Pulmonary hypertension in the child with bronchopulmonary dysplasia

Malloy, Kelsey W; Austin, Eric D.

doi:10.1002/ppul.25602

Cited by 31 publications

(15 citation statements)

References 79 publications

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“…Additionally, pulmonary vasodilator use was not associated with worse LAH. These medications were frequently in use before catheterization, particularly as expert consensus suggests the initiation of pulmonary vasodilator monotherapy without catheterization is reasonable in uncomplicated BPD-PH when balancing risks associated with catheterization (27,28). While the increased pulmonary blood flow that may result from pulmonary vasodilator therapy may pose theoretic risk for LAH in the less compliant myocardium of the premature infant, the use of sildenafil was not associated with increased risk for LAH in our cohort.…”

Section: Discussionmentioning

confidence: 67%

Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia

et al. 2022

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Left atrial hypertension (LAH) may contribute to pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD). Primary causes of LAH in infants with BPD include left ventricular diastolic dysfunction or hemodynamically significant left to right shunt. The incidence of LAH, which is definitively diagnosed by cardiac catheterization, and its contribution to PH is unknown in patients with BPD-PH. We report the prevalence of LAH in an institutional cohort with BPD-PH with careful examination of hemodynamic contributors and impact on patient outcomes. This single-center, retrospective cohort study examined children <2 years of age with BPD-PH who underwent cardiac catheterization at Lucile Packard Children's Hospital Stanford. Patients with unrepaired simple shunt congenital heart disease (CHD) and pulmonary vein stenosis (only 1 or 2 vessel disease) were included. Patients with complex CHD were excluded. From April 2010 to December 2021, 34 patients with BPD-PH underwent cardiac catheterization. We define LAH as pulmonary capillary wedge pressure (PCWP) or left atrial pressure (LAP) of at least 10 mmHg. In this cohort, median PCWP was 8 mmHg, with LAH present in 32% (n = 11) of the total cohort. A majority (88%, n = 30) of the cohort had severe BPD. Most patients had some form of underlying CHD and/or pulmonary vein stenosis: 62% (n = 21) with an atrial septal defect or patent foramen ovale, 62% (n = 21) with patent ductus arteriosus, 12% (n = 4) with ventricular septal defect, and 12% (n = 4) with pulmonary vein stenosis. Using an unadjusted logistic regression model, baseline requirement for positive pressure ventilation at time of cardiac catheterization was associated with increased risk for LAH (odds ratio 8.44, 95% CI 1.46–48.85, p = 0.02). Small for gestational age birthweight, sildenafil use, and CHD were not associated with increased risk for LAH. LAH was associated with increased risk for the composite outcome of tracheostomy and/or death, with a hazard ratio of 6.32 (95% CI 1.72, 22.96; p = 0.005). While the etiology of BPD-PH is multifactorial, LAH is associated with PH in some cases and may play a role in clinical management and patient outcomes.

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Section: Discussionmentioning

confidence: 67%

Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia

et al. 2022

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“…Consensus is lacking whether chronological or corrected age should be used for this definition in children born preterm 21 . Diagnosis should ideally be confirmed by cardiac catheterisation, especially before adding a second pulmonary vasodilator, but this is still seldom carried out 11,22–24 . The present study shows that 26% (19 children) had a heart catheterisation.…”

Section: Discussionmentioning

confidence: 73%

Outpatient prescription of pulmonary vasodilator therapy to preterm children with bronchopulmonary dysplasia

et al. 2022

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“…This is concordant with the literature, which shows that around 20% of patients with CLD have cPH; this probability increases with moderate-to-severe CLD (30%–50%), and the condition increases the risk of mortality ( 4 , 12 ). Nevertheless, there is significant variability in clinical practice regarding screening and treatment ( 13 ). Mourani and collaborators showed that early pulmonary vascular disease (based on echocardiograms at 7 days of age) with septal flattening and ventricular dilatation is associated with the development of cPH-CLD, and this can be used to identify high-risk patients ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Targeted neonatal echocardiography and lung ultrasound in preterm infants with chronic lung disease with and without pulmonary hypertension, screened using a standardized algorithm

et al. 2023

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IntroductionIncreased recognition of the development of chronic pulmonary hypertension (cPH) in preterm infants with chronic lung disease (CLD) has prompted enhanced monitoring for the identification of different phenotypes.MethodsAll newborns consulted for oxygen/respiratory support dependency (CLD assessment) from January 2018 to December 2021 were included. TnECHO and LUS screening for cPH-CLD were performed at 36 weeks postmenstrual age. Cases of cPH related to increased pulmonary blood flow (cPH-IPBF) were referred to Pediatric Cardiology. The objective of the study was to identify all cases of cPH (cPH-CLD/IPBF) in the CLD patients screened and to compare outcomes. Following a standardized algorithm, cPH-CLD patients were treated with diuretics; ultrasounds taken before and after treatment were analyzed.ResultsSeventy-two patients with CLD were screened. Twenty-two (30%) had cPH-CLD, and nine (12%) had cPH-IPBF. cPH infants underwent more days of mechanical ventilation, were more likely to have retinopathy of prematurity, and showed increased mortality. The LUS pattern observed in the 72 CLD patients consisted of a thickened pleural line and a B-line interstitial heterogeneous pattern; 29% of patients were found to have lung consolidations. After diuretic therapy, step-down in respiratory support occurred in 59% of neonates with cPH-CLD. A decrease in respiratory rate (RR), right ventricular output (RVO), markers of pulmonary vascular resistance (PVR), and B-line pattern was observed. In tissue Doppler imaging, biventricular diastolic function was found to be modified after diuretics.ConclusionsCLD infants with cPH showed increased morbidity and mortality. In cPH-CLD patients, a decrease in RR and step-down in respiratory support was observed after diuretic treatment. Follow-up ultrasound showed a decrease in RVO, markers of PVR, and B-lines.

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Pulmonary hypertension in the child with bronchopulmonary dysplasia

Cited by 31 publications

References 79 publications

Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia

Role of left atrial hypertension in pulmonary hypertension associated with bronchopulmonary dysplasia

Outpatient prescription of pulmonary vasodilator therapy to preterm children with bronchopulmonary dysplasia

Targeted neonatal echocardiography and lung ultrasound in preterm infants with chronic lung disease with and without pulmonary hypertension, screened using a standardized algorithm

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