BPD cared for at a single tertiary center between 2004 and 2008.ResultsTwenty-nine (25%) infants had PH >2 months after birth. PH occurred initially at a median age of 65 days (range, 7-232 days). Severe BPD, a birth weight <800 g, long-term ventilator care and oxygen supplementation, a high ventilator setting, infection, and a patent ductus arteriosus (PDA) were related to PH based on univariate analysis (p<0.05). The infants who had longer oxygen supplementation were significantly more likely to have PH (odds ratio, 18.5; 95% confidence interval, 4.1-84.6; p<0.001). PH was improved in 76% of infants after a median of 85 days (range, 20-765 days). Four infants (14%) died. The death of 3 infants was attributed to PH.ConclusionBPD was frequently complicated by PH. Although PH resolved in the majority of infants, PH in preterm infants with BPD can be fatal. Regular screening for PH and adequate management are required.

Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

“…1,3,4 Mortality rates in infants with BPD-PH are 4-fold greater than in infants without PH, with the majority of deaths linked directly to PH. 3,5 Supplemental oxygen is the mainstay of therapy for patients with BPD-PH.…”

“…Bronchopulmonary dysplasia (BPD) is associated with pulmonary hypertension (PH), [1][2][3] with BPD-PH occurring in 30% to 45% of infants with moderate to severe BPD. 1,3,4 Mortality rates in infants with BPD-PH are 4-fold greater than in infants without PH, with the majority of deaths linked directly to PH.…”

“…The objectives of the present study were: (1) to determine clinical characteristics associated with sildenafil exposure in infants with BPD-PH; and (2) to characterize hospitalspecific treatment frequency, age at first administration, and length of treatment.…”

The Robyn Barst Memorial Lecture: Differences between the Fetal, Newborn, and Adult Pulmonary Circulations: Relevance for Age‐Specific Therapies (2013 Grover Conference Series)

“…78 BPD is often complicated by sustained oxygen dependency, prolonged need for ventilator support, recurrent respiratory exacerbations with frequent rehospitalizations, exercise intolerance, and high risk for PAH. PAH is common in infants with BPD, with an estimated incidence of 18%-25% of preterm infants, [79][80][81] and is associated with high mortality (30%-40%), especially if sustained beyond the first months of life. [82][83][84][85] Although long-term studies of BPD have primarily focused on late abnormalities of airway function, PVD can also persist into childhood and adult life.…”

Pharmacotherapy of Pulmonary Hypertension

“…For instance, randomized studies have not demonstrated a consistent improvement in oxygenation in infants with congenital diaphragmatic hernia [28], although there appear to be benefits of stabilizing infants and preventing cardiac arrest before ECMO [29]. Up to one third of premature infants with bronchopulmonary dysplasia (BPD) will develop some degree of pulmonary hypertension or cor pulmonale [7,8], and alterations in NO signaling appear to play a role in the vascular and lung injury [30]. A recent case series indicates that iNO may reduce established BPDassociated pulmonary hypertension to a greater degree than oxygen alone [31].…”