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

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

doi:10.1038/s41372-019-0508-5

Cited by 11 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These included increasing FiO2 need and PaCO2 levels, pulmonary hypertension with only partial response to pulmonary vasodilator therapies, and recurrent cyanotic or hypoxemic episodes requiring frequent sedation with multiple pharmacologic agents. Our data supports previous reports of increased mortality in patients with documented pulmonary hypertension in BPD 22–24 . A large multicenter study has shown a relationship between tracheobronchomalacia, airway collapse, mechanical ventilation, and morbidity in severe or grade 3 BPD 25 .…”

Section: Discussionsupporting

confidence: 91%

“…Our data supports previous reports of increased mortality in patients with documented pulmonary hypertension in BPD. [22][23][24] A large multicenter study has shown a relationship between tracheobronchomalacia, airway collapse, mechanical ventilation, and morbidity in severe or grade 3 BPD. 25 In our cases, bedside flexible bronchoscopy performed during hypoxemic episodes did not confirm severe airway collapse as the primary trigger, although airway malacia was usually present.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Maynard,

Armstrong,

O'Grady

et al. 2024

Pediatric Pulmonology

View full text Add to dashboard Cite

BackgroundPremature infants surviving beyond a postmenstrual age (PMA) of 36 weeks with severe or grade 3 bronchopulmonary dysplasia (sBPD) have significant predischarge mortality. The in‐hospital mortality for BPD supported by invasive mechanical ventilation beyond 36 weeks PMA is not well described. The role of lung transplantation in treating severe BPD is uncertain. We studied our experience over 20 years to better define the predischarge mortality of infants with progressive grade 3 BPD and whether lung transplant is a feasible intervention.MethodsData were obtained from a retrospective review of medical records from Children's Minnesota over a 20‐year period (1997–2016). Inclusion criteria included prematurity <32 weeks PMA, BPD, tracheostomy for chronic respiratory failure, and survival beyond 36 weeks PMA. Collected data included perinatal demographics, in‐hospital medications and interventions, level of respiratory support, and outcomes.ResultsIn all, 2374 infants were identified who survived beyond 36 weeks PMA with a diagnosis of <32 weeks gestation prematurity and BPD. Of these, 143/2374 (6.0%) survived beyond 36 weeks PMA and required invasive mechanical ventilation with subsequent tracheostomy for management. Among these patients, discharge to home with tracheostomy occurred in 127/143 (88.8%), and predischarge death or lung transplantation occurred in 16/143 (11.2%). Deteriorating cardiopulmonary status was associated with pulmonary hypertension, prolonged hypoxemic episodes and the need for deep sedation or neuromuscular relaxation. Three of four patients referred for lung transplantation had >5‐year survival, chronic allograft rejection, and mild to moderate developmental delays.ConclusionsChronic respiratory failure requiring invasive mechanical ventilation for grade 3 BPD is associated with significant morbidity and mortality. For selected patients and their families, timely referral for lung transplantation is a viable option for end‐stage grade 3 BPD. As in other infants receiving solid organ transplants, long‐term issues with co‐morbidities and special needs persist into childhood.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Maynard,

Armstrong,

O'Grady

et al. 2024

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…Standards for timing and interpretation of screening echocardiogram for BPD-PH or elevated pulmonary pressures associated with evolving BPD remain unclear ( 36 , 37 ). However, echocardiogram screening for PH before 36 weeks may influence early approaches to mitigate PH, such as ventilator strategies, PDA/ASD closure, and avoidance of aspiration.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension

