Evaluation and Management of Pulmonary Hypertension in Children with Bronchopulmonary Dysplasia

Krishnan, Usha; Feinstein, Jeffrey A.; Adatia, Ian; Austin, Eric D.; Mullen, Mary P.; Hopper, Rachel K.; Hanna, Brian D.; Romer, Lew; Keller, Roberta L.; Fineman, Jeffrey R.; Steinhorn, Robin H.; Kinsella, John P.; Ivy, D. Dunbar; Rosenzweig, Erika B.; Raj, Usha; Humpl, Tilman; Abman, Steven H.

doi:10.1016/j.jpeds.2017.05.029

Cited by 197 publications

(227 citation statements)

References 74 publications

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“…BPD is diagnosed in roughly 40% of infants born ≤28 weeks gestational age, which results in 10 000‐15 000 new cases in the USA each year . While knowledge of the pathophysiology and pathobiology of BPD continues to evolve, BPD is defined as a chronic lung disease in preterm infants born ≤32 weeks’ gestation who require ongoing oxygen therapy at 36 weeks’ postconceptual age . The pathophysiology is characterized by a uniform arrest of lung development and dysmorphic pulmonary capillaries .…”

Section: Neonatal Phmentioning

confidence: 99%

“…The pathophysiology is characterized by a uniform arrest of lung development and dysmorphic pulmonary capillaries . Postnatal factors may further injure the already fragile pulmonary system, such as oxygen toxicity, volutrauma, infection, and pulmonary overcirculation …”

Section: Neonatal Phmentioning

confidence: 99%

“…However, this number may significantly underestimate the true incidence due to lack of diagnostic codes for BPD‐PH and high early mortality rates. The presence of pulmonary veins stenosis is increasingly recognized as a lethal contributing factor . Therefore, echocardiography is recommended in preterm infants with sustained need of respiratory support, which also means that a diagnosis of PH in this cohort may be delayed until fulfilling screening criteria at an older age .…”

Section: Neonatal Phmentioning

confidence: 99%

“…The genesis of elevated PVR in BPD‐PH is a combination of “fixed” PVR due to arrested lung growth, as well as “reactive” PVR due to pulmonary vascular remodeling, which is amenable to acute vasodilator therapy . The cornerstone of treatment is ensuring adequate ventilation and treating the underlying causes of hypoxia and lung disease . BPD‐PH has a mortality rate of 10%‐70%, depending on inclusion criteria and length of followup .…”

Section: Neonatal Phmentioning

confidence: 99%

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Current understanding and perioperative management of pediatric pulmonary hypertension

Latham

Yung

2018

Pediatric Anesthesia

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Summary Pediatric pulmonary hypertension is a complex disease with multiple, diverse etiologies affecting the premature neonate to the young adult. Pediatric pulmonary arterial hypertension, whether idiopathic or associated with congenital heart disease, is the most commonly discussed form of pediatric pulmonary hypertension, as it is progressive and lethal. However, neonatal forms of pulmonary hypertension are vastly more frequent, and while most cases are transient, the risk of morbidity and mortality in this group deserves recognition. Pulmonary hypertension due to left heart disease is another subset increasingly recognized as an important cause of pediatric pulmonary hypertension. One aspect of pediatric pulmonary hypertension is very clear: anesthetizing the child with pulmonary hypertension is associated with a significantly heightened risk of morbidity and mortality. It is therefore imperative that anesthesiologists who care for children with pulmonary hypertension have a firm understanding of the pathophysiology of the various forms of pediatric pulmonary hypertension, the impact of anesthesia and sedation in the setting of pulmonary hypertension, and anesthesiologists’ role as perioperative experts from preoperative planning to postoperative disposition. This review summarizes the current understanding of pediatric pulmonary hypertension physiology, preoperative risk stratification, anesthetic risk, and intraoperative considerations relevant to the underlying pathophysiology of various forms of pediatric pulmonary hypertension.

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Section: Neonatal Phmentioning

confidence: 99%

Section: Neonatal Phmentioning

confidence: 99%

Section: Neonatal Phmentioning

confidence: 99%

Section: Neonatal Phmentioning

confidence: 99%

See 2 more Smart Citations

Current understanding and perioperative management of pediatric pulmonary hypertension

Latham

Yung

2018

Pediatric Anesthesia

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“…Ongoing studies are exploring the impact of PH-specific drug therapies, such as sildenafil and other agents, on PH and related complications. Most importantly, the primary approach to PH therapies in BPD is rigorous evaluation and management of the underlying lung disease [16] . Recent studies have revealed the magnitude of PH in preterm infants, but many aspects of PVD remain understudied, and ongoing investigations continue to explore risk factors, mechanisms of disease, and long-term outcomes.…”

Section: Sh Abmanmentioning

confidence: 99%

Extended Abstracts: VIIIth Recent Advances in Neonatal Medicine. An International Symposium Honoring Prof. Bo Sun. Würzburg, October 8-10, 2017

2017

Neonatology

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Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Villamor,

van Westering-Kroon,

Gonzalez-Luis

et al. 2023

JAMA Netw Open

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ImportanceBronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies.ObjectiveTo explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies.Data SourcesPubMed and Embase were searched up to April 2023. Key search terms included BPD and PH.Study SelectionStudies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA.Main Outcomes and MeasuresThe primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0).ResultsA total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable.Conclusions and RelevanceIn this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.

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Evaluation and Management of Pulmonary Hypertension in Children with Bronchopulmonary Dysplasia

Cited by 197 publications

References 74 publications

Current understanding and perioperative management of pediatric pulmonary hypertension

Current understanding and perioperative management of pediatric pulmonary hypertension

Extended Abstracts: VIIIth Recent Advances in Neonatal Medicine. An International Symposium Honoring Prof. Bo Sun. Würzburg, October 8-10, 2017

Patent Ductus Arteriosus and Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

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