Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

Baker, Christopher D.; Abman, Steven H.; Mourani, Peter M.

doi:10.1089/ped.2013.0323

Cited by 112 publications

(102 citation statements)

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“…Preterm birth may disrupt normal lung development, resulting in a deficit in pulmonary circulation, decreased surface area for gas exchange, increased vasoreactivity and hypoxic vasoconstriction, which lead to increased pulmonary vascular resistance [20,21]. Persistent PH of the newborn (PPHN) can be associated with a number of neonatal cardiopulmonary diseases, including perinatal asphyxia, sepsis, or meconium aspiration syndrome, or it can be idiopathic.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Suzuki

Togari

Potenziano

et al. 2018

Journal of Perinatal Medicine

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Objective: To analyze data from a registry of Japanese neonates with hypoxic respiratory failure associated with pulmonary hypertension (PH) to compare the effectiveness of inhaled nitric oxide (iNO) in neonates born <34 weeks vs. ≥34 weeks gestational age (GA). Materials and methods: iNO was administered according to approved Japanese product labeling. Study data were collected before iNO administration and at predefined intervals until discontinuation. Results: A total of 1,114 neonates were included (n = 431, <34 weeks GA; n = 675, ≥34 weeks GA; n = 8, missing age data). Mean decrease from baseline oxygenation index (OI) was similar in both age groups. OI reduction was more pronounced in the <34 weeks subgroups with baseline OI ≥25. Survival rates were similar in the <34 weeks GA and ≥34 weeks GA groups stratified by baseline OI (OI < 15, 89% vs. 93%; 15 ≤ OI < 25, 85% vs. 91%; 25 ≤ OI ≤ 40, 73% vs. 79%; OI > 40, 64% vs. 66%). Conclusion: iNO improved oxygenation in preterm neonates as effectively as in late preterm and term neonates, without negative impact on survival. If clinically significant PH is present, as measured by pulse oximetry or echocardiography, a therapeutic trial of iNO might be indicated for preterm neonates.

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Section: Discussionmentioning

confidence: 99%

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Suzuki

Togari

Potenziano

et al. 2018

Journal of Perinatal Medicine

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“…Several recent reviews [56][57][58][59] note that the incidence of pulmonary hypertension among ELBW infants ranges between 17% and 43% and mortality between 14% and 38%. Of importance, only 25% of those with severe BPD and pulmonary hypertension survive to 2 to 3 years of age.…”

Section: -44mentioning

confidence: 99%

Outcomes for Extremely Premature Infants

Glass

Costarino

Stayer

et al. 2015

Survey of Anesthesiology

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E ReView ARticle duration in weeks, measured from the first day of the last menstrual period and, by convention, gestation is recorded as completed weeks and never rounded up. For example, an infant who is born at 32 weeks and 4 days is defined as being 32 weeks. The definition of the "estimated date of confinement" (EDC), also known as the due date, is 40 weeks added to the first day of the last menstrual period and estimates the day when the infant will be born.5 "Postmenstrual age" (PMA) is the time elapsed between the first day of the last menstrual period and the current day, 5 and PMA also can be calculated as the gestational age plus the time elapsed after birth (chronologic age). PMA is used clinically during the perinatal period beginning after the day of birth. "Postconceptual age" is not synonymous with PMA.5 "Corrected age," also called the adjusted age, describes children up to 3 years of age who were born preterm. "Corrected age" represents the age of the child since the EDC. "Term" birth is classically defined as 37 to 42 weeks. Recently, a National Institute of Child Health and Human Development (NICHD)-led group proposed subgrouping births between 37 and 39 weeks' gestation as "early term."6 "Preterm birth" is defined as any birth prior to 37 weeks' completed gestation or fewer than 259 days since the first day of the mother's last menstrual period. 2,3,5,6 Preterm birth often is subdivided further based on birth gestational age. "Late preterm" infants are those born 34 to less than 37 weeks' gestation, "moderate preterm" is designated as 32 to less than 34 weeks' gestation, "very preterm" is designated 28 to less than 32 weeks' gestation, and "extremely preterm," which is the primary focus of this discussion, is less than 28 weeks' gestational age 2,3,5,6 (Table 1). Other useful definitions include "small for gestational age" (SGA), defined as weight less than 10th percentile at a given fetal gestational age. "Large for gestational age" (LGA) is defined as weight greater than the 90th percentile for duration of gestation. Infants greater than 4500 g at term birth are LGA. 7 The terms SGA and LGA age do not distinguish among the various ideologies of these conditions. Low birth weight infants can be further classified into very low birth weight, which includes infants less than 1500 g, and extremely low birth weight infants (ELBW), which comprise infants less than 1000 g.A "live birth" is defined as the complete expulsion or extraction of the product of human conception regardless of the duration of pregnancy, and after such expulsion, the infant breathes or shows other evidence of life such as a beating heart, pulsation of the umbilical cord, or definitive movement of voluntary muscles. "Live birth" does not designate whether the umbilical cord has been cut or the placenta remains attached. Heartbeats need to be distinguished from transient cardiac contractions. Respirations need to be distinguished from fleeting respiratory efforts or gasps. "Fetal death" is death of the product of human conce...

