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Akangire GG, Manimtim W, Agarwal A, Alexiou S, Aoyama BC, Austin ED, Bansal M, Fierro JL, Hayden LP, Kaslow JA, Lai KV, Levin JC, Miller AN, Rice JL, Tracy MC, Baker CD, Bauer SE, Cristea AI, Dawson SK, Eldredge L, Henningfeld JK, McKinney RL, Siddaiah R, Villafranco NM, Abman SH, McGrath-Morrow SA, Collaco JM. Outcomes of infants and children with bronchopulmonary dysplasia-associated pulmonary hypertension who required home ventilation. Pediatr Res 2024:10.1038/s41390-024-03495-8. [PMID: 39181986 DOI: 10.1038/s41390-024-03495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND To characterize a cohort of ventilator-dependent infants and children with bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) and to describe their cardiorespiratory outcomes. METHODS Subjects with BPD on chronic home ventilation were recruited from outpatient clinics. PH was defined by its presence on ≥1 cardiac catheterization or echocardiogram on or after 36 weeks post-menstrual age. Kaplan-Meier analysis was used to compare the timing of key events. RESULTS Of the 154 subjects, 93 (60.4%) had PH and of those, 52 (55.9%) required PH-specific medications. The ages at tracheostomy, transition to home ventilator, and hospital discharge were older in those with PH. Most subjects were weaned off oxygen and liberated from the ventilator by 5 years of age, which did not occur later in subjects with PH. The mortality rate after initial discharge was 2.6%. CONCLUSIONS The majority of infants with BPD-PH receiving chronic invasive ventilation at home survived after initial discharge. Subjects with BPD-PH improved over time as evidenced by weaning off oxygen and PH medications, ventilator liberation, and tracheostomy decannulation. While the presence of PH was not associated with later ventilator liberation or decannulation, the use of PH medications may be a marker of a more protracted disease trajectory. IMPACT STATEMENT There is limited data on long-term outcomes of children with bronchopulmonary dysplasia (BPD) who receive chronic invasive ventilation at home, and no data on those with the comorbidity of pulmonary hypertension (PH). Almost all subjects with BPD-PH who were on chronic invasive ventilation at home survived after their initial hospital discharge. Subjects with BPD-PH improved over time as evidenced by weaning off oxygen, PH medications, liberation from the ventilator, and tracheostomy decannulation. The presence of PH did not result in later ventilator liberation or decannulation; however, the use of outpatient PH medications was associated with later ventilation liberation and decannulation.
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Affiliation(s)
- Gangaram G Akangire
- Division of Neonatology, Children's Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Winston Manimtim
- Division of Neonatology, Children's Mercy-Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Amit Agarwal
- Division of Pulmonary Medicine, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stamatia Alexiou
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Brianna C Aoyama
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Eric D Austin
- Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manvi Bansal
- Pulmonology and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Julie L Fierro
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Lystra P Hayden
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jacob A Kaslow
- Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN, USA
| | - Khanh V Lai
- Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jonathan C Levin
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Audrey N Miller
- Division of Neonatology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA
| | - Jessica L Rice
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Tracy
- Division of Pediatric Pulmonary, Asthma and Sleep Medicine, Stanford University, Stanford, CA, USA
| | - Christopher D Baker
- Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah E Bauer
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital and Indiana University, Indianapolis, IN, USA
| | - A Ioana Cristea
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital and Indiana University, Indianapolis, IN, USA
| | - Sara K Dawson
- Department of Pediatrics, Medical College of Wisconsin Milwaukee, Wisconsin, USA
| | - Laurie Eldredge
- Division of Pediatric Pulmonary and Sleep Medicine, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | | | - Robin L McKinney
- Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA
| | - Roopa Siddaiah
- Pediatric Pulmonology, Penn State Health, Hershey, PA, USA
| | - Natalie M Villafranco
- Pulmonary Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Steven H Abman
- Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sharon A McGrath-Morrow
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
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Alhumaid S, Alnaim AA, Al Ghamdi MA, Alahmari AA, Alabdulqader M, Al HajjiMohammed SM, Alalwan QM, Al Dossary N, Alghazal HA, Al Hassan MH, Almaani KM, Alhassan FH, Almuhanna MS, Alshakhes AS, BuMozah AS, Al-Alawi AS, Almousa FM, Alalawi HS, Al Matared SM, Alanazi FA, Aldera AH, AlBesher MA, Almuhaisen RH, Busubaih JS, Alyasin AH, Al Majhad AA, Al Ithan IA, Alzuwaid AS, Albaqshi MA, Alhmeed N, Albaqshi YA, Al Alawi Z. International treatment outcomes of neonates on extracorporeal membrane oxygenation (ECMO) with persistent pulmonary hypertension of the newborn (PPHN): a systematic review. J Cardiothorac Surg 2024; 19:493. [PMID: 39182148 PMCID: PMC11344431 DOI: 10.1186/s13019-024-03011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND PPHN is a common cause of neonatal respiratory failure and is still a serious condition and associated with high mortality. OBJECTIVES To compare the demographic variables, clinical characteristics, and treatment outcomes in neonates with PHHN who underwent ECMO and survived compared to neonates with PHHN who underwent ECMO and died. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature for studies on the development of PPHN in neonates who underwent ECMO, published from January 1, 2010 to May 31, 2023, with English language restriction. RESULTS Of the 5689 papers that were identified, 134 articles were included in the systematic review. Studies involving 1814 neonates with PPHN who were placed on ECMO were analyzed (1218 survived and 594 died). Neonates in the PPHN group who died had lower proportion of normal spontaneous vaginal delivery (6.4% vs 1.8%; p value > 0.05) and lower Apgar scores at 1 min and 5 min [i.e., low Apgar score: 1.5% vs 0.5%, moderately abnormal Apgar score: 10.3% vs 1.2% and reassuring Apgar score: 4% vs 2.3%; p value = 0.039] compared to those who survived. Neonates who had PPHN and died had higher proportion of medical comorbidities such as omphalocele (0.7% vs 4.7%), systemic hypotension (1% vs 2.5%), infection with Herpes simplex virus (0.4% vs 2.2%) or Bordetella pertussis (0.7% vs 2%); p = 0.042. Neonates with PPHN in the death group were more likely to present due to congenital diaphragmatic hernia (25.5% vs 47.3%), neonatal respiratory distress syndrome (4.2% vs 13.5%), meconium aspiration syndrome (8% vs 12.1%), pneumonia (1.6% vs 8.4%), sepsis (1.5% vs 8.2%) and alveolar capillary dysplasia with misalignment of pulmonary veins (0.1% vs 4.4%); p = 0.019. Neonates with PPHN who died needed a longer median time of mechanical ventilation (15 days, IQR 10 to 27 vs. 10 days, IQR 7 to 28; p = 0.024) and ECMO use (9.2 days, IQR 3.9 to 13.5 vs. 6 days, IQR 3 to 12.5; p = 0.033), and a shorter median duration of hospital stay (23 days, IQR 12.5 to 46 vs. 58.5 days, IQR 28.2 to 60.7; p = 0.000) compared to the neonates with PPHN who survived. ECMO-related complications such as chylothorax (1% vs 2.7%), intracranial bleeding (1.2% vs 1.7%) and catheter-related infections (0% vs 0.3%) were more frequent in the group of neonates with PPHN who died (p = 0.031). CONCLUSION ECMO in the neonates with PPHN who failed supportive cardiorespiratory care and conventional therapies has been successfully utilized with a neonatal survival rate of 67.1%. Mortality in neonates with PPHN who underwent ECMO was highest in cases born via the caesarean delivery mode or neonates who had lower Apgar scores at birth. Fatality rate in neonates with PPHN who underwent ECMO was the highest in patients with higher rate of specific medical comorbidities (omphalocele, systemic hypotension and infection with Herpes simplex virus or Bordetella pertussis) or cases who had PPHN due to higher rate of specific etiologies (congenital diaphragmatic hernia, neonatal respiratory distress syndrome and meconium aspiration syndrome). Neonates with PPHN who died may need a longer time of mechanical ventilation and ECMO use and a shorter duration of hospital stay; and may experience higher frequency of ECMO-related complications (chylothorax, intracranial bleeding and catheter-related infections) in comparison with the neonates with PPHN who survived.
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Affiliation(s)
- Saad Alhumaid
- School of Pharmacy, University of Tasmania, Hobart, 7000, Australia.
| | - Abdulrahman A Alnaim
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed A Al Ghamdi
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Abdulaziz A Alahmari
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Muneera Alabdulqader
- Pediatric Nephrology Specialty, Pediatric Department, Medical College, King Faisal University, 31982, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Sarah Mahmoud Al HajjiMohammed
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Qasim M Alalwan
- Pediatric Radiology Department, King Fahad Hofuf Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36358, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Header A Alghazal
- Microbiology Laboratory, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed H Al Hassan
- Administration of Nursing, Al-Ahsa Health Cluster, Al-Ahsa Health Cluster, Ministry of Health, 36421, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Khadeeja Mirza Almaani
- Alyahya Primary Health Centre, Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, 36341, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Fatimah Hejji Alhassan
- Alyahya Primary Health Centre, Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, 36341, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed S Almuhanna
- Department of Pharmacy, Maternity and Children Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Aqeel S Alshakhes
- Department of Psychiatry, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ahmed Salman BuMozah
- Administration of Dental Services, Al-Ahsa Health Cluster, Ministry of Health, 36421, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ahmed S Al-Alawi
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, 36421, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Fawzi M Almousa
- Pharmacy Department, Al Jabr Hospital for Eye, Ear, Nose and Throat, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Hassan S Alalawi
- Pharmacy Department, Imam Abdulrahman Alfaisal Hospital, C1 Riyadh Health Cluster, Ministry of Health, 14723, Riyadh, Saudi Arabia
| | - Saleh Mana Al Matared
- Department of Public Health, Kubash General Hospital, Ministry of Health, 66244, Najran, Saudi Arabia
| | | | - Ahmed H Aldera
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mustafa Ahmed AlBesher
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, 36361, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ramzy Hasan Almuhaisen
- Quality Assurance and Patient Safety Administration, Directorate of Health Affairs, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Jawad S Busubaih
- Gastroenterology Department, King Fahad Hofuf Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ali Hussain Alyasin
- Medical Store Department, Maternity and Children Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Abbas Ali Al Majhad
- Radiology Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ibtihal Abbas Al Ithan
- Renal Dialysis Department, King Fahad Hofuf Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ahmed Saeed Alzuwaid
- Pharmacy Department, Aljafr General Hospital, Al-Ahsa Health Cluster, Ministry of Health, 7110, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed Ali Albaqshi
- Pharmacy Department, Aljafr General Hospital, Al-Ahsa Health Cluster, Ministry of Health, 7110, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Naif Alhmeed
- Administration of Supply and Shared Services, C1 Riyadh Health Cluster, Ministry of Health, 14723, Riyadh, Saudi Arabia
| | - Yasmine Ahmed Albaqshi
- Respiratory Therapy Department, Maternity and Children Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, 31982, Al-Hofuf, Al-Ahsa, Saudi Arabia
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Hong KT, Shin SH, Kim EK, Kim HS. Clinical phenotype of pulmonary vascular disease requiring treatment in extremely preterm infants. BMC Pediatr 2024; 24:467. [PMID: 39033281 PMCID: PMC11264936 DOI: 10.1186/s12887-024-04943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Pulmonary vascular disease (PVD) and pulmonary hypertension (PH) is a significant disorder affecting prognosis of extremely preterm infants. However, there is still a lack of a consensus on the definition and optimal treatments of PH, and there is also a lack of research comparing these conditions with persistent pulmonary hypertension of newborn (PPHN), early PH, and late PH. To investigate PH in extremely preterm infants, this study compared the baseline characteristics, short-term outcomes, and treatment duration, categorized by the timing of requiring PH treatment. METHODS This study retrospectively analyzed extremely preterm infants admitted to a single tertiary center. Between 2018 and 2022, infants with clinical or echocardiographic diagnosis of PH who required treatment were divided into three groups based on the timing of treatment initiation: initial 3 days (extremely early-period), from day 4 to day 27 (early-period), and after day 28 (late-period). The study compared the outcomes, including mortality rates, bronchopulmonary dysplasia (BPD) severity, PH treatment duration, and oxygen therapy duration, among the three groups. RESULTS Among the 157 infants, 67 (42.7%) were treated for PH during their stay. Of these, 39 (57.3%) were treatment in extremely early, 21 (31.3%) in early, and seven (11.4%) in late periods. No significant differences were observed in maternal factors, neonatal factors, or morbidity between the three groups. However, infants who received extremely early-period treatment had a higher mortality rate, but shorter duration of noninvasive respiratory support, oxygen therapy, and PH medication use. On the other hand, the late-period treatment group received longer durations of respiratory support and treatment. CONCLUSIONS This study revealed differences in mortality rates, respiratory outcomes, and treatment duration between the three groups, suggesting varying pathophysiologies over time in extremely preterm infants.
