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DOI: 10.1055/s-0040-1722604
Cardiopulmonary Function Abnormalities in Cohort of Adults following Bronchopulmonary Dysplasia as Preterm Infants
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Abstract
Objective This study was aimed to describe the cardiopulmonary profiles of adult patients with bronchopulmonary dysplasia (BPD), comparing them to normative adult values.
Study Design This study presents a retrospective chart review of all BPD patients followed in the adult BPD clinic, identified from institutional and archive databases, born preterm at ≤33 weeks of estimated gestational age (EGA) between January 1980 and December 2000.
Results Forty-four patients with BPD (26.4 ± 2.7 weeks of EGA) were included. Average age at follow-up was 19 years. Majority (61.4%) of the patients had a diagnosis of asthma. Mean spirometry values were: first second of forced expiration (FEV1) 74.1%, forced vital capacity (FVC) 80.7%, and FEV1/FVC 82.5%. Echocardiography (ECHO) images were reviewed, left ventricular (LV) structure and performance did not differ between obstructive and nonobstructive pulmonary function test (PFT) groups, but values of LV longitudinal strain were 4.8% lower than expected normal for adults. Patients with obstructive PFT had additional decreased right ventricular (RV) function by ECHO.
Conclusion BPD patients in this study were found to have a burden of cardiorespiratory alterations that persisted into adulthood, with RV performance abnormalities found among patients with obstructive PFT.
Key Points
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BPD patients born at extremes of prematurity have cardiorespiratory alterations in adulthood.
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Among patients with obstructive lung function, subtle cardiac performance abnormalities were found.
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Future directions should include systematic follow-up of premature newborns with BPD.
Keywords
prematurity - bronchopulmonary dysplasia - chronic neonatal lung disease - echocardiography - pulmonary vascular disease - extremely low birth weightPublication History
Received: 02 July 2020
Accepted: 04 December 2020
Article published online:
17 January 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
- 2 Northway Jr. WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 1967; 276 (07) 357-368
- 3 Higgins RD, Jobe AH, Koso-Thomas M. et al. Bronchopulmonary dysplasia: executive summary of a workshop. J Pediatr 2018; 197: 300-308
- 4 Jobe AJ. The new BPD: an arrest of lung development. Pediatr Res 1999; 46 (06) 641-643
- 5 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
- 6 Cheong JLY, Doyle LW. An update on pulmonary and neurodevelopmental outcomes of bronchopulmonary dysplasia. Semin Perinatol 2018; 42 (07) 478-484
- 7 Tracy MK, Berkelhamer SK. Bronchopulmonary dysplasia and pulmonary outcomes of prematurity. Pediatr Ann 2019; 48 (04) e148-e153
- 8 Bader D, Ramos AD, Lew CD, Platzker AC, Stabile MW, Keens TG. Childhood sequelae of infant lung disease: exercise and pulmonary function abnormalities after bronchopulmonary dysplasia. J Pediatr 1987; 110 (05) 693-699
- 9 Andréasson B, Lindroth M, Mortensson W, Svenningsen NW, Jonson B. Lung function eight years after neonatal ventilation. Arch Dis Child 1989; 64 (01) 108-113
- 10 Smyth JA, Tabachnik E, Duncan WJ, Reilly BJ, Levison H. Pulmonary function and bronchial hyperreactivity in long-term survivors of bronchopulmonary dysplasia. Pediatrics 1981; 68 (03) 336-340
- 11 Nuyt AM, Lavoie JC, Mohamed I, Paquette K, Luu TM. Adult consequences of extremely preterm birth: cardiovascular and metabolic diseases risk factors, mechanisms, and prevention avenues. Clin Perinatol 2017; 44 (02) 315-332
