Changes in pulmonary arterial pressure in preterm infants with chronic lung disease

Abstract

Background-Pulmonary arterial pressure (PAP) is raised in preterm infants with respiratory distress syndrome who subsequently develop chronic lung disease. The natural history of pulmonary hypertension in infants with chronic lung disease is unknown. Objectives-To investigate changes in PAP, assessed non-invasively using Doppler echocardiography, in infants with chronic lung disease during the 1st year of life. Methods-Serial examinations were performed in infants with chronic lung disease and healthy preterm infants. The Doppler derived acceleration time to right ventricular ejection time ratio (AT/RVET) was calculated from measurements made from the pulmonary artery velocity waveform. Results-A total of 248 examinations were performed in 54 infants with chronic lung disease and 44 healthy preterm infants. The median AT/RVET was significantly lower in infants with chronic lung disease than in healthy preterm infants (0.31 v 0.37). AT/RVET significantly correlated with age corrected for prematurity in both infants with chronic lung disease (r = 0.67) and healthy infants (r = 0.55). There was no significant diVerence between the rate of change in AT/RVET between the two groups. In infants with chronic lung disease, multivariate analysis showed that AT/RVET was significantly independently associated with age and inversely with duration of supplemental oxygen treatment. Median AT/RVET was significantly lower in infants with chronic lung disease until 40-52 weeks of age corrected for prematurity. Conclusions-Although PAP falls with increasing age in both infants with chronic lung disease and healthy preterm infants, it remains persistently raised in infants with chronic lung disease until the end of the 1st year of life. (Arch Dis Child Fetal Neonatal Ed 2000;82:F243-F247)

Pediatric Pulmonary Hypertension

“…Despite striking changes in the nature and epidemiology of BPD over the past decades, PH continues to contribute significantly to high morbidity and mortality in BPD and can occur early in the course of disease. 259,260 Original descriptions of BPD reported striking pulmonary hypertensive vascular remodeling in severe cases and that the presence of PH beyond 3 months of age was associated with a high mortality rate (40%). 261 In the postsurfactant era, late PH continues to be strongly linked with poor survival in the "new BPD."…”

A role for platelet-derived growth factor β-receptor in a newborn rat model of endothelin-mediated pulmonary vascular remodeling

“…Recent data from human infants with bronchopulmonary dysplasia (BPD), a chronic neonatal lung injury that affects preterm infants, have demonstrated structural remodeling of pulmonary resistance arteries as early as 2 wk after birth (30). These data provide a pathological correlate for recent echocardiographic studies demonstrating raised pulmonary arterial resistance in infants with BPD (27,28), which together indicate that pulmonary hypertension remains a common manifestation of this condition.…”

Cardiovascular Consequences of Bronchopulmonary Dysplasia in Prematurely Born Preschool Children

“…In the postsurfactant era, a limited number of studies have shown that severe pulmonary hypertension in BPD patients is related to decreased survival, and high pulmonary arterial pressures persist until the end of the first year, but not until 7-8 years of age [3,4,5]. Neither the duration nor the significance of echocardiographic changes is clear in new BPD patients, and we do not know whether there are risk factors that can be avoided to prevent cardiac sequelae in this group of patients.…”