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Affiliation(s)
- Ki Teak Hong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Maia PD, Abman SH, Mandell E. Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: Basing Care on Physiology. Neoreviews 2024; 25:e415-e433. [PMID: 38945971 DOI: 10.1542/neo.25-7-e415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/31/2023] [Accepted: 01/13/2024] [Indexed: 07/02/2024]
Abstract
Bronchopulmonary dysplasia (BPD) is the heterogeneous chronic lung developmental disease of prematurity, which is often accompanied by multisystem comorbidities. Pulmonary vascular disease and pulmonary hypertension (PH) contribute significantly to the pathogenesis and pathophysiology of BPD and dramatically influence the outcomes of preterm infants with BPD. When caring for those patients, clinicians should consider the multitude of phenotypic presentations that fall under the "BPD-PH umbrella," reflecting the need for matching therapies to specific physiologies to improve short- and long-term outcomes. Individualized management based on the patient's prenatal and postnatal risk factors, clinical course, and cardiopulmonary phenotype needs to be identified and prioritized to provide optimal care for infants with BPD-PH.
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Affiliation(s)
- Paula Dias Maia
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Steven H Abman
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
- Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Erica Mandell
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
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Li T, Xia B, Liang S, He Q, Zhang S, Chen X, Xu N. Right ventricular function indices and platelet parameters for early prediction value of bronchopulmonary dysplasia: a retrospective study. BMC Pediatr 2024; 24:391. [PMID: 38862972 PMCID: PMC11167767 DOI: 10.1186/s12887-024-04868-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/31/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND To examine the value of early echocardiographic indices for the right ventricular function combined with platelet(PLT) parameters for predicting bronchopulmonary dysplasia (BPD) in preterm infants. METHODS This retrospective study included infants with gestational age (GA) below 32 weeks, who were admitted to the neonatal intensive care unit(NICU). The detection rate of tricuspid regurgitation jet velocity (TRVJ), ventricular septal flattening, pulmonary artery widening, right ventricular dilation, and right atrial enlargement on the 7th day of life (DOL 7) were compared between BPD and non-BPD infants. Echocardiographic indices of the right ventricular function including tricuspid annular plane systolic excursion (TAPSE) and right ventricular index of myocardial performance (RIMP) were measured on 1 day of life (DOL 1)、on DOL 7 and on 14 day of life (DOL 14) respectively. The PLT parameters including the PLT count, mean platelet volume (MPV), platelet hematocrit (PCT) level, and platelet distribution width (PDW) were measured on the DOL 1,DOL 7, and DOL 14. Multivariate logistic regression was used to analyze the relationship between these parameters and BPD. Receiver operating characteristic curve analysis was performed to assess the predictive value of the right ventricular function indices and PLT parameters for BPD. RESULTS A total of 220 preterm infants were included in this study, and of these, 85 infants developed BPD among them. The RIMP of the BPD group on DOL 14 was higher than that of the non-BPD group (P < 0.05). The TAPSE of the BPD group on DOL 14 was lower than that of the non-BPD group (P < 0.05). The PLT count of the BPD group on DOL 1 was lower than that of the non-BPD group (P < 0.05), and the MPV of the BPD group on DOL 1 was higher than that of the non-BPD group (P < 0.05). Using multivariate logistic regression, GA、invasive mechanical ventilation duration ≥ 7 days、 PLT、 MPV、 TAPSE and RIMP were found to be independent risk factors for BPD. The area under the receiver operating characteristic curve was 0.846 (95CI: 0.794∼0.899), which improved when using right ventricular function indices combined with platelet parameters. CONCLUSION TAPSE and RIMP combined with PLT count and MPV can help identify preterm infants at an increased risk of developing BPD.
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Affiliation(s)
- Tianzi Li
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China
| | - Bei Xia
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China
| | - Suixin Liang
- Department of neonatology, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, Guangdong, China
| | - Qiancheng He
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China
| | - Shuangshuang Zhang
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China
| | - Xiaoyi Chen
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China
| | - Na Xu
- Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, Guangdong, China.
- Department of Ultrasound, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen, Guangdong, China.
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Wang D, Huang S, Cao J, Feng Z, Jiang Q, Zhang W, Chen J, Kutty S, Liu C, Liao W, Zhang L, Zhu G, Guo W, Yang J, Liu L, Yang J, Li Q. A comprehensive study on machine learning models combining with oversampling for bronchopulmonary dysplasia-associated pulmonary hypertension in very preterm infants. Respir Res 2024; 25:199. [PMID: 38720331 PMCID: PMC11077703 DOI: 10.1186/s12931-024-02797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) remains a devastating clinical complication seriously affecting the therapeutic outcome of preterm infants. Hence, early prevention and timely diagnosis prior to pathological change is the key to reducing morbidity and improving prognosis. Our primary objective is to utilize machine learning techniques to build predictive models that could accurately identify BPD infants at risk of developing PH. METHODS The data utilized in this study were collected from neonatology departments of four tertiary-level hospitals in China. To address the issue of imbalanced data, oversampling algorithms synthetic minority over-sampling technique (SMOTE) was applied to improve the model. RESULTS Seven hundred sixty one clinical records were collected in our study. Following data pre-processing and feature selection, 5 of the 46 features were used to build models, including duration of invasive respiratory support (day), the severity of BPD, ventilator-associated pneumonia, pulmonary hemorrhage, and early-onset PH. Four machine learning models were applied to predictive learning, and after comprehensive selection a model was ultimately selected. The model achieved 93.8% sensitivity, 85.0% accuracy, and 0.933 AUC. A score of the logistic regression formula greater than 0 was identified as a warning sign of BPD-PH. CONCLUSIONS We comprehensively compared different machine learning models and ultimately obtained a good prognosis model which was sufficient to support pediatric clinicians to make early diagnosis and formulate a better treatment plan for pediatric patients with BPD-PH.
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Affiliation(s)
- Dan Wang
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Cardiology, Hunan Children's Hospital, Changsha, China
| | - Shuwei Huang
- School of Software, Tsinghua University, Beijing, China
| | - Jingke Cao
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhichun Feng
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qiannan Jiang
- Department of Neonatology, Qingdao Women and Children's Hospital, Qingdao, China
| | - Wanxian Zhang
- Department of Neonatology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Jia Chen
- Department of Neonatology, Guangdong Women and Children Hospital, Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Shelby Kutty
- Pediatric and Congenital Cardiology, Taussig Heart Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Changgen Liu
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wenyu Liao
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Le Zhang
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Guli Zhu
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Wenhao Guo
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Jie Yang
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lin Liu
- School of Software, Tsinghua University, Beijing, China.
| | - Jingwei Yang
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China.
| | - Qiuping Li
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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7
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Torok RD, Gardner RA, Barker PCA, McCrary AW, Li JS, Hornik CP, Laughon MM, Jackson WM. Correlating Severity of Pulmonary Hypertension by Echocardiogram with Mortality in Premature Infants with Bronchopulmonary Dysplasia. Am J Perinatol 2024. [PMID: 38698596 DOI: 10.1055/s-0044-1786544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth. Infants with BPD are at increased risk for pulmonary hypertension (PH). Cardiac catheterization is the gold standard for diagnosing PH, but cardiac catheterization is challenging to perform in small, sick, premature infants. The utility of echocardiography for diagnosing PH and predicting outcomes in extremely premature infants has not been clearly defined. Therefore, we sought to use predefined criteria to diagnose PH by echocardiogram and relate PH severity to mortality in extremely premature infants with BPD. STUDY DESIGN Echocardiograms from 46 infants born ≤28 weeks' postmenstrual age with a diagnosis of BPD were assessed for PH by three pediatric cardiologists using predefined criteria, and survival times among categories of PH patients were compared. A total of 458 echocardiograms were reviewed, and 15 (33%) patients were found to have at least moderate PH. Patients with at least moderate PH had similar demographic characteristics to those with no/mild PH. RESULTS Ninety percent of infants without moderate to severe PH survived to hospital discharge, compared with 67% of infants with at least moderate PH (p = 0.048). Patients with severe PH had decreased survival to hospital discharge (38%) compared with moderate (100%) and no/mild PH (90%) groups. Kaplan-Meier survival curves also differed among PH severity groups (Wilcoxon p < 0.001). CONCLUSION Using predefined criteria for PH, premature infants with BPD can be stratified into PH severity categories. Patients diagnosed with severe PH by echocardiogram have significantly reduced survival. KEY POINTS · A composite score definition of PH by echocardiogram showed high inter- and intrarater reliability.. · Infants with severe PH by echocardiogram had decreased survival rates.. · Early diagnosis of PH by echocardiogram dictates treatment which may improve outcomes..
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Affiliation(s)
- Rachel D Torok
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Robert A Gardner
- Division of Pediatric Pulmonology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Piers C A Barker
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Andrew W McCrary
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Jennifer S Li
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Christoph P Hornik
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
- Division of Pediatric Critical Care, Duke University Medical Center, Durham, North Carolina
| | - Matthew M Laughon
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wesley M Jackson
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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8
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Boyd SM, Kluckow M, McNamara PJ. Targeted Neonatal Echocardiography in the Management of Neonatal Pulmonary Hypertension. Clin Perinatol 2024; 51:45-76. [PMID: 38325947 DOI: 10.1016/j.clp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Pulmonary hypertension (PH) in neonates, originating from a range of disease states with heterogeneous underlying pathophysiology, is associated with significant morbidity and mortality. Although the final common pathway is a state of high right ventricular afterload leading to compromised cardiac output, multiple hemodynamic phenotypes exist in acute and chronic PH, for which cardiorespiratory treatment strategies differ. Comprehensive appraisal of pulmonary pressure, pulmonary vascular resistance, cardiac function, pulmonary and systemic blood flow, and extrapulmonary shunts facilitates delivery of individualized cardiovascular therapies in affected newborns.
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Affiliation(s)
- Stephanie M Boyd
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Corner Hawkesbury Road, Hainsworth Street, Westmead, Sydney 2145, Australia; The University of Sydney, Sydney, Australia
| | - Martin Kluckow
- The University of Sydney, Sydney, Australia; Department of Neonatology, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Sydney, Australia
| | - Patrick J McNamara
- Division of Neonatology, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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9
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Abman SH, Lakshminrusimha S. Pulmonary Hypertension in Established Bronchopulmonary Dysplasia: Physiologic Approaches to Clinical Care. Clin Perinatol 2024; 51:195-216. [PMID: 38325941 DOI: 10.1016/j.clp.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Preterm infants with bronchopulmonary dysplasia (BPD) are prone to develop pulmonary hypertension (PH). Strong laboratory and clinical data suggest that antenatal factors, such as preeclampsia, chorioamnionitis, oligohydramnios, and placental dysfunction leading to fetal growth restriction, increase susceptibility for BPD-PH after premature birth. Echocardiogram metrics and serial assessments of NT-proBNP provide useful tools to diagnose and monitor clinical course during the management of BPD-PH, as well as monitoring for such complicating conditions as left ventricular diastolic dysfunction, shunt lesions, and pulmonary vein stenosis. Therapeutic strategies should include careful assessment and management of underlying airways and lung disease, cardiac performance, and systemic hemodynamics, prior to initiation of PH-targeted drug therapies.