- 12 Altit G, Dancea A, Renaud C, Perreault T, Lands LC, Sant'Anna G. Pathophysiology, screening and diagnosis of pulmonary hypertension in infants with bronchopulmonary dysplasia - a review of the literature. Paediatr Respir Rev 2017; 23: 16-26
- 13 Altit G, Bhombal S, Hopper RK, Tacy TA, Feinstein J. Death or resolution: the “natural history” of pulmonary hypertension in bronchopulmonary dysplasia. J Perinatol 2019; 39 (03) 415-425
- 14 Chung KF, Wenzel SE, Brozek JL. et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43 (02) 343-373
- 15 Simonneau G, Montani D, Celermajer DS. et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 2019; 53 (01) 1801913
- 16 Lang RM, Badano LP, Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28 (01) 1-39.e14
- 17 Altit G, Bhombal S, Feinstein J, Hopper RK, Tacy TA. Diminished right ventricular function at diagnosis of pulmonary hypertension is associated with mortality in bronchopulmonary dysplasia. Pulm Circ 2019; 9 (03) 2045894019878598
- 18 Arunamata A, Selamet Tierney ES, Tacy TA, Punn R. Echocardiographic measures associated with early postsurgical myocardial dysfunction in pediatric patients with mitral valve regurgitation. J Am Soc Echocardiogr 2015; 28 (03) 284-293
- 19 Fine NM, Shah AA, Han IY. et al. Left and right ventricular strain and strain rate measurement in normal adults using velocity vector imaging: an assessment of reference values and intersystem agreement. Int J Cardiovasc Imaging 2013; 29 (03) 571-580
- 20 Carasso S, Biaggi P, Rakowski H. et al. Velocity vector imaging: standard tissue-tracking results acquired in normals–the VVI-STRAIN study. J Am Soc Echocardiogr 2012; 25 (05) 543-552
- 21 Punn R, Axelrod DM, Sherman-Levine S, Roth SJ, Tacy TA. Predictors of mortality in pediatric patients on venoarterial extracorporeal membrane oxygenation. Pediatr Crit Care Med 2014; 15 (09) 870-877
- 22 Lorch SM, Ludomirsky A, Singh GK. Maturational and growth-related changes in left ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population. J Am Soc Echocardiogr 2008; 21 (11) 1207-1215
- 23 Park JH, Park MM, Farha S. et al. Impaired global right ventricular longitudinal strain predicts long-term adverse outcomes in patients with pulmonary arterial hypertension. J Cardiovasc Ultrasound 2015; 23 (02) 91-99
- 24 Stevenson DK, Verter J, Fanaroff AA. et al. Sex differences in outcomes of very low birthweight infants: the newborn male disadvantage. Arch Dis Child Fetal Neonatal Ed 2000; 83 (03) F182-F185
- 25 Rutkowska M, Hożejowski R, Helwich E, Borszewska-Kornacka MK, Gadzinowski J. Severe bronchopulmonary dysplasia - incidence and predictive factors in a prospective, multicenter study in very preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med 2019; 32 (12) 1958-1964
- 26 Zysman-Colman Z, Tremblay GM, Bandeali S, Landry JS. Bronchopulmonary dysplasia - trends over three decades. Paediatr Child Health 2013; 18 (02) 86-90
- 27 Binet ME, Bujold E, Lefebvre F, Tremblay Y, Piedboeuf B. Canadian Neonatal Network™. Role of gender in morbidity and mortality of extremely premature neonates. Am J Perinatol 2012; 29 (03) 159-166
- 28 Public Health Agency of Canada. Asthma and chronic obstructive pulmonary disease (COPD) in Canada 2018: report from the Canadian Chronic Disease Surveillance System. Accessed March 1, 2020 at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary-disease-canada-2018.html
- 29 Vollsæter M, Røksund OD, Eide GE, Markestad T, Halvorsen T. Lung function after preterm birth: development from mid-childhood to adulthood. Thorax 2013; 68 (08) 767-776
- 30 Caskey S, Gough A, Rowan S. et al. Structural and functional lung impairment in adult survivors of bronchopulmonary dysplasia. Ann Am Thorac Soc 2016; 13 (08) 1262-1270
- 31 Landry JS, Tremblay GM, Li PZ, Wong C, Benedetti A, Taivassalo T. Lung function and bronchial hyperresponsiveness in adults born prematurely. a cohort study. Ann Am Thorac Soc 2016; 13 (01) 17-24