et al. 2023

Self Cite

View full text Add to dashboard Cite

ObjectiveTo describe our multidisciplinary bronchopulmonary dysplasia (BPD) consult team's systematic approach to BPD associated pulmonary hypertension (PH), to report our center outcomes, and to evaluate clinical associations with outcomes.Study designRetrospective cohort of 60 patients with BPD-PH who were referred to the Seattle Children's Hospital BPD team from 2018 to 2020. Patients with critical congenital heart disease were excluded. Demographics, comorbidities, treatments, closure of hemodynamically relevant intracardiac shunts, and clinical outcomes including time to BPD-PH resolution were reviewed.ResultsMedian gestational age of the 60 patients was 25 weeks (IQR: 24–26). 20% were small for gestational age (SGA), 65% were male, and 25% received a tracheostomy. With aggressive cardiopulmonary management including respiratory support optimization, patent ductus arteriosus (PDA) and atrial septal defect (ASD) closure (40% PDA, 5% ASD, 3% both), and limited use of pulmonary vasodilators (8%), all infants demonstrated resolution of PH during the follow-up period, including three (5%) who later died from non-BPD-PH morbidities. Neither SGA status nor the timing of PH diagnosis (<36 vs. ≥36 weeks PMA) impacted the time to BPD-PH resolution in our cohort [median 72 days (IQR 30.5–166.5)].ConclusionOur multidisciplinary, systematic approach to BPD-PH management was associated with complete resolution of PH with lower mortality despite less sildenafil use than reported in comparable cohorts. Unique features of our approach included aggressive PDA and ASD device closure and rare initiation of sildenafil only after lack of BPD-PH improvement with respiratory support optimization and diagnostic confirmation by cardiac catheterization.

show abstract

“…PH contributes significantly to the severity of BPD and, when severe, is associated with a high rate of mortality ( 19 , 20 ). Unfortunately, the pathophysiology of PH is as complex as that of BPD.…”

Section: Bpd-related Pulmonary Hypertensionmentioning

confidence: 99%

Respiratory support strategies in the management of severe, longstanding bronchopulmonary dysplasia

Logan

Nath²,

Shah³

et al. 2022

Front. Pediatr.

Self Cite

View full text Add to dashboard Cite

Despite efforts to minimize ventilator-induced lung injury, some preterm infants require positive pressure support after 36 weeks' post-menstrual age. Infants with severe BPD typically experience progressive mismatch of ventilation and perfusion, which manifests as respiratory distress, hypoxemia in room air, hypercarbia, and growth failure. Lung compliance varies, but lung resistance generally increases with prolonged exposure to positive pressure ventilation and other sources of inflammation. Serial lung radiographs reveal a heterogeneous pattern, with areas of both hyperinflation and atelectasis; in extreme cases, macrocystic changes may be noted. Efforts to wean the respiratory support are often unsuccessful, and trials of high frequency ventilation, exogenous corticosteroids, and diuretics are common. The incidence of pulmonary hypertension increases with the severity of BPD, as does the mortality rate. Therefore, periodic screening and efforts to mitigate the risk of PH is fundamental to the management of longstanding BPD. Failure of conventional, lung-protective strategies (e.g., high rate/low tidal-volume and/or high frequency ventilation) warrants consideration of ventilatory strategies individualized to the disease physiology. Non-invasive modes of respiratory support may be successful in infants with mild to moderate BPD phenotypes. However, infants with moderate to severe BPD phenotypes often require invasive respiratory support, and pressure-limited or volume-targeted conventional ventilation may be better suited to the physiology than high-frequency ventilation. The consistent provision of adequate support is fundamental to the management of longstanding BPD and is best achieved with a stepwise increase in ventilator support until comfortable spontaneous respirations are achieved. Adequately supported infants typically experience improvements in both oxygenation and ventilation, which, if sustained, may arrest and generally reverses the course of a potentially lethal lung disease. Care should be individualized to address the most likely pulmonary mechanics, including variable lung compliance, elevated airway resistance, and variable airway obstruction.

show abstract

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

Cited by 11 publications

References 30 publications

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

Predischarge death or lung transplantation in tracheostomy and ventilator dependent grade 3 bronchopulmonary dysplasia

A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension

Respiratory support strategies in the management of severe, longstanding bronchopulmonary dysplasia

Contact Info

Product

Resources

About