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Affiliation(s)
- Steven H Abman
- Department of Pediatrics, The Pediatric Heart Lung Center, University of Colorado Anschutz Medical Campus, Mail Stop B395, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University of California, UC Davis Children's Hospital, 2516 Stockton Boulevard, Sacramento, CA 95817, USA
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10
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Stieren ES, Sankaran D, Lakshminrusimha S, Rottkamp CA. Comorbidities and Late Outcomes in Neonatal Pulmonary Hypertension. Clin Perinatol 2024; 51:271-289. [PMID: 38325946 PMCID: PMC10850767 DOI: 10.1016/j.clp.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Long-term outcomes of persistent pulmonary hypertension of newborn (PPHN) depend on disease severity, duration of ventilation, and associated anomalies. Congenital diaphragmatic hernia survivors may have respiratory morbidities and developmental delay. The presence of PPHN is associated with increased mortality in hypoxic-ischemic encephalopathy, though the effects on neurodevelopment are less clear. Preterm infants can develop pulmonary hypertension (PH) early in the postnatal course or later in the setting of bronchopulmonary dysplasia (BPD). BPD-PH is associated with higher mortality, particularly within the first year. Evidence suggests that both early and late PH in preterm infants are associated with neurodevelopmental impairment.
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MESH Headings
- Infant
- Infant, Newborn
- Humans
- Nitric Oxide
- Infant, Premature
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/therapy
- Bronchopulmonary Dysplasia/epidemiology
- Bronchopulmonary Dysplasia/therapy
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/epidemiology
- Hernias, Diaphragmatic, Congenital/therapy
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Affiliation(s)
- Emily S Stieren
- Division of Neonatology, Department of Pediatrics, University of California, Davis, USA.
| | - Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University of California, Davis, USA
| | | | - Catherine A Rottkamp
- Division of Neonatology, Department of Pediatrics, University of California, Davis, USA
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11
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Mani S, Mirza H, Ziegler J, Chandrasekharan P. Early Pulmonary Hypertension in Preterm Infants. Clin Perinatol 2024; 51:171-193. [PMID: 38325940 PMCID: PMC10850766 DOI: 10.1016/j.clp.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Pulmonary hypertension (PH) in preterm neonates has multifactorial pathogenesis with unique characteristics. Premature surfactant-deficient lungs are injured following exposure to positive pressure ventilation and high oxygen concentrations resulting in variable phenotypes of PH. The prevalence of early PH is variable and reported to be between 8% and 55% of extremely preterm infants. Disruption of the lung development and vascular signaling pathway could lead to abnormal pulmonary vascular transition. The management of early PH and the off-label use of selective pulmonary vasodilators continue to be controversial.
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Affiliation(s)
- Srinivasan Mani
- Section of Neonatology, Department of Pediatrics, The University of Toledo/ ProMedica Russell J. Ebeid Children's Hospital, Toledo, OH 43606, USA
| | - Hussnain Mirza
- Section of Neonatology, Department of Pediatrics, Advent Health for Children/ UCF College of Medicine, Orlando, FL 32408, USA
| | - James Ziegler
- Division of Cardiovascular Diseases, Department of Pediatrics, Hasbro Children's Hospital/ Brown University, Providence, RI 02903, USA
| | - Praveen Chandrasekharan
- Division of Neonatology, Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 32408, USA; Oishei Children's Hospital, 818 Ellicott Street, Buffalo, NY 14203, USA.
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12
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Wei E, Chen XH, Zhou SJ. Comparison of treprostinil and oral sildenafil for the treatment of persistent pulmonary hypertension of the newborn: a retrospective cohort study. Front Pediatr 2023; 11:1270712. [PMID: 38027274 PMCID: PMC10654787 DOI: 10.3389/fped.2023.1270712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aims to evaluate the effectiveness of treprostinil and oral sildenafil in managing persistent pulmonary hypertension of newborns (PPHN). Methods We conducted a retrospective cohort study of 42 neonates with PPHN treated with continuous intravenous treprostinil or oral sildenafil from January 2020 to October 2022 in China. Outcomes assessed included echocardiographic pulmonary artery systolic pressure (PASP), shunt direction, and arterial blood gas measures. Results Treprostinil lowered PASP and improved oxygenation significantly better than sildenafil on days 1, 2, and 3 of treatment (P < 0.05). Treprostinil also corrected shunt direction faster than sildenafil (P < 0.05). The duration of mechanical ventilation, length of NICU stay, and overall hospital stay did not significantly differ between the two groups (P > 0.05). Conclusions Treprostinil effectively lowers pulmonary artery pressure and improves oxygenation in neonates with PPHN, without being associated with severe complications. It may serve as a beneficial adjunct therapy for neonates with PPHN.
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Affiliation(s)
- Enhuan Wei
- Department of Neonatology, Affiliated Sanming First Hospital, Fujian Medical University, Sanming, China
| | - Xiu-hua Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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13
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Mirza H, Mandell EW, Kinsella JP, McNamara PJ, Abman SH. Pulmonary Vascular Phenotypes of Prematurity: The Path to Precision Medicine. J Pediatr 2023; 259:113444. [PMID: 37105409 PMCID: PMC10524716 DOI: 10.1016/j.jpeds.2023.113444] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Pulmonary hypertension (PH) is associated with significant morbidities and high mortality in preterm infants, yet mechanisms contributing to the pathogenesis of PH, the impact of early pulmonary vascular disease (PVD) on the risk for BPD, the role for PH-targeted drug therapies, and long-term pulmonary vascular sequelae remain poorly understood. PVD is not a homogeneous disease, rather, PVD in the setting of prematurity includes various phenotypes as based on underlying pathophysiology, the severity of associated PH, the timing of disease onset, its contribution to hemodynamic and respiratory status, late outcomes, and other features. As with term newborns, severe hypoxemia with acute respiratory failure (HRF) in preterm infants can be due to marked elevation of pulmonary artery pressure with extrapulmonary shunt, traditionally referred to as persistent pulmonary hypertension of the newborn (PPHN). Transient and less severe levels of PH can also be observed during the early transition after birth without evidence of severe HRF, representing physiologic PH or delayed pulmonary vascular transition in preterm infants. Importantly, echocardiographic evidence of early PH has been strongly associated with the subsequent development of bronchopulmonary dysplasia (BPD), late PH, and chronic respiratory disease during infancy and early childhood. Late PH beyond the first postnatal months in preterm in neonates with established BPD is further associated with poor outcomes, especially as related to BPD severity. In addition, echocardiographic signs of PVD can further persist throughout childhood and may lead to chronic PH of variable severity and cardiac maldevelopment in prematurely born young adults. This review discusses the importance of characterizing diverse pulmonary vascular phenotypes in preterm infants to better guide clinical care and research, and to enhance the development of more precise therapeutic strategies to optimize early and late outcomes of preterm infants.
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Affiliation(s)
- Hussnain Mirza
- Section of Neonatology, Department of Pediatrics, Advent Health for Children/UCF College of Medicine, Orlando, FL
| | - Erica W Mandell
- Pediatric Heart Lung Center and Section of Neonatology, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - John P Kinsella
- Pediatric Heart Lung Center and Section of Neonatology, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa School of Medicine, Iowa City, IA
| | - Steven H Abman
- Pediatric Heart Lung Center and Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO.
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14
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Fike CD, Aschner JL. Pharmacotherapy for Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia: Past, Present, and Future. Pharmaceuticals (Basel) 2023; 16:503. [PMID: 37111262 PMCID: PMC10141152 DOI: 10.3390/ph16040503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023] Open
Abstract
Approximately 8-42% of premature infants with chronic lung disease of prematurity, bronchopulmonary dysplasia (BPD), develop pulmonary hypertension (PH). Infants with BPD-PH carry alarmingly high mortality rates of up to 47%. Effective PH-targeted pharmacotherapies are desperately needed for these infants. Although many PH-targeted pharmacotherapies are commonly used to treat BPD-PH, all current use is off-label. Moreover, all current recommendations for the use of any PH-targeted therapy in infants with BPD-PH are based on expert opinion and consensus statements. Randomized Control Trials (RCTs) are needed to determine the efficacy of PH-targeted treatments in premature infants with or at risk of BPD-PH. Prior to performing efficacy RCTs, studies need to be conducted to obtain pharmacokinetic, pharmacodynamic, and safety data for any pharmacotherapy used in this understudied and fragile patient population. This review will discuss current and needed treatment strategies, identify knowledge deficits, and delineate both challenges to be overcome and approaches to be taken to develop effective PH-targeted pharmacotherapies that will improve outcomes for premature infants with or at risk of developing BPD-PH.
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Affiliation(s)
- Candice D. Fike
- Department of Pediatrics, University of Utah Health, Salt Lake City, UT 84108, USA
| | - Judy L. Aschner
- Department of Pediatrics, Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, Hackensack, NJ 07601, USA
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
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15
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de Carvalho Nunes G, Wutthigate P, Simoneau J, Dancea A, Beltempo M, Renaud C, Altit G. The biventricular contribution to chronic pulmonary hypertension of the extremely premature infant. J Perinatol 2023; 43:174-180. [PMID: 36008520 DOI: 10.1038/s41372-022-01497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Evaluate factors associated with significant pulmonary hypertension [PH] (≥2/3 systemic) and its impact on ventricular function at 36 weeks postmenstrual age (PMA). STUDY DESIGN Retrospective cohort of infants born at <29 weeks who survived to their echocardiography screening for PH at 36 weeks PMA. Masked experts extracted conventional and speckle-tracking echocardiography [STE] data. RESULTS Of 387 infants, 222 were included and 24 (11%) categorized as significant PH. Significant PH was associated with a decrease in tricuspid annular plane systolic excursion (0.79 vs 0.87 cm, p = 0.03), right peak longitudinal strain [pLS] by STE (-19.6 vs -23.1%, p = 0.003) and left pLS (-25.0 vs -22.7%, p = 0.02). The association between biventricular altered function by STE and significant PH persisted after adjustment for potential confounders - LV-pLS (p = 0.007) and RV-pLS (p = 0.01). CONCLUSION Our findings are suggestive that premature newborns with significant PH at 36 weeks PMA have a biventricular cardiac involvement to their pathophysiology.
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Affiliation(s)
- Gabriela de Carvalho Nunes
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
- Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Punnanee Wutthigate
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
- Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
- Division of Neonatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jessica Simoneau
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
- Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Adrian Dancea
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
- Division of Pediatric Cardiology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Marc Beltempo
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
- Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Claudia Renaud
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
- Division of Pediatric Cardiology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Gabriel Altit
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.
- Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.
