Clinical Significance of Early Pulmonary Hypertension in Preterm Infants

Arjaans, Sanne; Fries, M; Schoots, Mirthe H.; Schilte, Carine F.M.; Roofthooft, Marcus T. R.; Vrijlandt, Elianne J.L.E.; Bos, Arie; Kooi, Elisabeth M. W.; Berger, Rolf M. F.

doi:10.1016/j.jpeds.2022.07.039

Cited by 27 publications

(10 citation statements)

References 42 publications

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“…38 The common causes of PPHN in very preterm neonates in this study were pneumonia and moderate or severe RDS. In a study from the Netherlands, multivariable logistic regression found that PPHN was associated with death, 37 which is similar to the findings in our study.…”

Section: Discussionsupporting

confidence: 91%

“…The first cranial ultrasound was performed within 3-5 days of birth for neonates with GA less than 26 weeks and 7-14 days of birth in neonates with GA of 26-32 weeks by a pediatric radiologist. The second cranial ultrasound was performed at GA 4-6 weeks of life or at [37][38][39][40][41][42] weeks in regards to postmenstrual age. Targeted neonatal echocardiography was performed by a neonatal fellow and/or pediatric cardiologist when a neonate was suspected to have patent ductus arteriosus (PDA) or PPHN.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…35 In another study from Japan, extremely preterm neonates with post-acute inhaled nitric oxide utilization, were 1.9% in 2016, and were associated with lower GA, SGA, histological-chorioamnionitis, 5-minute Apgar score less than 4, air leak, and bubbly/cystic appearance on chest X-ray. 36 A study from the Netherlands reported that the PPHN rate in neonates with GA less than 30 weeks and/or extremely low birth weight infants was 11.5% (12/104), 37 while no PPHN cases were reported in a study on Turkish very preterm neonates. 38 The common causes of PPHN in very preterm neonates in this study were pneumonia and moderate or severe RDS.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Risk Factors for Mortality or Major Morbidities of Very Preterm Infants: A Study from Thailand

et al. 2023

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Objective Very preterm neonates have high rates of composite outcomes featuring mortality and major morbidities. If the modifiable risk factors could be identified, perhaps the rates could be decreased especially in resource-limited settings. Study Design We performed a prospective study in a Thai neonatal intensive care unit to identify the risk factors of composite outcomes between 2014 and 2021. The inclusion criterion was neonates who were born in our hospital at a gestational age (GA) of less than 32 weeks. The exclusion criteria were neonates who died in the delivery room or had major congenital anomalies. The composite outcomes were analyzed by multivariable logistic regression with adjusted odds ratios (aOR) and a 95% confidence interval (CI). Results Over the 8-year study period, 555 very preterm inborn neonates without major birth defects were delivered. The composite outcomes were 29.4% (163/555). The medians (interquartile ranges) of GA and birthweights of the neonates were 29 (27, 31) weeks and 1180 (860, 1475) grams, respectively. By multivariable analysis, GA (aOR 0.65; 95% CI 0.55–0.77), small for GA (aOR 4.93; 95% CI 1.79–13.58), multifetal gestation (aOR 2.23; 95% CI 1.12–4.46), intubation within 24 h (aOR 5.39; 95% CI 1.35–21.64), and severe respiratory distress syndrome (aOR 5.00; 95% CI 1.05–23.89) were significantly associated with composite outcomes. Conclusion Very preterm infants who had a lower GA, were small for GA, twins or more, respiratory failure on the first day of life, and severe respiratory distress syndrome were associated with mortality and/or major morbidities.

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Section: Discussionsupporting

confidence: 91%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

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Risk Factors for Mortality or Major Morbidities of Very Preterm Infants: A Study from Thailand

et al. 2023

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“…Pulmonary vascular injury presents as hemodynamic, functional, and structural abnormalities. Several studies have aimed to de ne the phenotypes of PVD [8,11,23]. In the present study, the overall incidence of PH treatment was 43% and most infants were treated in extremely early period (57.3%), followed by early period (31.3%) and late period (11.4%).…”

Section: Discussionmentioning

confidence: 60%

“…Infants with compromised pulmonary vascular function often require intensive respiratory support, including mechanical ventilation and pharmacological interventions, to optimize oxygenation and pulmonary blood ow [9,10]. Moreover, long-term sequelae such as pulmonary hypertension (PH) and chronic respiratory insu ciency may ensue, further impacting the infant's health and development [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Clinical Phenotype of Pulmonary Vascular Disease Requiring Treatment in Extremely Preterm Infants

Hong,

Shin,

Kim

et al. 2024

Preprint

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Background Pulmonary vascular disease (PVD) and pulmonary hypertension (PH) is a significant disorder affecting prognosis of extremely preterm infants. However, there is still a lack of a consensus on the definition and optimal treatments of PH, and there is also a lack of research comparing these conditions with persistent pulmonary hypertension of newborn (PPHN), early PH, and late PH. To investigate pulmonary hypertension (PH) in extremely preterm infants, this study compared the basal characteristics, short-term outcomes, and treatment duration, categorized by the timing of requiring PH treatment. Methods This study retrospectively analyzed extremely preterm infants admitted to a single tertiary center. Between 2018 and 2022, infants with clinical symptoms or echocardiographic evidence of PH who required treatment were divided into three groups based on the timing of treatment initiation: from birth to day 2 (extremely early-period), from day 3 to day 27 (early-period), and after day 28 (late-period). The study compared the outcomes, including mortality rates, bronchopulmonary dysplasia (BPD) severity, PH treatment duration, and oxygen therapy duration, among the three groups. Results Among the 157 infants, 67 (42.7%) were treated for PH during their stay. Of these, 39 (57.3%) were treatment in extremely early, 21 (31.3%) in early, and seven (11.4%) in late periods. No significant differences were observed in maternal factors, neonatal factors, or morbidity between the three groups. However, infants who received extremely early-period treatment had a higher mortality rate, but shorter duration of noninvasive respiratory support, oxygen therapy, and PH medication use. On the other hand, the late-period treatment group received longer durations of respiratory support and treatment. Conclusions This study revealed differences in mortality rates, respiratory outcomes, and treatment duration between the three groups, suggesting varying pathophysiologies over time in extremely preterm infants.

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