The Impact of Atrial Left-to-Right Shunt on Pulmonary Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

Choi, Eui Kyung; Jung, Young Hwa; Kim, Han Suk; Shin, Seung Han; Choi, Chang Won; Kim, Ee Kyung; Kim, Beyong Il; Choi, Jung Hwan

doi:10.1016/j.pedneo.2014.12.006

Cited by 39 publications

(62 citation statements)

References 27 publications

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“…Further, this association was strengthened in a subgroup of infants who had their final echocardiogram showing PH at or near term. Supporting these findings, other investigators have also found an association between the presence of an ASD and the development of PH in infants with BPD, a diagnosis that conferred an increased risk of mortality [22, 23]. Animal models of chronic left-to-right shunting have increased pulmonary vascular resistance and arteriolar medial thickness, implying biologic plausibility to the association between ASD and PH [24, 25].…”

Section: Discussionmentioning

confidence: 76%

Early characteristics of infants with pulmonary hypertension in a referral neonatal intensive care unit

et al. 2017

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BackgroundApproximately 8–23% of premature infants develop pulmonary hypertension (PH), and this diagnosis confers a higher possibility of mortality. As a result, professional societies recommend PH screening in premature infants. However, the risk factors for and the outcomes of PH may differ depending on the timing of its diagnosis, and little evidence is available to determine at-risk infants in the referral neonatal population. The objective of this study was to define clinical and echocardiographic characteristics of infants with pulmonary hypertension during the neonatal hospital course and at or near-term.MethodsInfants who had the following billing codes: < 32 weeks, birth weight < 1500 g, neonatal unit, and echocardiograph had records abstracted from a data warehouse at Children’s Healthcare of Atlanta. The outcome was defined as late PH on the final echocardiogram for all patients, and, separately, for patients with multiple studies. Descriptive statistics, univariable, and multivariable models were evaluated, and odds ratios and 95% confidence intervals are expressed below as (OR, CI).Results556 infants were included in the overall study, 59 had PH on their final echocardiogram (11%). In multivariable analyses, atrial septal defect (2.9, 1.4–6.1), and intrauterine growth restriction (2.7, 1.2–6.3) increased the odds of late PH, whereas caffeine therapy decreased PH (0.4, 0.2–0.8). When the analyses were restricted to 32 infants who had multiple echocardiograms during their hospitalization, the association between atrial septal defect (5.9, 2.0–16.5) and growth restriction (3.7, 1.3–10.7) and late PH was strengthened, but the effect of caffeine therapy was no longer significant. In this smaller subgroup, infants with late PH had their final echocardiogram at a median of 116 days of life, and 42–74% of them had right ventricular pathology.ConclusionsEarly clinical variables are associated with PH persistence in a referral neonatal population. Identification of early clinical factors may help guide the ascertainment of infant risk for late PH, and may aid in targeting sub-groups that are most likely to benefit from PH screening.

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Section: Discussionmentioning

confidence: 76%

Early characteristics of infants with pulmonary hypertension in a referral neonatal intensive care unit

et al. 2017

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“…We included two articles by scanning the reference lists. Finally, 25 articles, 16 retrospective and 9 prospective studies, were eligible for inclusion in the study . The flow chart of this excluding process is given in Figure .…”

Section: Resultsmentioning

confidence: 99%

Identification of gaps in the current knowledge on pulmonary hypertension in extremely preterm infants: A systematic review and meta‐analysis

Arjaans

Zwart

Ploegstra

et al. 2018

Paediatric Perinatal Epid

125

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Pulmonary hypertension occurs in particularly in infants with severe BPD, and increases risk of mortality. Due to selected study populations, heterogeneous pulmonary hypertension-definitions and poorly reported timing of pulmonary hypertension assessments, however, data available in current reports are insufficient to allow accurate assessment of true prevalence, risk factors, and time-related outcome. Prospective studies, with standardised methodology and follow-up are needed to determine these factors.

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“…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 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 . Those who survive generally demonstrate resolution of PH concordant with pulmonary vascular growth; however, longitudinal studies of BPD survivors suggest the presence of lifelong compromised pulmonary function, as well as risk of RV dysfunction and possible recurrent PH in adulthood …”

Section: Neonatal Phmentioning

confidence: 99%

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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The Impact of Atrial Left-to-Right Shunt on Pulmonary Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

Abstract: The presence of an atrial left-to-right shunt was associated with PH in preterm infants with moderate or severe BPD. Close follow up is needed for infants with interatrial shunts, and a more tailored prognostic evaluation and treatment are recommended.

Cited by 39 publications

References 27 publications

Early characteristics of infants with pulmonary hypertension in a referral neonatal intensive care unit

Early characteristics of infants with pulmonary hypertension in a referral neonatal intensive care unit

Identification of gaps in the current knowledge on pulmonary hypertension in extremely preterm infants: A systematic review and meta‐analysis

Current understanding and perioperative management of pediatric pulmonary hypertension

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