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16
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Muhsen W, Nestaas E, Hosking J, Latour JM. Echocardiography parameters used in identifying right ventricle dysfunction in preterm infants with early bronchopulmonary dysplasia: A scoping review. Front Pediatr 2023; 11:1114587. [PMID: 37020655 PMCID: PMC10067920 DOI: 10.3389/fped.2023.1114587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 04/07/2023] Open
Abstract
Background Bronchopulmonary Dysplasia (BPD) is a chronic condition that affects preterm infants and is associated with long-term complications. Haemodynamic effects of BPD can lead to right ventricular (RV) dysfunction. Objective To synthesise and map the evidence of echo parameters used in identifying RV dysfunction in the first two weeks-after-birth (WAB) of preterm infants with early BPD. Information Sources This scoping review included the databases: Medline, CINAHL, PubMed, EMBASE, Scopus, ProQuest, Web of Science, Cochrane Library, JBI Evidence-Based Practise and Gray Literature. Search Strategy The search utilised Boolean operators and descriptors registered in Medical Subject Headings. Inclusion and exclusion criteria Included were studies utilising echo parameters to examine RV function in preterm infants with early BPD in the first two WAB. Synthesis of results The results are presented as a map of the extracted findings in a tabular format with a narrative summary. Results Eight studies were included. Differences were observed in the number and timing of echo scans performed in the first two WAB and the variations in the echo parameters used to compare preterm infants with and without early BPD. Only echo scans performed at the end of the first WAB, demonstrated significant differences in the echo parameters measurements between preterm infants with and without BPD. Studies using RV Myocardial Performance Index (MPI) to identify RV-dysfunction associated with early BPD demonstrated similar findings. The Pulsed-Wave Doppler technique identified differences in RV-MPI between preterm infants with and without BPD, while Tissue-Doppler-Imaging did not demonstrate similar results. Speckle tracking can measure strain (S) and strain rate (SR) and diagnose RV-dysfunction. However, the findings of studies that utilised speckle tracking varied. Finally, two of the included studies added blood tests to their diagnostic model of early BPD, which was able to demonstrate significant differences in blood test results between BPD-affected and control preterm infants. Conclusion BPD could adversely affect the myocardium function of the RV; these negative influences can be captured in the first two WAB. However, there are still knowledge gaps regarding the appropriate number, timing and the most suitable echo parameters to assess RV function.
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Affiliation(s)
- Wisam Muhsen
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Neonatal Intensive Care Unit, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
- Correspondence: Wisam Muhsen
| | - Eirik Nestaas
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Clinic of Pediatrics andAdolesence, Akershus University Hospital, Nordbyhagen, Norway
| | - Joanne Hosking
- Medical Statistics, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Jos M. Latour
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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17
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Martini S, Corsini I, Corvaglia L, Suryawanshi P, Chan B, Singh Y. A scoping review of echocardiographic and lung ultrasound biomarkers of bronchopulmonary dysplasia in preterm infants. Front Pediatr 2023; 11:1067323. [PMID: 36846161 PMCID: PMC9950276 DOI: 10.3389/fped.2023.1067323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023] Open
Abstract
Despite recent improvements in neonatal care, moderate to severe bronchopulmonary dysplasia (BPD) is still associated with high mortality and with an increased risk of developing pulmonary hypertension (PH). This scoping review provides an updated overview of echocardiographic and lung ultrasound biomarkers associated with BPD and PH, and the parameters that may prognosticate their development and severity, which could be clinically helpful to undertake preventive strategies. A literature search for published clinical studies was conducted in PubMed using MeSH terms, free-text words, and their combinations obtained through appropriate Boolean operators. It was found that the echocardiography biomarkers for BPD, and especially those assessing right ventricular function, are reflective of the high pulmonary vascular resistance and PH, indicating a strong interplay between heart and lung pathophysiology; however, early assessment (e.g., during the first 1-2 weeks of life) may not successfully predict later BPD development. Lung ultrasound indicating poor lung aeration at day 7 after birth has been reported to be highly predictive of later development of BPD at 36 weeks' postmenstrual age. Evidence of PH in BPD infants increases risk of mortality and long-term PH; hence, routine PH surveillance in all at risk preterm infants at 36 weeks, including an echocardiographic assessment, may provide useful information. Progress has been made in identifying the echocardiographic parameters on day 7 and 14 to predict later development of pulmonary hypertension. More studies on sonographic markers, and especially on echocardiographic parameters, are needed for the validation of the currently proposed parameters and the timing of assessment before recommendations can be made for the routine clinical practice.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, IRCCS AOUBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, IRCCS AOUBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, India
| | - Belinda Chan
- Division of Neonatology, University of Utah, Salt Lake City, UT, United States
| | - Yogen Singh
- Department of Pediatrics - Division of Neonatology, Loma Linda University School of Medicine, Loma linda, CA, United States.,Neonatology/Pediatric Cardiology, Cambridge University Hospitals, Cambridge, United Kingdom
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18
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Muhsen WS, Nestaas E, Hosking J, Latour J. Exploring right ventricular function applicability in a prediction model to identify preterm infants with early bronchopulmonary dysplasia (REPORT-BPD study): a mixed-methods observational cohort feasibility study protocol. Pilot Feasibility Stud 2022; 8:248. [PMID: 36482482 PMCID: PMC9733192 DOI: 10.1186/s40814-022-01201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a chronic disease that affects the immature lungs of preterm infants. Infants born before 32 weeks of gestation are at a greater risk of developing BPD due to the need for respiratory support with higher oxygen requirement. Pulmonary vascular remodelling in early BPD can impose an additional burden on the right ventricle (RV) and RV dysfunction. This protocol outlines the study design and aims to formulate a prediction model to identify early BPD through the data generated from echo scans analysis. METHODS The mixed-methods observational cohort feasibility study, which comprises three work-packages (WPs), will be conducted at the regional neonatal unit, University Hospital Plymouth, Plymouth, UK. WP-I will recruit 40 preterm infants; each participant will have two heart scans performed in the first ten days after birth (DABs). WP-II will collect the documentation of the participating preterm infants' parents in the study neonatal unit diaries in the first 10 DABs. WP-III will involve semi-structured interviews of 10-15 parents of participating preterm infants and 10-15 health professionals who participated in WP-I. The study recruitment will be conducted over 18-months. The start date is 01 June 2022. WP-I and WP-II recruitment will occur during this period, while WP-III recruitment will occur during the second half. The results are expected to be submitted for publication by mid-2024. DISCUSSION This paper outlines the study design. If the study successfully identifies the most sensitive echo parameter in recognising the RV dysfunction associated with early BPD, it will be an important finding in constructing an early BPD prediction model. TRIAL REGISTRATION ClinicalTrials.gov Identifier is NCT05235399.
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Affiliation(s)
- Wisam S. Muhsen
- grid.418670.c0000 0001 0575 1952Neonatal Intensive Care Unit, University Hospital Plymouth NHS Trust, Plymouth, UK ,grid.11201.330000 0001 2219 0747Faculty of Health, University of Plymouth, Plymouth, UK
| | - Eirik Nestaas
- grid.11201.330000 0001 2219 0747Faculty of Health, University of Plymouth, Plymouth, UK ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XClinic of Pediatrics and Adolesence, Akershus University Hospital, Nordbyhagen, Norway
| | - Joanne Hosking
- grid.11201.330000 0001 2219 0747Medical Statistics, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jos Latour
- grid.11201.330000 0001 2219 0747Faculty of Health, University of Plymouth, Plymouth, UK
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19
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Arjaans S, Fries MWF, Schoots MH, Schilte CFM, Roofthooft MTR, Vrijlandt EJLE, Bos AF, Kooi EMW, Berger RMF. Clinical Significance of Early Pulmonary Hypertension in Preterm Infants. J Pediatr 2022; 251:74-81.e3. [PMID: 35934129 DOI: 10.1016/j.jpeds.2022.07.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To characterize different phenotypes of early pulmonary hypertension (PH) in preterm infants and their respective associations with bronchopulmonary dysplasia (BPD) and survival. STUDY DESIGN A prospective cohort study in a tertiary university medical center from June 2016 until March 2019. Infants with a gestational age <30 weeks and/or a birth weight <1000 g were included. Echocardiographic assessment for PH was performed at 3-10 days after birth. Subsequent development of BPD at 36 weeks postmenstrual age and mortality were assessed. RESULTS Early PH was identified in 55% of 104 included infants, including 21% with persistent PH of the newborn (PPHN), 61% with flow-associated PH, and 18% PH without shunt. Only PPHN was associated with placental fetal vascular malperfusion, lower gestational age, and low Apgar score. Both PPHN and flow PH were associated with the development of BPD. Early PH was associated with poorer survival, driven by PPHN. CONCLUSIONS Early PH is highly prevalent (55%) in preterm infants and associated with the development of BPD, independent of the phenotype of PH. Infants with PPHN had the poorest survival. Early PH presents in various phenotypes characterized by differences in etiology, pathophysiology, and associated long-term sequelae.
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Affiliation(s)
- Sanne Arjaans
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Center for Congenital Heart Diseases, Beatrix Children's Hospital, Groningen, The Netherlands.
| | - Marian W F Fries
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Center for Congenital Heart Diseases, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Mirthe H Schoots
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carine F M Schilte
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Center for Congenital Heart Diseases, Beatrix Children's Hospital, Groningen, The Netherlands; Department of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Marc T R Roofthooft
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Center for Congenital Heart Diseases, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Elianne J L E Vrijlandt
- Department of Pediatric Pulmonology & Allergology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Arie F Bos
- Department of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- Department of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Rolf M F Berger
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Center for Congenital Heart Diseases, Beatrix Children's Hospital, Groningen, The Netherlands
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20
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Screening Echocardiography Identifies Risk Factors for Pulmonary Hypertension at Discharge in Premature Infants with Bronchopulmonary Dysplasia. Pediatr Cardiol 2022; 43:1743-1751. [PMID: 35488130 DOI: 10.1007/s00246-022-02911-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
HYPOTHESIS Premature infants with bronchopulmonary dysplasia (BPD) are at increased risk of secondary pulmonary hypertension (BPD-PH). Prior studies yielded mixed results on the utility of echocardiographic screening at 36 weeks post-menstrual age (PMA). We present our experience using echocardiographic screening at the time of BPD diagnosis to identify infants at highest risk of BPD-PH at discharge. MATERIALS AND METHODS Retrospective cohort analysis of clinical/ demographic data and screening echocardiograms in patients with BPD. Discharge echocardiograms identified infants with or without BPD-PH at discharge. 36 weeks PMA screening echocardiograms and clinical data were then reviewed to identify which factors were associated with increased odds of BPD-PH at discharge. Associations between echocardiographic findings were evaluated with 2- and 3-variable models to predict increased risk of BPD-PH at discharge. RESULTS In our cohort of 64 infants with severe BPD, BPD-PH was present in 22/64 (34%) infants at discharge. There were no clinical differences at time of 36 weeks PMA screening evaluation (mean PMA 36.6 ± 2.9 weeks). PH at screening was poorly predictive of PH at discharge as PH at screening resolved in 49% of patients. However, having an ASD, RV dilation, hypertrophy, or reduced function on screening, especially in combination, were associated with BPD-PH at discharge. CONCLUSION In our cohort of premature infants with BPD, 36 weeks PMA screening echocardiogram identified patients at increased risk for BPD-PH at discharge when ASD, RVH, or impaired RV function were present. Larger prospective studies are indicated to validate these findings.