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“…Survivors of premature birth are at risk for developing pulmonary arterial hypertension, recurrent wheeze and asthma, and chronic obstructive pulmonary disease (COPD) at relatively young ages (3,6,17,21,34). The underlying pathology has a multifactorial etiology, and the NO-soluble guanylate cyclase (sGC)-cGMP pathway is involved in many factors that contribute to it.…”

Section: ϩmentioning

confidence: 99%

“…Airway hyperresponsiveness and asthma are serious complicating factors in survivors of premature birth (3,6,17,21). Smooth muscle cells play an important role in asthma by regulating airway tone and play an important role in remodeling, a process that is triggered by oxidative stress.…”

Section: Impact Of Neonatal Lung Disease and Oxygen Treatment On Asthmentioning

confidence: 99%

Therapeutic potential of soluble guanylate cyclase modulators in neonatal chronic lung disease

Wagenaar

Hiemstra

Gosens

2015

American Journal of Physiology-Lung Cellular and Molecular Phys

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Wagenaar GT, Hiemstra PS, Gosens R. Therapeutic potential of soluble guanylate cyclase modulators in neonatal chronic lung disease. Am J Physiol Lung Cell Mol Physiol 309: L1037-L1040, 2015. First published October 2, 2015; doi:10.1152/ajplung.00333.2015.-Supplemental oxygen after premature birth results in aberrant airway, alveolar, and pulmonary vascular development with an increased risk for bronchopulmonary dysplasia, and development of wheeze and asthma, pulmonary hypertension, and chronic obstructive pulmonary disease in survivors. Although stimulation of the nitric oxide (NO)-soluble guanylate cyclase (sGC)-cGMP signal transduction pathway has significant beneficial effects on disease development in animal models, so far this could not be translated to the clinic. Oxidative stress reduces the NO-sGC-cGMP pathway by oxidizing heme-bound sGC, resulting in inactivation or degradation of sGC. Reduced sGC activity and/or expression is associated with pathology due to premature birth, oxidative stress-induced lung injury, including impaired alveolar maturation, smooth muscle cell (SMC) proliferation and contraction, impaired airway relaxation and vasodilation, inflammation, pulmonary hypertension, right ventricular hypertrophy, and an aggravated response toward hyperoxia-induced neonatal lung injury. Recently, Britt et al. (10) demonstrated that histamine-induced Ca 2ϩ responses were significantly elevated in hyperoxia-exposed fetal human airway SMCs compared with normoxic controls and that this hyperoxia-induced increase in the response was strongly reduced by NO-independent stimulation and activation of sGC. These recent studies highlight the therapeutic potential of sGC modulators in the treatment of preterm infants for respiratory distress with supplemental oxygen. Such treatment is aimed at improving aberrant alveolar and vascular development of the neonatal lung and preventing the development of wheezing and asthma in survivors of premature birth. In addition, these studies highlight the suitability of fetal human airway SMCs as a translational model for pathological airway changes in the neonate.airway remodeling, calcium response; fetal human airway smooth muscle cells; hyperoxia; oxidative stress; nitric oxide; soluble guanylate cyclase; guanosine 3=, 5=-cyclic monophosphate TREATMENT OF RESPIRATORY DISTRESS after premature birth with supplemental oxygen may interfere with the development of the immature lung, resulting in aberrant airway, alveolar, and vascular development. Survivors of premature birth are at risk for developing pulmonary arterial hypertension, recurrent wheeze and asthma, and chronic obstructive pulmonary disease (COPD) at relatively young ages (3,6,17,21,34). The underlying pathology has a multifactorial etiology, and the NO-soluble guanylate cyclase (sGC)-cGMP pathway is involved in many factors that contribute to it. Nitric oxide (NO) is a key signaling molecule in many biological and physiological processes, regulating cell growth, differentiation, proliferation, smooth muscle r...

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Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

Cited by 112 publications

References 125 publications

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

Outcomes for Extremely Premature Infants

Therapeutic potential of soluble guanylate cyclase modulators in neonatal chronic lung disease

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