Evidence of Early Pulmonary Hypertension Is Associated with Increased Mortality in Very Low Birth Weight Infants

Berenz, Andrew; Vergales, Jeffrey; Swanson, Jonathan R.; Sinkin, Robert A.

doi:10.1055/s-0037-1598246

Cited by 36 publications

(27 citation statements)

References 25 publications

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“…Furthermore, this explanation may be extended to the higher prevalence of PH in HC group infants in our study. PH can develop at the early (within 7–14 days based on previous literature 31 , 32 ) or late (variously defined in literature, but the onset generally described to be at weeks to months of life 33 , 34 ) stage of life in preterm infants. Kallapur et al.…”

Section: Discussionmentioning

confidence: 99%

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

et al. 2018

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We aimed to evaluate the association between the presence of histologic chorioamnionitis (HC) and development of pulmonary hypertension (PH) during neonatal intensive care unit (NICU) stay. Data of preterm infants born at 32 weeks of gestation or less were reviewed. The development of PH and other respiratory outcomes were compared according to the presence of HC. Potential risk factors associated with the development of PH during NICU stay were used for multivariable logistic regression analysis. A total of 188 infants were enrolled: 72 in the HC group and 116 in the no HC group. The HC group infants were born at a significantly shorter gestational age and lower birthweight, with a greater proportion presenting preterm premature rupture of membrane (pPROM) > 18 h before delivery. More infants in the HC group developed pneumothorax (P = 0.008), and moderate and severe bronchopulmonary dysplasia (BPD; P = 0.001 and P = 0.006, respectively). PH in the HC group was significantly more frequent compared to the no HC group (25.0% versus 8.6%, P = 0.002). Based on a multivariable logistic regression analysis, birthweight (P = 0.009, odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995–0.999), the presence of HC (P = 0.047, OR = 2.799, 95% CI = 1.014–7.731), and duration of invasive mechanical ventilation (MV) > 14 days (P = 0.015, OR = 8.036, 95% CI = 1.051–43.030) were significant factors. The presence of HC and prolonged invasive MV in infants with lower birthweight possibly synergistically act against preterm pulmonary outcomes and leads to the development of PH. Verification of this result and further investigation to establish effective strategies to prevent or ameliorate these adverse outcomes are needed.

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Section: Discussionmentioning

confidence: 99%

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

et al. 2018

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“…It leads to extrapulmonary right-to-left shunting through the ductus arteriosus or across the foramen ovale, further resulting in profound cyanosis and hypoxemia [63][64][65]. Of note, the earlier we confirm the delayed pulmonary vascular transition by echocardiography [65], the higher the risk of developing BPD and pulmonary hypertension [65,67]. Based on retrospective studies, PH may occur in up to 17-43% of BPD affected preterm infants [68][69][70][71], and the mortality rate may be as high as 14-38% [61].…”

Section: Distal Airspace and Vasculaturementioning

confidence: 99%

Phenotypes of Bronchopulmonary Dysplasia

Wang

Tsao

2020

IJMS

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Bronchopulmonary dysplasia (BPD) is the most common chronic morbidity in preterm infants. In the absence of effective interventions, BPD is currently a major therapeutic challenge. Several risk factors are known for this multifactorial disease that results in disrupted lung development. Inflammation plays an important role and leads to persistent airway and pulmonary vascular disease. Since corticosteroids are potent anti-inflammatory agents, postnatal corticosteroids have been used widely for BPD prevention and treatment. However, the clinical responses vary to a great degree across individuals, and steroid-related complications remain major concerns. Emerging studies on the molecular mechanism of lung alveolarization during inflammatory stress will elucidate the complicated pathway and help discover novel therapeutic targets. Moreover, with the advances in metabolomics, there are new opportunities to identify biomarkers for early diagnosis and prognosis prediction of BPD. Pharmacometabolomics is another novel field aiming to identify the metabolomic changes before and after a specific drug treatment. Through this “metabolic signature,” a more precise treatment may be developed, thereby avoiding unnecessary drug exposure in non-responders. In the future, more clinical, genetic, and translational studies would be required to improve the classification of BPD phenotypes and achieve individualized care to enhance the respiratory outcomes in preterm infants.

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“…26) BPD should be recognized as both an important manifestation of critical CHD that requires prolonged use of a ventilator assist device and a cause of mortality representing pulmonary conditions leading to unfavourable outcomes. 11,27,28) This is a retrospective study conducted at a single center with a small sample size, and risk factors for longterm outcome were not considered. Although infants with CHD of MRACHS 5 or 6 had higher mortality than those with M-RACHS 1−4, there was no mortality in infants with MRACHS 4.…”

Section: Discussionmentioning

confidence: 99%

New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease

et al. 2020

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Background: Despite advances in neonatal intensive care and surgical procedures, perinatal mortality rates for premature infants with congenital heart disease (CHD) remain relatively high.Purpose: We aimed to describe the outcomes of premature infants with critical CHD and identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) category associated with in-hospital mortality in a Korean tertiary center.Methods: This was a retrospective cohort study of premature infants with critical CHD admitted to the neonatal intensive care unit from January 2005 to December 2016.Results: A total of 78 premature infants were enrolled. The median gestational age (GA) at birth was 34.9 weeks (range, 26.7–36.9 weeks), and the median birth weight was 1.91 kg (range, 0.53–4.38 kg). Surgical or percutaneous intervention was performed in 68 patients with a median GA at birth of 34.7 weeks (range, 26.7–36.8 weeks) and a median birth weight of 1.92 kg (range, 0.53–4.38 kg). The in-hospital survival rate was 76.9% among all enrolled preterm infants and 86.8% among patients who received an intervention. Very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS category 5 or higher (more complex CHD) were independently associated with in-hospital mortality. For the 68 premature infants undergoing cardiac interventions, independent risk factors for mortality were VLBW, BPD, and CHD complexity. Late preterm infant and age at intervention were not associated with patient survival.Conclusion: For premature infants with critical CHD, VLBW, PPHN, BPD, and M-RACHS category ≥5 were risk factors for mortality. A careful approach to surgical intervention and prenatal care should be taken according to CHD type and neonatal condition.

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Evidence of Early Pulmonary Hypertension Is Associated with Increased Mortality in Very Low Birth Weight Infants

Cited by 36 publications

References 25 publications

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

Phenotypes of Bronchopulmonary Dysplasia

New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease

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