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21
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Abman SH. Characterization of Early Pulmonary Hypertension in Infants Born Preterm: A Key Step Toward Improving Outcomes. J Pediatr 2022; 251:44-46. [PMID: 36100087 DOI: 10.1016/j.jpeds.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Steven H Abman
- Section of Pulmonary Medicine and the Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
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22
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Kim YJ, Shin SH, Park HW, Kim EK, Kim HS. Risk factors of early pulmonary hypertension and its clinical outcomes in preterm infants: a systematic review and meta-analysis. Sci Rep 2022; 12:14186. [PMID: 35986155 PMCID: PMC9391329 DOI: 10.1038/s41598-022-18345-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/09/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this meta-analysis was to determine the incidence and risk factors of early pulmonary hypertension (PHT) in preterm infants and evaluate the association of early PHT with morbidities such as bronchopulmonary dysplasia (BPD), late PHT, and in-hospital mortality. We searched the PubMed (1980–2021), Embase (1968–2021), CINAHL (2002–2021), Cochrane library (1989–2021), and KoreaMed (1993–2021). Observational studies on the association between early PHT diagnosed within the first 2 weeks after birth and its clinical outcomes in preterm infants born before 37 weeks of gestation or with very low birth weight (< 1500 g) were included. Two authors independently extracted the data and assessed the quality of each study using a modified Newcastle–Ottawa Scale. We performed meta-analysis using Comprehensive Meta-Analysis version 3.3. A total of 1496 potentially relevant studies were found, of which 8 studies (7 cohort studies and 1 case–control study) met the inclusion criteria comprising 1435 preterm infants. The event rate of early PHT was 24% (95% confidence interval [CI] 0.174–0.310). The primary outcome of our study was moderate to severe BPD at 36 weeks postmenstrual age, and it was associated with early PHT (6 studies; odds ratio [OR] 1.682; 95% CI 1.262–2.241; P < 0.001; heterogeneity: I2 = 0%; P = 0.492). Preterm infants with early PHT had higher OR of in-hospital mortality (6 studies; OR 2.372; 95% CI 1.595–3.528; P < 0.001; heterogeneity: I2 = 0%; P = 0.811) and developing late PHT diagnosed after 4 weeks of life (4 studies; OR 2.877; 95% CI 1.732–4.777; P < 0.001; heterogeneity: I2 = 0%; P = 0.648). Infants with oligohydramnios (4 studies; OR 2.134; 95% CI 1.379–3.303; P = 0.001) and those who were small-for-gestational-age (5 studies; OR 1.831; 95% CI 1.160–2.890; P = 0.009) had an elevated risk of developing early PHT. This study showed that early PHT is significantly associated with mortality and morbidities, such as BPD and late PHT. Preterm infants with a history of oligohydramnios and born small-for-gestational-age are at higher risk for developing early PHT; however, high-quality studies that control for confounders are necessary.
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23
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Sharma M, Bellio MA, Benny M, Kulandavelu S, Chen P, Janjindamai C, Han C, Chang L, Sterling S, Williams K, Damianos A, Batlahally S, Kelly K, Aguilar-Caballero D, Zambrano R, Chen S, Huang J, Wu S, Hare JM, Schmidt A, Khan A, Young K. Mesenchymal Stem Cell-derived Extracellular Vesicles Prevent Experimental Bronchopulmonary Dysplasia Complicated By Pulmonary Hypertension. Stem Cells Transl Med 2022; 11:828-840. [PMID: 35758326 PMCID: PMC9397655 DOI: 10.1093/stcltm/szac041] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
Mesenchymal stem cell (MSC) extracellular vesicles (EVs) have beneficial effects in preclinical bronchopulmonary dysplasia and pulmonary hypertension (BPD-PH) models. The optimal source, dosing, route, and duration of effects are however unknown. The objectives of this study were to (a) compare the efficacy of GMP-grade EVs obtained from Wharton’s Jelly MSCs (WJ-MSCs) and bone marrow (BM-MSCs), (b) determine the optimal dosing and route of administration, (c) evaluate its long-term effects, and (d) determine how MSC EVs alter the lung transcriptome. Newborn rats exposed to normoxia or hyperoxia (85% O2) from postnatal day (P)1-P14 were given (a) intra-tracheal (IT) BM or WJ-MSC EVs or placebo, (b) varying doses of IT WJ-MSC EVs, or (c) IT or intravenous (IV) WJ-MSC EVs on P3. Rats were evaluated at P14 or 3 months. Early administration of IT BM-MSC or WJ-MSC EVs had similar beneficial effects on lung structure and PH in hyperoxia-exposed rats. WJ-MSC EVs however had superior effects on cardiac remodeling. Low, medium, and high dose WJ-MSC EVs had similar cardiopulmonary regenerative effects. IT and IV WJ-MSC EVs similarly improved vascular density and reduced PH in hyperoxic rats. Gene-set enrichment analysis of transcripts differentially expressed in WJ-MSC EV-treated rats showed that induced transcripts were associated with angiogenesis. Long-term studies demonstrated that a single early MSC EV dose has pulmonary vascular protective effects 3 months after administration. Together, our findings have significant translational implications as it provides critical insight into the optimal source, dosing, route, mechanisms of action, and duration of effects of MSC-EVs for BPD-PH.
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Affiliation(s)
- Mayank Sharma
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Bellio
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Merline Benny
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shathiyah Kulandavelu
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pingping Chen
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chawisa Janjindamai
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chenxu Han
- Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Liming Chang
- Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shanique Sterling
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kevin Williams
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andreas Damianos
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sunil Batlahally
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kaitlyn Kelly
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniela Aguilar-Caballero
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ronald Zambrano
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shaoyi Chen
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jian Huang
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shu Wu
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Augusto Schmidt
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karen Young
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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24
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Higano NS, Bates AJ, Gunatilaka CC, Hysinger EB, Critser PJ, Hirsch R, Woods JC, Fleck RJ. Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value. Pediatr Radiol 2022; 52:643-660. [PMID: 35122130 PMCID: PMC8921108 DOI: 10.1007/s00247-021-05250-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 12/31/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a common long-term complication of preterm birth. The chest radiograph appearance and survivability have evolved since the first description of BPD in 1967 because of improved ventilation and clinical strategies and the introduction of surfactant in the early 1990s. Contemporary imaging care is evolving with the recognition that comorbidities of tracheobronchomalacia and pulmonary hypertension have a great influence on outcomes and can be noninvasively evaluated with CT and MRI techniques, which provide a detailed evaluation of the lungs, trachea and to a lesser degree the heart. However, echocardiography remains the primary modality to evaluate and screen for pulmonary hypertension. This review is intended to highlight the important findings that chest radiograph, CT and MRI can contribute to precision diagnosis, phenotyping and prognosis resulting in optimal management and therapeutics.
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Affiliation(s)
- Nara S Higano
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Chamindu C Gunatilaka
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erik B Hysinger
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul J Critser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Russel Hirsch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert J Fleck
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Radiology, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
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25
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Arattu Thodika FMS, Nanjundappa M, Dassios T, Bell A, Greenough A. Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation. J Perinat Med 2022; 50:327-333. [PMID: 34847313 DOI: 10.1515/jpm-2021-0366] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pulmonary hypertension (PH) is a complication of bronchopulmonary dysplasia (BPD) and associated with increased mortality and morbidity. Our aim was to identify, in infants with BPD, the effect of PH on health-care utilisation and health related cost of care. METHODS An electronic data recording system was used to identify infants ≤32 weeks of gestation who developed BPD. PH was classified as early (≤28 days after birth) or late (>28 days after birth). RESULTS In the study period, 182 infants developed BPD; 22 (12.1%) developed late PH. Development of late PH was associated with a lower gestational age [24.6 (23.9-26.9) weeks, p=0.001] and a greater need for positive pressure ventilation on day 28 after birth (100%) compared to infants without late PH (51.9%) (odds ratio (OR) 19.5, 95% CI: 2.6-148), p<0.001. Late PH was associated with increased mortality (36.4%) compared those who did not develop late PH (1.9%) after adjusting for gestational age and ventilation duration (OR: 26.9, 95% CI: 3.8-189.4), p<0.001. In infants who survived to discharge, late PH development was associated with a prolonged duration of stay [147 (118-189) days] compared to the infants that did not develop late PH [109 (85-149) days] (p=0.03 after adjusting for gestational age). Infants who had late PH had a higher cost of stay compared to infants with BPD who did not develop late PH (median £113,494 vs. £78,677, p=0.016 after adjusting for gestational age). CONCLUSIONS Development of late PH was associated with increased mortality, a prolonged duration of stay and higher healthcare cost.
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Affiliation(s)
- Fahad M S Arattu Thodika
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mahesh Nanjundappa
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Aaron Bell
- Department of Paediatric Cardiology, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.,NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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26
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Hocq C, Vanhoutte L, Guilloteau A, Massolo AC, Van Grambezen B, Carkeek K, Piersigilli F, Danhaive O. Early diagnosis and targeted approaches to pulmonary vascular disease in bronchopulmonary dysplasia. Pediatr Res 2022; 91:804-815. [PMID: 33674739 DOI: 10.1038/s41390-021-01413-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/25/2021] [Indexed: 01/31/2023]
Abstract
Pulmonary hypertension has emerged as a life-threatening disease in preterm infants suffering from bronchopulmonary dysplasia (BPD). Its development is closely linked to respiratory disease, as vasculogenesis and alveologenesis are closely interconnected. Once clinically significant, BPD-associated pulmonary hypertension (BPD-PH) can be challenging to manage, due to poor reversibility and multiple comorbidities frequently associated. The pulmonary vascular disease process underlying BPD-PH is the result of multiple innate and acquired factors, and emerging evidence suggests that it progressively develops since birth and, in certain instances, may begin as early as fetal life. Therefore, early recognition and intervention are of great importance in order to improve long-term outcomes. Based on the most recent knowledge of BPD-PH pathophysiology, we review state-of-the-art screening and diagnostic imaging techniques currently available, their utility for clinicians, and their applicability and limitations in this specific population. We also discuss some biochemical markers studied in humans as a possible complement to imaging for the detection of pulmonary vascular disease at its early stages and the monitoring of its progression. In the second part, we review pharmacological agents currently available for BPD-PH treatment or under preclinical investigation, and discuss their applicability, as well as possible approaches for early-stage interventions in fetuses and neonates. IMPACT: BPD-associated PH is a complex disease involving genetic and epigenetic factors, as well as environmental exposures starting from fetal life. The value of combining multiple imaging and biochemical biomarkers is emerging, but requires larger, multicenter studies for validation and diffusion. Since "single-bullet" approaches have proven elusive so far, combined pharmacological regimen and cell-based therapies may represent important avenues for research leading to future cure and prevention.
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Affiliation(s)
- Catheline Hocq
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Laetitia Vanhoutte
- Division of Pediatric Cardiology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Axelle Guilloteau
- Division of Clinical Pharmacy, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Anna Claudia Massolo
- Department of Surgical and Medical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Bénédicte Van Grambezen
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Kate Carkeek
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Fiammetta Piersigilli
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Olivier Danhaive
- Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium. .,Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
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27
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Bonnet D, Szezepanski I, Delacourt C, Malkezadeh-Milani S, Lévy M. Multifactorial pulmonary hypertension in infantile scimitar syndrome. Arch Cardiovasc Dis 2022; 115:142-150. [DOI: 10.1016/j.acvd.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
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28
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Huang Z, Lin B, Han D, Wang X, Zhong J, Wagenaar GTM, Yang C, Chen X. Platelets are indispensable for alveolar development in neonatal mice. Front Pediatr 2022; 10:943054. [PMID: 36016884 PMCID: PMC9396244 DOI: 10.3389/fped.2022.943054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Previous studies suggest that platelets are involved in fetal and adult lung development, but their role in postnatal lung development especially after premature birth is elusive. There is an urgent need to scrutinize this topic because the incidence of bronchopulmonary dysplasia (BPD), a chronic lung disease after premature birth, remains high. We have previously shown impaired platelet biogenesis in infants and rats with BPD. In this study, we investigated the role of anti-CD41 antibody-induced platelet depletion during normal postnatal lung development and thrombopoietin (TPO)-induced platelet biogenesis in mice with experimental BPD. We demonstrate that platelet deficient mice develop a BPD-like phenotype, characterized by enlarged alveoli and vascular remodeling of the small pulmonary arteries, resulting in pulmonary arterial hypertension (PAH)-induced right ventricular hypertrophy (RVH). Vascular remodeling was potentially caused by endothelial dysfunction demonstrated by elevated von Willebrand factor (vWF) concentration in plasma and reduced vWF staining in lung tissue with platelet depletion. Furthermore, TPO-induced platelet biogenesis in mice with experimental BPD improved alveolar simplification and ameliorated vascular remodeling. These findings demonstrate that platelets are indispensable for normal postnatal lung development and attenuation of BPD, probably by maintaining endothelial function.