- 32 Doyle LW, Irving L, Haikerwal A, Lee K, Ranganathan S, Cheong J. Airway obstruction in young adults born extremely preterm or extremely low birth weight in the postsurfactant era. Thorax 2019; 74 (12) 1147-1153
- 33 Gough A, Linden M, Spence D, Patterson CC, Halliday HL, McGarvey LP. Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia. Eur Respir J 2014; 43 (03) 808-816
- 34 Northway Jr. WH, Moss RB, Carlisle KB. et al. Late pulmonary sequelae of bronchopulmonary dysplasia. N Engl J Med 1990; 323 (26) 1793-1799
- 35 Doyle LW, Adams AM, Robertson C. et al; Victorian Infant Collaborative Study Group. Increasing airway obstruction from 8 to 18 years in extremely preterm/low-birthweight survivors born in the surfactant era. Thorax 2017; 72 (08) 712-719
- 36 Doyle LW, Andersson S, Bush A. et al; Adults born Preterm International Collaboration. Expiratory airflow in late adolescence and early adulthood in individuals born very preterm or with very low birthweight compared with controls born at term or with normal birthweight: a meta-analysis of individual participant data. Lancet Respir Med 2019; 7 (08) 677-686
- 37 Lange P, Celli B, Agustí A. et al. Lung-function trajectories leading to chronic obstructive pulmonary disease. N Engl J Med 2015; 373 (02) 111-122
- 38 Sugimoto T, Dulgheru R, Bernard A. et al. Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017; 18 (08) 833-840
- 39 Huckstep OJ, Williamson W, Telles F. et al. Physiological stress elicits impaired left ventricular function in preterm-born adults. J Am Coll Cardiol 2018; 71 (12) 1347-1356
- 40 Lewandowski AJ, Augustine D, Lamata P. et al. Preterm heart in adult life: cardiovascular magnetic resonance reveals distinct differences in left ventricular mass, geometry, and function. Circulation 2013; 127 (02) 197-206
- 41 Lewandowski AJ, Bradlow WM, Augustine D. et al. Right ventricular systolic dysfunction in young adults born preterm. Circulation 2013; 128 (07) 713-720
- 42 Goss KN, Beshish AG, Barton GP. et al. Early pulmonary vascular disease in young adults born preterm. Am J Respir Crit Care Med 2018; 198 (12) 1549-1558
- 43 Altit G, Lee HC, Hintz S, Tacy TA, Feinstein JA, Bhombal S. Practices surrounding pulmonary hypertension and bronchopulmonary dysplasia amongst neonatologists caring for premature infants. J Perinatol 2018; 38 (04) 361-367
- 44 Abman SH, Hansmann G, Archer SL. et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Surgery and Anesthesia, and the American Thoracic Society. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 2015; 132 (21) 2037-2099
- 45 Krishnan U, Feinstein JA, Adatia I. et al; Pediatric Pulmonary Hypertension Network (PPHNet). Evaluation and management of pulmonary hypertension in children with bronchopulmonary dysplasia. J Pediatr 2017; 188: 24-34.e1
- 46 Jone PN, Ivy DD. Echocardiography in pediatric pulmonary hypertension. Front Pediatr 2014; 2: 124
- 47 Jone PN, Ivy DD. Comprehensive noninvasive evaluation of right ventricle-pulmonary circulation axis in pediatric patients with pulmonary hypertension. Curr Treat Options Cardiovasc Med 2019; 21 (01) 6
- 48 Jone PN, Schäfer M, Pan Z, Bremen C, Ivy DD. 3D echocardiographic evaluation of right ventricular function and strain: a prognostic study in paediatric pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2018; 19 (09) 1026-1033
- 49 Mertens LL, Friedberg MK. Imaging the right ventricle--current state of the art. Nat Rev Cardiol 2010; 7 (10) 551-563
- 50 Bogaard HJ, Abe K, Vonk Noordegraaf A, Voelkel NF. The right ventricle under pressure: cellular and molecular mechanisms of right-heart failure in pulmonary hypertension. Chest 2009; 135 (03) 794-804
- 51 Farquhar M, Fitzgerald DA. Pulmonary hypertension in chronic neonatal lung disease. Paediatr Respir Rev 2010; 11 (03) 149-153
- 52 Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation 2008; 117 (13) 1717-1731
- 53 Flahault A, Luu TM, Nuyt AM. Cardiovascular risk in adults born preterm: time to act. JAMA Pediatr 2019; 173 (08) 720-721