The biventricular contribution to chronic pulmonary hypertension of the extremely premature infant

Nunes, Gabriela de Carvalho; Simoneau, Jessica; Dancea, Adrian; Beltempo, Marc; Renaud, Claudia; Altit, Gabriel

doi:10.1038/s41372-022-01497-0

Cited by 2 publications

(7 citation statements)

References 37 publications

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“…20 21 This definition has been previously described by our group. 22 Infants without an echocardiography were considered to be free of PH. Severe PH was defined as estimated sPAP ≥2/3 of systemic systolic blood pressure obtained at the time of echocardiography.…”

Section: Methodsmentioning

confidence: 99%

“…We based our definition of PH on previous studies outlined in publications by our group. 22,26 Although echocardiography is widely used for the identification of infants with signs of PH, it has numerous limitations and infants in our cohort did not undergo confirmatory invasive studies and future studies should evaluate if these infants require further diagnostic evaluations. Furthermore, we were not able to correlate the pathophysiology seen on echocardiography to the infant's other clinical manifestation (such as respiratory distress, tachypnea, intolerance to feeds, and/or diaphoresis).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Duration of diazoxide therapy until hypoglycemia resolution was longer in those with the adverse outcomes, but the total duration of diazoxide treatment was similar between outcome groups. Infants with PH or suspected/confirmed NEC had a longer length of hospitalization and greater postmenstrual age at discharge (►Table 2), with the overall population spending a median of 16 days in hospital [IQR: [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]]. The subgroup with NEC or suspected NEC (►Supplementary Table S1, available in the online version) required a longer duration of IV fluids (30 vs. a By using the Fenton growth chart.…”

Section: Resource Utilizationmentioning

confidence: 99%

“…5 days, p < 0.0001) and had a longer hospital stay (15 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs. 48 days, p < 0.0001).…”

Section: Resource Utilizationmentioning

confidence: 99%

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Pulmonary Hypertension and Necrotizing Enterocolitis in Neonates Treated with Diazoxide

et al. 2023

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Objective This study aimed to evaluate the prevalence of adverse outcomes, specifically pulmonary hypertension (PH) and suspected or confirmed necrotizing enterocolitis (NEC), and their associated risk factors, in neonates treated with diazoxide. Study Design A retrospective study in infants born ≥ 316/7 weeks and admitted between January 2014 and June 2020. Combined adverse outcomes possibly associated to diazoxide were PH (systolic pulmonary pressure of ≥40 mm Hg or an eccentricity index ≥1.3) and suspected or confirmed NEC (suspected: stop feeds and antibiotics and confirmed: modified Bell stage ≥2). Echocardiography data extractors were masked to infants' characteristics. Results A total of 63 infants were included; 7 (11%) with suspected and 1 (2%) with confirmed NEC. Of the 36 infants with an available echocardiography after initiation of diazoxide treatment, 12 (33%) had PH. All infants with suspected or confirmed NEC were males (p = 0.01), whereas PH occurred mostly in females (75%, p = 0.02). The combined adverse outcome occurred in 14/26 (54%) infants exposed to >10 mg/kg/day, compared to 6/37 (16%) exposed to ≤10 mg/kg/day (p = 0.006). This association remained significant after adjustment for sex, small for gestational age status, and gestational age at birth (odds ratio: 6.1, 95% confidence interval: 1.7–21.7, p = 0.005). Left ventricular dysfunction was found in 19 infants (30%) but was not discriminative for the combined outcome. Conclusion PH and suspected or confirmed NEC were identified frequently in neonates treated with diazoxide. A total dose >10 mg/kg/day was associated with an increased occurrence of these complications. Key Points

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Section: Methodsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Resource Utilizationmentioning

confidence: 99%

“…5 days, p < 0.0001) and had a longer hospital stay (15 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs. 48 days, p < 0.0001).…”

Section: Resource Utilizationmentioning

confidence: 99%

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Pulmonary Hypertension and Necrotizing Enterocolitis in Neonates Treated with Diazoxide

et al. 2023

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“…Additionally, observational data suggest that diuretic therapy may be associated with improvement in pulmonary pressures and right and left ventricular function in BPD-PH infants [ 67 ]. Future studies should also evaluate the contribution of altered LV diastolic performance and increased systemic vascular tone as potential contributors to the BPD-PH phenotype [ 33 , 87 ]. Indeed, new therapeutic avenues to be studied may involve LV afterload reduction in such circumstances.…”

Section: Challenge #2: Multitiered Management Of Bpd-phmentioning

confidence: 99%

Navigating Diagnostic and Treatment Challenges of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia

Varghese,

Altit,

Gubichuk

et al. 2024

JCM

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Advances in perinatal intensive care have significantly enhanced the survival rates of extremely low gestation-al-age neonates but with continued high rates of bronchopulmonary dysplasia (BPD). Nevertheless, as the survival of these infants improves, there is a growing awareness of associated abnormalities in pulmonary vascular development and hemodynamics within the pulmonary circulation. Premature infants, now born as early as 22 weeks, face heightened risks of adverse development in both pulmonary arterial and venous systems. This risk is compounded by parenchymal and airway abnormalities, as well as factors such as inflammation, fibrosis, and adverse growth trajectory. The presence of pulmonary hypertension in bronchopulmonary dysplasia (BPD-PH) has been linked to an increased mortality and substantial morbidities, including a greater susceptibility to later neurodevelopmental challenges. BPD-PH is now recognized to be a spectrum of disease, with a multifactorial pathophysiology. This review discusses the challenges associated with the identification and management of BPD-PH, both of which are important in minimizing further disease progression and improving cardiopulmonary morbidity in the BPD infant.

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The biventricular contribution to chronic pulmonary hypertension of the extremely premature infant

Cited by 2 publications

References 37 publications

Pulmonary Hypertension and Necrotizing Enterocolitis in Neonates Treated with Diazoxide

Pulmonary Hypertension and Necrotizing Enterocolitis in Neonates Treated with Diazoxide

Navigating Diagnostic and Treatment Challenges of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia

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