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Affiliation(s)
- Zilu Huang
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Bingchun Lin
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Dongshan Han
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xuan Wang
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Junyan Zhong
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | | | - Chuanzhong Yang
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xueyu Chen
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
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Wang C, Ma X, Xu Y, Chen Z, Shi L, Du L. A prediction model of pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Front Pediatr 2022; 10:925312. [PMID: 35935371 PMCID: PMC9354604 DOI: 10.3389/fped.2022.925312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Pulmonary hypertension (PH) is a severe cardiovascular complication of bronchopulmonary dysplasia (BPD) that contributes to the high mortality rates for preterm infants. The objective of this study is to establish a prediction model of BPD-associated PH (BPD-PH) by integrating multiple predictive factors for infants with BPD. METHOD A retrospective investigation of the perinatal clinical records and data of echocardiography in all the preterm infants with BPD was performed from January 2012 to December 2019. A prediction model of BPD-PH was established based on the univariate and multivariate logistic regression analysis of the clinical data and evaluated by using the area under the receiver operating characteristic (ROC) curve (AUC), combined with the Hosmer-Lemeshow (HL) test. Internal validation was performed with bootstrap resampling. RESULT A total of 268 infants with BPD were divided into the BPD-PH group and the no-PH group. Multivariate logistic regression analysis showed that the independent predictive factors of BPD-PH were moderate to severe BPD, small for gestational age, duration of hemodynamically significant patent ductus arteriosus ≥ 28 days, and early PH. A prediction model was established based on the β coefficients of the four predictors. The area under the ROC curve of the prediction model was 0.930. The Hosmer-Lemeshow test (p = 0.976) and the calibration curve showed good calibration. CONCLUSION The prediction model based on the four risk factors predicts the development of BPD-PH with high sensitivity and specificity and might help clinicians to make individualized interventions to minimize the disease risk.
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Affiliation(s)
- Chenhong Wang
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Xiaolu Ma
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Yanping Xu
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Zheng Chen
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Liping Shi
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Lizhong Du
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
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The value of early echocardiographic parameters to predict late pulmonary hypertension in extreme premature infants. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Neumann RP, Schulzke SM, Pohl C, Wellmann S, Metze B, Burdensky AK, Boos V, Barikbin P, Bührer C, Czernik C. Right ventricular function and vasoactive peptides for early prediction of bronchopulmonary dysplasia. PLoS One 2021; 16:e0257571. [PMID: 34550991 PMCID: PMC8457497 DOI: 10.1371/journal.pone.0257571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To assess the prognostic value of early echocardiographic indices of right ventricular function and vasoactive peptides for prediction of bronchopulmonary dysplasia (BPD) or death in very preterm infants. METHODS Prospective study involving 294 very preterm infants (median [IQR] gestational age 28.4 [26.4-30.4] weeks, birth weight 1065 [800-1380] g), of whom 57 developed BPD (oxygen supplementation at 36 weeks postmenstrual age) and 10 died. Tricuspid annular plane systolic excursion (TAPSE), right ventricular index of myocardial performance (RIMP), plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) and C-terminal pro-endothelin-1 (CT-proET1) were measured on day 7 of life. RESULTS RIMP was significantly increased (median [IQR] 0.3 [0.23-0.38] vs 0.22 [0.15-0.29]), TAPSE decreased (median [IQR] 5.0 [5.0-6.0] vs 6.0 [5.4-7.0] mm), MR-proANP increased (median [IQR] 784 [540-936] vs 353 [247-625] pmol/L), and CT-proET1 increased (median [IQR] 249 [190-345] vs 199 [158-284] pmol/L) in infants who developed BPD or died, as compared to controls. All variables showed significant but weak correlations with each other (rS -0.182 to 0.359) and predicted BPD/death with similar accuracy (areas under receiver operator characteristic curves 0.62 to 0.77). Multiple regression revealed only RIMP and birth weight as independent predictors of BPD or death. CONCLUSIONS Vasoactive peptide concentrations and echocardiographic assessment employing standardized measures, notably RIMP, on day 7 of life are useful to identify preterm infants at increased risk for BPD or death.
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Affiliation(s)
- Roland P. Neumann
- Department of Neonatology, University Children’s Hospital Basel UKBB, University of Basel, Basel, Switzerland
- * E-mail:
| | - Sven M. Schulzke
- Department of Neonatology, University Children’s Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Christian Pohl
- Department of Neonatology, University Children’s Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Sven Wellmann
- Department of Neonatology, University Children’s Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Neonatology, University Regensburg Children’s Hospital (KUNO), University of Regensburg, Regensburg, Germany
| | - Boris Metze
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ann-Katrin Burdensky
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vinzenz Boos
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neonatology, Hospital Zollikerberg, Zollikerberg, Switzerland
| | - Payman Barikbin
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Pediatrics, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Czernik
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Wang L, Zhang F, Li J, Liu Z, Kou Y, Song Y, Xu H, Wang H, Wang Y. Using pulmonary artery acceleration time to evaluate pulmonary hemodynamic changes on preterm infants with respiratory distress syndrome. Transl Pediatr 2021; 10:2287-2297. [PMID: 34733669 PMCID: PMC8506067 DOI: 10.21037/tp-21-341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary artery acceleration time (PAAT) is a reliable and non-invasive method for assessing pulmonary hemodynamics. To date, few studies have used PAAT to assess preterm infants, especially those with respiratory distress syndrome (RDS). This study aimed to assess changes in PAAT among preterm infants with RDS undergoing pulmonary surfactant (PS) therapy or not, and determine its potential effects on the pulmonary vascular disease (PVD) outcomes of preterm infants with RDS in the late postnatal period. METHODS The risk of RDS was reviewed in 62 preterm infants with a gestational age of 26-31 weeks. The infants receiving PS therapy were allocated to the PS group, and the others were allocated to the control group. PAAT, right ventricular ejection time (RVET), and other ultrasonic parameters at 3 different time points after birth were studied and compared. RESULTS Infants in the PS group had a significantly lower PAAT (52.7±5.9 vs. 59.6±8.7; P=0.001) and PAAT/RVET (0.30±0.03 vs. 0.33±0.03; P=0.001) than those in the control group at 36 weeks postmenstrual age (PMA). No significant increases in PAAT/RVET were detected at 3 different times for the PS group (P=0.117), but both PAAT and PAAT/RVET increased significantly with time after birth in the control group (P<0.001). CONCLUSIONS Preterm infants with RDS might still have PVD in the late postnatal period and thus require long-term follow-up observation. PAAT appears to be a reliable non-invasive screening measure for evaluating pulmonary hemodynamics in preterm infants with RDS and late PVD.
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Affiliation(s)
- Liling Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fengjuan Zhang
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiahui Li
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhijie Liu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yan Kou
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yanting Song
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Xu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yulin Wang
- Department of Pediatric Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Early pulmonary hypertension is a risk factor for bronchopulmonary dysplasia-associated late pulmonary hypertension in extremely preterm infants. Sci Rep 2021; 11:11206. [PMID: 34045608 PMCID: PMC8160152 DOI: 10.1038/s41598-021-90769-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
This study evaluated whether early pulmonary hypertension (PH) in extremely preterm infants (EPIs) at 22–27 weeks of gestation detected clinically with echocardiography at 4–7 postnatal days (PND) is a risk factor for death before 36 weeks post-menstrual age (PMA) or late PH in moderate or severe (m/s) bronchopulmonary dysplasia (BPD) (BPD-PH). We analyzed risk factors for death before 36 weeks PMA or BPD-PH. Among 247 EPIs enrolled, 74 (30.0%) had early PH. Twenty-one (28.4%) infants with early PH and 18 (10.4%) without early PH died before 36 weeks PMA; 14 (18.9%) infants with early PH and 9 (5.2%) without early PH had BPD-PH at 36–38 weeks PMA. Multivariate analysis revealed that early PH (adjusted odds ratio, 6.55; 95% confidence interval, 3.10–13.82, P < 0.05), clinical chorioamnionitis (2.50; 1.18–5.31), intraventricular hemorrhage (grade 3–4) (3.43; 1.26–9.37), and late sepsis (6.76; 3.20–14.28) independently increased the risk of development of death before 36 weeks PMA or BPD-PH. Subgroup analysis among m/s BPD patients revealed that early PH (4.50; 1.61–12.58) and prolonged invasive ventilator care (> 28 days) (4.91; 1.02–23.68) increased the risk for late PH independently. In conclusion, EPIs with early PH at 4–7 PND should be monitored for BPD-associated late PH development.
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Varghese NP, Tillman RH, Keller RL. Pulmonary hypertension is an important co-morbidity in developmental lung diseases of infancy: Bronchopulmonary dysplasia and congenital diaphragmatic hernia. Pediatr Pulmonol 2021; 56:670-677. [PMID: 33561308 DOI: 10.1002/ppul.25258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/30/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022]
Abstract
Bronchopulmonary dysplasia (BPD) following preterm birth and congenital diaphragmatic hernia (CDH) are both forms of developmental lung disease that may result in persistent pulmonary and pulmonary vascular morbidity in childhood. The pulmonary vascular disease (PVD) which accompanies BPD and CDH is due to developmental abnormalities and ongoing perinatal insults. This may be accompanied by evidence of elevated right heart pressures and pulmonary vascular resistance, leading to diagnosis of pulmonary hypertension (PH). The development of PH in these conditions is associated with increased morbidity and mortality in the vulnerable BPD and CDH populations. We present a review of PVD pathogenesis and evaluation in BPD and CDH and discuss management of related sequelae of PH co-morbidity for affected infants.
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Affiliation(s)
| | - Robert H Tillman
- Pediatric Pulmonary Medicine, Atrium Health, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Roberta L Keller
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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35
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Lakshminrusimha S. Neonatal and Postneonatal Pulmonary Hypertension. CHILDREN-BASEL 2021; 8:children8020131. [PMID: 33670256 PMCID: PMC7918656 DOI: 10.3390/children8020131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
During transition at birth with ventilation of the lungs, pulmonary vascular resistance (PVR) decreases from high fetal values, leading to an 8 to 10-fold increase in pulmonary blood flow (Qp). In some infants, this transition does not occur, resulting in pulmonary hypertension (PH). In infants, PH can present as: (a) primary PH in term neonates (idiopathic), (b) PH secondary to lung disease or hypoplasia in term infants, (c) acute PH in preterm infants with respiratory distress syndrome (RDS), (d) chronic PH with bronchopulmonary dysplasia (BPD) in preterm infants and (e) post-neonatal PH. A hemodynamically significant patent ductus arteriosus (PDA) can exacerbate PH in preterm infants due to increased Qp. Pulmonary vein stenosis (PVS) can complicate BPD with PH. Diagnosis of PH is based on clinical features, echocardiography and, in some intractable cases, cardiac catheterization. Therapy of PH includes oxygen, invasive or non-invasive ventilation, correction of acidosis, surfactant and selective and non-selective pulmonary vasodilators such as inhaled nitric oxide and sildenafil, respectively. Early closure of a hemodynamically significant PDA has the potential to limit pulmonary vascular remodeling associated with BPD and PH. The role of thiamine in pathogenesis of PH is also discussed with the recent increase in thiamine-responsive acute pulmonary hypertension in early infancy. Recognition and prompt therapy of PH can prevent right ventricular dysfunction, uncoupling and failure.
