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DOI: 10.1055/s-0037-1598246
Evidence of Early Pulmonary Hypertension Is Associated with Increased Mortality in Very Low Birth Weight Infants
Publication History
26 August 2016
06 January 2017
Publication Date:
15 February 2017 (online)
![](https://www.thieme-connect.de/media/ajp/201708/lookinside/thumbnails/10-1055-s-0037-1598246_160392-1.jpg)
Abstract
Objective The objective of this study was to describe the inhospital outcomes of a high-risk cohort of very low birth weight infants with evidence of pulmonary hypertension (PHT) within the first 2 weeks after delivery.
Design A retrospective cohort study of consecutively admitted neonates with birth weight < 1,500 g admitted to a Level IV neonatal intensive care unit who were evaluated by echocardiogram between 72 hours and 14 days.
Results A total of 343 eligible infants were included in the cohort with a median gestational age of 25.5 weeks and birth weight of 790 g. Evidence of early PHT was associated with birth weight Z-score (odds ratio [OR]: 0.65, confidence interval [CI]: 0.48–0.87) and maternal African American race (OR: 1.9, CI: 1.03–3.69). Early PHT was associated with decreased in-hospital survival compared with those with no evidence of PHT (OR: 2.0, CI: 1.02–3.90), and was associated with an increased rate of moderate-to-severe bronchopulmonary dysplasia at 36 weeks postmenstrual age (OR: 2.92, CI: 1.24–6.89).
Conclusion The presence of early PHT on echocardiogram between 72 hours and 14 days of age was associated with decreased in-hospital survival and worse pulmonary outcomes. This population represents a group of infants who warrant further investigation to improve outcomes.
Keywords
pulmonary hypertension - bronchopulmonary dysplasia - preterm - neonate - echocardiogram - patent ductus arteriosus-
References
- 1 Slaughter JL, Pakrashi T, Jones DE, South AP, Shah TA. Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation. J Perinatol 2011; 31 (10) 635-640
- 2 Bhat R, Salas AA, Foster C, Carlo WA, Ambalavanan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics 2012; 129 (03) e682-e689
- 3 An HS, Bae EJ, Kim GB. , et al. Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Korean Circ J 2010; 40 (03) 131-136
- 4 Mourani PM, Sontag MK, Younoszai A. , et al. Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. Am J Respir Crit Care Med 2015; 191 (01) 87-95
- 5 Mirza H, Ziegler J, Ford S, Padbury J, Tucker R, Laptook A. Pulmonary hypertension in preterm infants: prevalence and association with bronchopulmonary dysplasia. J Pediatr 2014; 165 (05) 909-914.e1
- 6 Walther FJ, Benders MJ, Leighton JO. Persistent pulmonary hypertension in premature neonates with severe respiratory distress syndrome. Pediatrics 1992; 90 (06) 899-904
- 7 Chu J, Clements JA, Cotton EK. , et al. Neonatal pulmonary ischemia. I. Clinical and physiological studies. Pediatrics 1967; 40 (04) 709-782
- 8 Stahlman M, Blankenship WJ, Shepard FM, Gray J, Young WC, Malan AF. Circulatory studies in clinical hyaline membrane disease. Biol Neonate 1972; 20 (03) 300-320
- 9 Kumar VH, Hutchison AA, Lakshminrusimha S, Morin III FC, Wynn RJ, Ryan RM. Characteristics of pulmonary hypertension in preterm neonates. J Perinatol 2007; 27 (04) 214-219
- 10 Muraskas JK, Juretschke LJ, Weiss MG, Bhola M, Besinger RE. Neonatal-perinatal risk factors for the development of persistent pulmonary hypertension of the newborn in preterm newborns. Am J Perinatol 2001; 18 (02) 87-91
- 11 Danhaive O, Margossian R, Geva T, Kourembanas S. Pulmonary hypertension and right ventricular dysfunction in growth-restricted, extremely low birth weight neonates. J Perinatol 2005; 25 (07) 495-499
- 12 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59 . Doi: 10.1186/1471-2431-13-59
- 13 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
- 14 Mourani PM, Sontag MK, Younoszai A, Ivy DD, Abman SH. Clinical utility of echocardiography for the diagnosis and management of pulmonary vascular disease in young children with chronic lung disease. Pediatrics 2008; 121 (02) 317-325
- 15 Check J, Gotteiner N, Liu X. , et al. Fetal growth restriction and pulmonary hypertension in premature infants with bronchopulmonary dysplasia. J Perinatol 2013; 33 (07) 553-557
- 16 Collaco JM, Dadlani GH, Nies MK. , et al. Risk factors and clinical outcomes in preterm infants with pulmonary hypertension. PLoS One 2016; 11 (10) e0163904 . Doi: 10.1371/journal.pone.0163904
- 17 Mestan KK, Check J, Minturn L. , et al. Placental pathologic changes of maternal vascular underperfusion in bronchopulmonary dysplasia and pulmonary hypertension. Placenta 2014; 35 (08) 570-574
- 18 Yallapragada SG, Mestan KK, Palac H. , et al. Placental villous vascularity is decreased in premature infants with bronchopulmonary dysplasia-associated pulmonary hypertension. Pediatr Dev Pathol 2016; 19 (02) 101-107
- 19 Hernández-Díaz S, Van Marter LJ, Werler MM, Louik C, Mitchell AA. Risk factors for persistent pulmonary hypertension of the newborn. Pediatrics 2007; 120 (02) e272-e282
- 20 Ballard RA, Truog WE, Cnaan A. , et al; NO CLD Study Group. Inhaled nitric oxide in preterm infants undergoing mechanical ventilation. N Engl J Med 2006; 355 (04) 343-353
- 21 Schreiber MD, Gin-Mestan K, Marks JD, Huo D, Lee G, Srisuparp P. Inhaled nitric oxide in premature infants with the respiratory distress syndrome. N Engl J Med 2003; 349 (22) 2099-2107
- 22 Halliday H, Hirschfeld S, Riggs T, Liebman J, Fanaroff A, Bormuth C. Respiratory distress syndrome: echocardiographic assessment of cardiovascular function and pulmonary vascular resistance. Pediatrics 1977; 60 (04) 444-449
- 23 del Cerro MJ, Sabaté Rotés A, Cartón A. , et al. Pulmonary hypertension in bronchopulmonary dysplasia: clinical findings, cardiovascular anomalies and outcomes. Pediatr Pulmonol 2014; 49 (01) 49-59
- 24 Khemani E, McElhinney DB, Rhein L. , et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics 2007; 120 (06) 1260-1269
- 25 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (01) 92-100
- 26 Murthy K, Savani RC, Lagatta JM. , et al. Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol 2014; 34 (07) 543-548