Right ventricular function and vasoactive peptides for early prediction of bronchopulmonary dysplasia

Abstract

Background To assess the prognostic value of early echocardiographic indices of right ventricular function and vasoactive peptides for prediction of bronchopulmonary dysplasia (BPD) or death in very preterm infants. Methods Prospective study involving 294 very preterm infants (median [IQR] gestational age 28.4 [26.4–30.4] weeks, birth weight 1065 [800–1380] g), of whom 57 developed BPD (oxygen supplementation at 36 weeks postmenstrual age) and 10 died. Tricuspid annular plane systolic excursion (TAPSE), right ventricular index of myocardial performance (RIMP), plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) and C-terminal pro-endothelin-1 (CT-proET1) were measured on day 7 of life. Results RIMP was significantly increased (median [IQR] 0.3 [0.23–0.38] vs 0.22 [0.15–0.29]), TAPSE decreased (median [IQR] 5.0 [5.0–6.0] vs 6.0 [5.4–7.0] mm), MR-proANP increased (median [IQR] 784 [540–936] vs 353 [247–625] pmol/L), and CT-proET1 increased (median [IQR] 249 [190–345] vs 199 [158–284] pmol/L) in infants who developed BPD or died, as compared to controls. All variables showed significant but weak correlations with each other (rS -0.182 to 0.359) and predicted BPD/death with similar accuracy (areas under receiver operator characteristic curves 0.62 to 0.77). Multiple regression revealed only RIMP and birth weight as independent predictors of BPD or death. Conclusions Vasoactive peptide concentrations and echocardiographic assessment employing standardized measures, notably RIMP, on day 7 of life are useful to identify preterm infants at increased risk for BPD or death.

Echocardiography parameters used in identifying right ventricle dysfunction in preterm infants with early bronchopulmonary dysplasia: A scoping review

“…All studies were conducted in tertiary perinatal centres. Only four studies examined exclusively preterm infants born before 32 weeks of gestation ( 11 , 13 – 15 ) ( Table 1 ). The study by Helfer et al, 2014, included preterm infants born at 32 weeks gestation as the recruitment was per birth weight rather than gestational age ( 16 ).…”

“…The studies' timing and frequency of echo scans varied ( Table 2 ). Three studies performed one echo scan within the first two weeks after birth ( 13 , 15 , 17 ); one study had the echo scans performed on the first day after birth (DAB) ( 17 ), and the other two studies performed the echo scans at the 7th DAB, respectively ( 13 , 15 ). The remaining five studies had several echo scans performed within the first two weeks after birth ( 11 , 14 , 16 , 18 , 19 ).…”

“…Four studies showed a delay in the normal maturation of the RV-MPI, i.e., persistently raised RV-MPI in BPD-affected preterm infants in comparison to the controls. The differences in the RV-MPI between the two groups (preterm infants with and without early BPD) were detected in the echo scans performed after the first three days after birth ( 11 , 13 – 15 ). In addition, Neumann et al, 2021, demonstrated that TAPSE is lower in BPD-affected preterm infants ( 15 ).…”

“…The differences in the RV-MPI between the two groups (preterm infants with and without early BPD) were detected in the echo scans performed after the first three days after birth ( 11 , 13 – 15 ). In addition, Neumann et al, 2021, demonstrated that TAPSE is lower in BPD-affected preterm infants ( 15 ).…”

Macitentan attenuates cardiovascular remodelling in infant rats with chronic lung disease

“…Moreover, BPD-PH is associated with prolonged time on the respirator, longer oxygen dependency, higher tracheostomy rates, and higher frequency of readmissions to the intensive care setting compared to BPD alone [ 14 ]. Recently, it has been shown that echocardiographic right ventricular performance markers significantly worsen already on the 7th day of life (DOL) in very preterm infants who will later be diagnosed with BPD [ 15 ].…”