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Affiliation(s)
- Satyan Lakshminrusimha
- Department of Pediatrics, UC Davis Children's Hospital; University of California Davis, Sacramento, CA 95817, USA
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36
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McKinney RL, Schmidhoefer JJ, Balasco AL, Machan JT, Hirway P, Keszler M. Severe bronchopulmonary dysplasia: outcomes before and after the implementation of an inpatient multidisciplinary team. J Perinatol 2021; 41:544-550. [PMID: 33097819 PMCID: PMC7581687 DOI: 10.1038/s41372-020-00863-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/01/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Severe bronchopulmonary dysplasia (sBPD) can lead to long term morbidity. We created a sBPD multidisciplinary team in 2011 to optimize care and improve outcomes. STUDY DESIGN Retrospective chart review of three groups between 2008 and 2016: patients with sBPD born before 2011, patients with sBPD born after 2011, and patients with moderate BPD born after 2011. RESULTS Infants with sBPD after 2011 had a shorter NICU length of stay compared with children born before 2011 (mean 140 days vs 170 days p < 0.007), weighed more at discharge (z-score -0.8 vs -1.35 p = 0.01), had less failure to thrive post discharge (32% vs 51% p = 0.05) and had more well visits in the first six months of life (mean 6.7 vs 5.3 p = 0.04). No difference was observed in the rate of readmissions in the first two years of life. CONCLUSION Our multidisciplinary team has improved the inpatient management of patients with sBPD.
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Affiliation(s)
- Robin L. McKinney
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Joseph J. Schmidhoefer
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Alyssa L. Balasco
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Jason T. Machan
- grid.40263.330000 0004 1936 9094Lifespan Biostatistics Core and Departments of Orthopedics and Surgery, Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Priya Hirway
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Martin Keszler
- grid.40263.330000 0004 1936 9094Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
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Du Y, Yuan L, Zhou JG, Huang XY, Lin SB, Yuan M, He Y, Mao WY, Ai DY, Chen C. Echocardiography evaluation of bronchopulmonary dysplasia-associated pulmonary hypertension: a retrospective observational cohort study. Transl Pediatr 2021; 10:73-82. [PMID: 33633939 PMCID: PMC7882291 DOI: 10.21037/tp-20-192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Echocardiography has poor accuracy in grading the severity of pulmonary hypertension (PH) compared to cardiac catheterization. However, the relationship between degree of PH and prognostic outcomes remains uncertain. Our primary objective was to determine whether echocardiogram-assessed PH severity is associated with mortality and hospital readmission in the first year of life. METHODS A retrospective cohort study of infants born less than 32 weeks of gestational age with bronchopulmonary dysplasia (BPD) underwent echocardiography was performed. Echocardiograms were performed at 36-38 weeks postmenstrual age. Data during hospitalization and post-discharge collected at 1-year age were analyzed with cox regression models and logistic regression models to identify the association of PH severity with mortality and readmission. Area under curve (AUC) was calculated to examine the accuracy of these models to reflect the likelihood of outcomes. RESULTS Fifty-six of 237 (23.6%) infants were diagnosed as PH. Moderate and severe PH was significantly associated with mortality during the first one year of life (moderate PH vs. none HR =26.58, 95% CI: 4.40-160.78, P<0.001; severe PH vs. none HR =36.49, 95% CI: 5.65-235.84, P<0.001). Male, preeclampsia and inhaled nitric oxide were also associated with mortality. Mild PH was significantly associated with readmission (OR =2.42, 95% CI: 1.12-5.26, P=0.025), but not associated with mortality (HR =2.09, 95% CI: 0.43-10.18, P=0.36). The PH severity model based on echocardiography accurately informed mortality (AUC 0.79). CONCLUSIONS Echocardiogram-assessed PH severity is associated with prognostic outcomes, including mortality and readmission in very preterm infants with BPD. The severity of PH based on echocardiography is a potential predictor of mortality in the first year of life.
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Affiliation(s)
- Yang Du
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Yuan
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Jian-Guo Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiang-Yuan Huang
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China
| | - Sam Bill Lin
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Meng Yuan
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yue He
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Wei-Ying Mao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Dan-Yang Ai
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Pulmonary hypertension in extremely preterm infants: a call to standardize echocardiographic screening and follow-up policy. Eur J Pediatr 2021; 180:1855-1865. [PMID: 33528615 PMCID: PMC8105237 DOI: 10.1007/s00431-021-03931-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/06/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension (PH) is a frequent complication in extremely preterm born infants that seriously affects outcome. We aimed to describe the prevalence of PH in extremely preterm infants and the policy on screening and follow-up in the ten Dutch intensive care units (NICUs). We performed a retrospective cohort study at the University Medical Centre Groningen on infants with gestational age < 30 weeks and/or birthweight < 1000 g, born between 2012 and 2013. Additionally, we carried out a survey among the Dutch NICUs covering questions on the awareness of PH, the perceived prevalence, and policy regarding screening and following PH in extremely preterm infants. Prevalence of early-onset PH in our study was 26% and 5% for late-onset PH. PH was associated with poor survival and early-onset PH was associated with subsequent development of bronchopulmonary dysplasia (BPD). All the NICUs completed the questionnaire and we found that no standardized policy existed regarding screening and following PH in extremely preterm infants.Conclusion: Despite the frequent occurrence of PH and its clinically important consequences, (inter-)national standardized guidelines regarding screening and following of PH in extremely preterm infants are lacking. Standardizing screening and follow-up will enable early identification of infants with late-onset PH and allow for earlier treatment. Additionally, greater clarity is required regarding the prevalence of early PH as are new preventive treatment strategies to combat BPD. What is known? • Pulmonary hypertension (PH) substantially impairs the survival of extremely preterm infants. • PH is associated with bronchopulmonary dysplasia (BPD): Early-onset PH predicts the development of BPD. Late-onset PH is prevalent in infants with severe BPD. What is new? • Pulmonary hypertension (PH) is prevalent in preterm infants. Its consequences for morbidity and mortality justify a standardized policy aimed at early detection to improve prevention and treatment. • No structured policy exists in the Netherlands regarding screening/follow-up for PH in extremely preterm infants.
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Arjaans S, Haarman MG, Roofthooft MTR, Fries MWF, Kooi EMW, Bos AF, Berger RMF. Fate of pulmonary hypertension associated with bronchopulmonary dysplasia beyond 36 weeks postmenstrual age. Arch Dis Child Fetal Neonatal Ed 2021; 106:45-50. [PMID: 32571832 PMCID: PMC7788204 DOI: 10.1136/archdischild-2019-318531] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the survival and evolution of pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD) in extremely premature born infants beyond 36 weeks postmenstrual age (PMA). DESIGN A single-centre retrospective cohort study from a university hospital. PATIENTS Extremely preterm (gestational age <30 weeks and/or birth weight <1000 g) infants, born between 2012 and 2017, in the University Medical Center Groningen with confirmed PH at/beyond 36 weeks PMA. MAIN OUTCOME MEASURES Survival, mortality rate and PH resolution. Patient characteristics, treatment, presence and evolution of PH were collected from patient charts. RESULTS Twenty-eight infants were included. All had BPD, while 23 (82%) had severe BPD and 11 infants (39%) died. Survival rates at 1, 3 and 7 months from 36 weeks PMA were 89%, 70% and 58%, respectively. In 16 of the 17 surviving infants, PH resolved over time, with a resolution rate at 1 and 2 years corrected age of 47% and 79%, respectively. At 2.5 years corrected age, the resolution rate was 94%. CONCLUSIONS These extremely preterm born infants with PH-BPD had a survival rate of 58% at 6 months corrected age. Suprasystemic pulmonary artery pressure was associated with poor outcome. In the current study, infants surviving beyond the corrected age of 6 months showed excellent survival and resolution of PH in almost all cases. Prospective follow-up studies should investigate whether resolution of PH in these infants can be improved by multi-modal therapies, including respiratory, nutritional and cardiovascular treatments.
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Affiliation(s)
- Sanne Arjaans
- Pediatric and Congenital Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Meindina G Haarman
- Pediatric and Congenital Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcus T R Roofthooft
- Pediatric and Congenital Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marian W F Fries
- Pediatric and Congenital Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- Division of Neonatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Division of Neonatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf M F Berger
- Pediatric and Congenital Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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40
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Chen Y, Zhang D, Li Y, Yan A, Wang X, Hu X, Shi H, Du Y, Zhang W. Risk Factors and Outcomes of Pulmonary Hypertension in Infants With Bronchopulmonary Dysplasia: A Meta-Analysis. Front Pediatr 2021; 9:695610. [PMID: 34249820 PMCID: PMC8267150 DOI: 10.3389/fped.2021.695610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary hypertension is one of the most common co-morbidities in infants with bronchopulmonary dysplasia (BPD), but its risk factors are unclear. The onset of pulmonary hypertension in BPD has been associated with poor morbidity- and mortality-related outcomes in infants. Two review and meta-analysis studies have evaluated the risk factors and outcomes associated with pulmonary hypertension in infants with BPD. However, the limitations in those studies and the publication of recent cohort studies warrant our up-to-date study. We designed a systematic review and meta-analysis to evaluate the risk factors and outcomes of pulmonary hypertension in infants with BPD. Objective: To systematically evaluate the risk factors and outcomes associated with pulmonary hypertension in infants with BPD. Methods: We systematically searched the academic literature according to the PRISMA guidelines across five databases (Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE). We conducted random-effects meta-analyses to evaluate the pulmonary hypertension risk factors in infants with BPD. We also evaluated the overall morbidity- and mortality-related outcomes in infants with BPD and pulmonary hypertension. Results: We found 15 eligible studies (from the initial 963 of the search result) representing data from 2,156 infants with BPD (mean age, 25.8 ± 0.71 weeks). The overall methodological quality of the included studies was high. Our meta-analysis in infants with severe BPD revealed increased risks of pulmonary hypertension [Odds ratio (OR) 11.2], sepsis (OR, 2.05), pre-eclampsia (OR, 1.62), and oligohydramnios (OR, 1.38) of being small for gestational age (3.31). Moreover, a comparative analysis found medium-to-large effects of pulmonary hypertension on the total duration of hospital stay (Hedge's g, 0.50), the total duration of oxygen received (g, 0.93), the cognitive score (g, -1.5), and the overall mortality (g, 0.83) in infants with BPD. Conclusion: We identified several possible risk factors (i.e., severe BPD, sepsis, small for gestational age, pre-eclampsia) which promoted the onset of pulmonary hypertension in infants with BPD. Moreover, our review sheds light on the morbidity- and mortality-related outcomes associated with pulmonary hypertension in these infants. Our present findings are in line with the existing literature. The findings from this research will be useful in development of efficient risk-based screening system that determine the outcomes associated with pulmonary hypertension in infants with BPD.
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Affiliation(s)
- Ying Chen
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Di Zhang
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Ying Li
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Aixia Yan
- Department of Pediatrics, Aerspace Central Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Xiaoming Hu
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Hangting Shi
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yue Du
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Wenhui Zhang
- Department of Neonatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
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Impact of pulmonary hypertension and congenital heart disease with hemodynamic repercussion on the severity of acute respiratory infections in children under 5 years of age at a pediatric referral center in Colombia, South America. Cardiol Young 2020; 30:1866-1873. [PMID: 32993838 DOI: 10.1017/s1047951120002991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute respiratory infection is one of the main causes of morbidity in children. Some studies have suggested that pulmonary hypertension and congenital heart disease with haemodynamic repercussion increase the severity of respiratory infections, but there are few publications in developing countries. METHODS This was a prospective cohort study evaluating the impact of pulmonary hypertension and congenital heart disease (CHD) with haemodynamic repercussion as predictors of severity in children under 5 years of age hospitalised for acute respiratory infection. RESULTS Altogether, 217 children hospitalised for a respiratory infection who underwent an echocardiogram were evaluated; 62 children were diagnosed with CHD with haemodynamic repercussion or pulmonary hypertension. Independent predictors of admission to intensive care included: pulmonary hypertension (RR 2.14; 95% CI 1.06-4.35, p = 0.034), respiratory syncytial virus (RR 2.52; 95% CI 1.29-4.92, p = 0.006), and bacterial pneumonia (RR 3.09; 95% CI 1.65-5.81, p = 0.000). A significant difference was found in average length of hospital stay in children with the cardiovascular conditions studied (p = 0.000). CONCLUSIONS Pulmonary hypertension and CHD with haemodynamic repercussion as well as respiratory syncytial virus and bacterial pneumonia were predictors of severity in children with respiratory infections in this study. Early recognition of cardiovascular risks in paediatric populations is necessary to lessen the impact on respiratory infections.
