The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year

Lagatta, Joanne; Hysinger, Erik B.; Zaniletti, Isabella; Wymore, Erica; Vyas-Read, Shilpa; Yallapragada, Sushmita; Nelin, Leif D.; Truog, William E.; Padula, Michael A.; Porta, Nicolas F M; Savani, Rashmin C.; Potoka, Karin P; Kawut, Steven M.; DiGeronimo, Robert; Natarajan, Girija; Zhang, Huayan; Grover, Theresa R.; Engle, William A.; Murthy, Karna

doi:10.1016/j.jpeds.2018.07.035

Cited by 108 publications

(97 citation statements)

References 35 publications

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“…[5][6][7] Compared to BPD without PH, BPD-PH is associated with suboptimal somatic growth and neurodevelopmental outcome, 8,9 and higher rates of tracheostomy, increased use of supplemental oxygen, feeding problems, and frequent hospital admissions. 10 Young adults born preterm (very low birth weight ≤1500 g; average gestational age 28 weeks) are at increased risk for PVD, PH, and right ventricular (RV) dysfunction. 11 The increased survival of even the most immature infants makes infants with BPD-PH an ever-growing population among pediatric PH patients, requiring highly specialized care.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension in bronchopulmonary dysplasia

et al. 2020

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Bronchopulmonary dysplasia (BPD) is a major complication in prematurely born infants. Pulmonary hypertension (PH) associated with BPD (BPD-PH) is characterized by alveolar diffusion impairment, abnormal vascular remodeling, and rarefication of pulmonary vessels (vascular growth arrest), which lead to increased pulmonary vascular resistance and right heart failure. About 25% of infants with moderate to severe BPD develop BPD-PH that is associated with high morbidity and mortality. The recent evolution of broader PH-targeted pharmacotherapy in adults has opened up new treatment options for infants with BPD-PH. Sildenafil became the mainstay of contemporary BPD-PH therapy. Additional medications, such as endothelin receptor antagonists and prostacyclin analogs/mimetics, are increasingly being investigated in infants with PH. However, pediatric data from prospective or randomized controlled trials are still sparse. We discuss comprehensive diagnostic and therapeutic strategies for BPD-PH and briefly review the relevant differential diagnoses of parenchymal and interstitial developmental lung diseases. In addition, we provide a practical framework for the management of children with BPD-PH, incorporating the modified definition and classification of pediatric PH from the 2018 World Symposium on Pulmonary Hypertension, and the 2019 EPPVDN consensus recommendations on established and newly developed therapeutic strategies. Finally, current gaps of knowledge and future research directions are discussed.

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Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension in bronchopulmonary dysplasia

et al. 2020

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“…Severe bronchopulmonary dysplasia (sBPD) affects approximately 20% of extremely low-birthweight infants [1]. Pulmonary arterial hypertension (PH) can occur in 15-25% of infants with sBPD, and is associated with an increased risk of mortality [2][3][4]. Recognizing this concern, the American Heart Association recommends screening echocardiography to monitor for PH in infants with BPD [5].…”

Section: Introductionmentioning

confidence: 99%

Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia

et al. 2019

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Objective To determine the relationship between interventricular septal position (SP) and right ventricular systolic pressure (RVSP) and mortality in infants with severe BPD (sBPD). Study design Infants with sBPD in the Children's Hospitals Neonatal Database who had echocardiograms 34-44 weeks' postmenstrual age (PMA) were included. SP and RVSP were categorized normal, abnormal (flattened/bowed SP or RVSP > 40 mmHg) or missing. Results Of 1157 infants, 115 infants (10%) died. Abnormal SP or RVSP increased mortality (SP 19% vs. 8% normal/ missing, RVSP 20% vs. 9% normal/missing, both p < 0.01) in unadjusted and multivariable models, adjusted for significant covariates (SP OR 1.9, 95% CI 1.2-3.0; RVSP OR 2.2, 95% CI 1.1-4.7). Abnormal parameters had high specificity (SP 82%; RVSP 94%), and negative predictive value (SP 94%, NPV 91%) for mortality. Conclusions Abnormal SP or RVSP is independently associated with mortality in sBPD infants. Negative predictive values distinguish infants most likely to survive.

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“…131,132 Patients with PAH are more likely to be born at lower birth weight, be smallfor-gestational age, born to African-American mothers, and born to mothers with a history of hypertension. 133 The incidence of PAH in patients with BPD based on two studies is 18-25%. 11,[134][135][136] There are both acute and chronic management approaches for PAH.…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

“…131,138 Patients with PAH have higher rates of tracheostomy and gastrostomy tube placement (27% vs 9%, 80% vs 46%, respectively, p <0.001). 133…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

<p>Bronchopulmonary Dysplasia: An Overview</p>

Gisondo¹,

Donn²

2020

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Bronchopulmonary dysplasia (BPD) is the most common long-term respiratory morbidity of infants born prematurely. Historically thought to be a direct consequence of lung injury from mechanical ventilation and exposure to high concentrations of oxygen, recent evidence suggests that the BPD of today may be the result of altered lung development and altered alveolarization. In this paper, we will review historical and contemporary definitions of BPD as well as frequently used prevention and management strategies.

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The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year

Abstract: Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.

Cited by 108 publications

References 35 publications

Pulmonary hypertension in bronchopulmonary dysplasia

Pulmonary hypertension in bronchopulmonary dysplasia

Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia

<p>Bronchopulmonary Dysplasia: An Overview</p>

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