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Jang MJ, Song YH, Yoon JM, Cheon EJ, Ko KO, Lim JW. Mortality Rate and Major Causes of Death by Gestational Age in Korean Children under 5 Years of Age. J Korean Med Sci 2020; 35:e340. [PMID: 33075854 PMCID: PMC7572229 DOI: 10.3346/jkms.2020.35.e340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preterm birth is associated with increased infant mortality. However, it is not clear whether prematurity is associated with mortality after 1 year of age. There is a lack of research on mortality rate and causes of death after infancy in preterm babies in Korea. We aimed to analyze the mortality rates and causes of deaths up to 5 years of age in Korea. METHODS Using the Microdata Integrated Service of Statistics Korea database, this retrospective cohort study screened infants born between 2010 and 2012. After applying the exclusion criteria, 1,422,913 live births were classified into the following groups by gestational age: those born at < 32 weeks' gestation (n = 10,411), those born between 32 and 36 weeks' gestation (n = 75,657), and those born at ≥ 37 weeks' gestation (n = 1,336,845). The association of gestational age with mortality in infancy (< 1 year of age) and childhood (1-5 years of age) was analyzed, with and without covariates. The major causes of death in infancy and childhood were analyzed by gestational age. RESULTS Overall, 4,930 (0.3%) children died between birth and 5 years of age, with 19.1% of these deaths occurring after infancy. Adjusted hazard ratios (HRs) for infant death were 78.79 (95% confidence interval [CI], 71.33-87.04) and 4.62 (95% CI, 4.07-5.24) for the < 32 and 32-36 weeks groups, respectively, compared to the full-term group; the adjusted HRs for deaths occurring at ages 1-5 years were 9.25 (95% CI, 6.85-12.50) and 2.42 (95% CI, 1.95-3.01), respectively. In infancy, conditions originating in the perinatal period were the most common cause of deaths in the < 32 and 32-36 weeks groups (88.7% and 41.9%, respectively). Contrarily, in the ≥ 37 weeks group, conditions originating in the perinatal period explained 22.7% of infant deaths, with congenital malformations primarily accounting for 29.6% of these deaths. The most common cause of death in children (after infancy) in the < 32 weeks group was perinatal causes (25.0%); in the 32-36 weeks group, congenital malformation and nervous system disease were the common causes (21.7% and 19.1%, respectively). In the ≥ 37 weeks group, injury, poisoning, and other consequences of external causes explained 26.6% of childhood deaths, followed by neoplasms and nervous system disease (15.7% and 14.7%, respectively). CONCLUSION Low gestational age is associated with not only infant mortality but also child mortality. The major causes of death differed by gestational age in infancy and childhood. For the care of preterm infants, especially those born at < 32 weeks' gestation, particular attention and continuous monitoring are needed in consideration of the major causes of deaths until 5 years of age.
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Affiliation(s)
- Min Jeong Jang
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Young Hwa Song
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Kyung Ok Ko
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea.
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Gong J, Feng Z, Peterson AL, Carr JF, Vang A, Braza J, Choudhary G, Dennery PA, Yao H. Endothelial to mesenchymal transition during neonatal hyperoxia-induced pulmonary hypertension. J Pathol 2020; 252:411-422. [PMID: 32815166 DOI: 10.1002/path.5534] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Abstract
Bronchopulmonary dysplasia (BPD), a chronic lung disease in premature infants, results from mechanical ventilation and hyperoxia, amongst other factors. Although most BPD survivors can be weaned from supplemental oxygen, many show evidence of cardiovascular sequelae in adulthood, including pulmonary hypertension and pulmonary vascular remodeling. Endothelial-mesenchymal transition (EndoMT) plays an important role in mediating vascular remodeling in idiopathic pulmonary arterial hypertension. Whether hyperoxic exposure, a known mediator of BPD in rodent models, causes EndoMT resulting in vascular remodeling and pulmonary hypertension remains unclear. We hypothesized that neonatal hyperoxic exposure causes EndoMT, leading to the development of pulmonary hypertension in adulthood. To test this hypothesis, newborn mice were exposed to hyperoxia and then allowed to recover in room air until adulthood. Neonatal hyperoxic exposure gradually caused pulmonary vascular and right ventricle remodeling as well as pulmonary hypertension. Male mice were more susceptible to developing pulmonary hypertension compared to female mice, when exposed to hyperoxia as newborns. Hyperoxic exposure induced EndoMT in mouse lungs as well as in cultured lung microvascular endothelial cells (LMVECs) isolated from neonatal mice and human fetal donors. This was augmented in cultured LMVECs from male donors compared to those from female donors. Using primary mouse LMVECs, hyperoxic exposure increased phosphorylation of both Smad2 and Smad3, but reduced Smad7 protein levels. Treatment with a selective TGF-β inhibitor SB431542 blocked hyperoxia-induced EndoMT in vitro. Altogether, we show that neonatal hyperoxic exposure caused vascular remodeling and pulmonary hypertension in adulthood. This was associated with increased EndoMT. These novel observations provide mechanisms underlying hyperoxia-induced vascular remodeling and potential approaches to prevent BPD-associated pulmonary hypertension by targeting EndoMT. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Jiannan Gong
- Department of Molecular Biology, Cell Biology & Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA.,Department of Respiratory and Critical Care Medicine, Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, PR China
| | - Zihang Feng
- Department of Molecular Biology, Cell Biology & Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Abigail L Peterson
- Department of Molecular Biology, Cell Biology & Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Jennifer F Carr
- Department of Molecular Biology, Cell Biology & Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Alexander Vang
- Vascular Research Laboratory, Providence VA Medical Center, Providence, RI, USA
| | - Julie Braza
- Vascular Research Laboratory, Providence VA Medical Center, Providence, RI, USA
| | - Gaurav Choudhary
- Vascular Research Laboratory, Providence VA Medical Center, Providence, RI, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Phyllis A Dennery
- Department of Molecular Biology, Cell Biology & Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA.,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hongwei Yao
- Department of Molecular Biology, Cell Biology & Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA
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Giagnorio R, Hansmann G. Mineralocorticoid receptor blockade improves pulmonary hypertension and right ventricular function in bronchopulmonary dysplasia: a case report. Cardiovasc Diagn Ther 2020; 10:1686-1690. [PMID: 33224781 DOI: 10.21037/cdt.2020.02.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a combined pulmonary vascular and parenchymal disease, representing the most common cause of chronic lung disease (CLD) in infancy. Pulmonary hypertension (PH) is frequently associated with BPD and-if persistent-substantially increases mortality. We report on a 4-month-old, former preterm infant with BPD, severe PH and right heart failure who greatly and rapidly improved clinical status and right ventricular (RV) function by means of blood biomarkers [N-terminal prohormone of brain natriuretic peptide (NT-pro-BNP), cardiac troponin T] and transthoracic echocardiography, following the addition of spironolactone and hydrochlorothiazide to the treatment regimen.
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Affiliation(s)
- Roberto Giagnorio
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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Yoon YM, Bae SP, Kim YJ, Kwak JG, Kim WH, Song MK, Shin SH, Kim EK, Kim HS. New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease. Clin Exp Pediatr 2020; 63:395-401. [PMID: 32668824 PMCID: PMC7568950 DOI: 10.3345/cep.2019.01522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/18/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite advances in neonatal intensive care and surgical procedures, perinatal mortality rates for premature infants with congenital heart disease (CHD) remain relatively high. PURPOSE We aimed to describe the outcomes of premature infants with critical CHD and identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) category associated with in-hospital mortality in a Korean tertiary center. METHODS This was a retrospective cohort study of premature infants with critical CHD admitted to the neonatal intensive care unit from January 2005 to December 2016. RESULTS A total of 78 premature infants were enrolled. The median gestational age (GA) at birth was 34.9 weeks (range, 26.7-36.9 weeks), and the median birth weight was 1.91 kg (range, 0.53-4.38 kg). Surgical or percutaneous intervention was performed in 68 patients with a median GA at birth of 34.7 weeks (range, 26.7-36.8 weeks) and a median birth weight of 1.92 kg (range, 0.53-4.38 kg). The in-hospital survival rate was 76.9% among all enrolled preterm infants and 86.8% among patients who received an intervention. Very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS category 5 or higher (more complex CHD) were independently associated with in-hospital mortality. For the 68 premature infants undergoing cardiac interventions, independent risk factors for mortality were VLBW, BPD, and CHD complexity. Late preterm infant and age at intervention were not associated with patient survival. CONCLUSION For premature infants with critical CHD, VLBW, PPHN, BPD, and M-RACHS category ≥5 were risk factors for mortality. A careful approach to surgical intervention and prenatal care should be taken according to CHD type and neonatal condition.
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Affiliation(s)
- Young Mi Yoon
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Seong Phil Bae
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Yoon-Joo Kim
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Hospital Children`s Hospital, Seoul, Korea
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Shapiro S, Trail-Burns E, Slader MG, Laptook A, De Paepe ME. Correlation between chorionic plate vascularization and risk of bronchopulmonary dysplasia in extremely preterm infants. Placenta 2020; 101:154-158. [PMID: 32980792 DOI: 10.1016/j.placenta.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION/OBJECTIVES The chorionic plate vessels of the placenta are in direct continuity with the fetal vasculature, suggesting chorionic and fetal angiogenesis may be subjected to similar regulatory mechanisms. In this study, we determined the correlation between chorionic plate vascularization and complications of prematurity, focusing on bronchopulmonary dysplasia (BPD) and other conditions with important microvascular components. METHODS We performed a clinicoplacental analysis of 127 extremely preterm infants (23-28 weeks gestation). Chorionic plate vascularization was assessed by number and density of perforating chorionic vessels (PCVs). Charts were reviewed for relevant maternal and neonatal data, including respiratory, neurologic and gastrointestinal complications of prematurity. RESULTS The placentas displayed marked variability in number (36-523/placenta) and density of PCVs (0.46-3.74 PC V/cm2). The median PCV density of infants with severe BPD was significantly higher than that of infants without BPD (1.51 PC V/cm2 versus 1.09 PC V/cm2, P < 0.05). Conversely, the frequency of moderate-to-severe BPD was 33% higher in infants with PCV density ≥1.50 PC V/cm2 than in those with PCV density <1.50 PC V/cm2 (56% versus 40%, P < 0.01). There was no correlation with neonatal neurologic or gastrointestinal complications. CONCLUSION Chorionic plate vascularization correlates with frequency and severity of BPD, supporting a vascular basis that in part is antenatal in origin. Quantitative assessment of chorionic plate vascularization may allow early identification of preterm infants at high risk for BPD (proposed threshold: PCV density ≥1.50 PC V/cm2). The lack of correlation between chorionic vascularization and neurologic/gastrointestinal complications suggests these conditions may have less important antenatal and/or vascular contributions.
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Affiliation(s)
- Svetlana Shapiro
- Departments of Pathology and Pediatrics, Women and Infants Hospital, Department of Pathology and Laboratory Medicine and the Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, 02905, USA
| | - Elizabeth Trail-Burns
- Departments of Pathology and Pediatrics, Women and Infants Hospital, Department of Pathology and Laboratory Medicine and the Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, 02905, USA
| | - Margaret G Slader
- Departments of Pathology and Pediatrics, Women and Infants Hospital, Department of Pathology and Laboratory Medicine and the Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, 02905, USA
| | - Abbot Laptook
- Departments of Pathology and Pediatrics, Women and Infants Hospital, Department of Pathology and Laboratory Medicine and the Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, 02905, USA
| | - Monique E De Paepe
- Departments of Pathology and Pediatrics, Women and Infants Hospital, Department of Pathology and Laboratory Medicine and the Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, 02905, USA.
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Wu KY, Jensen EA, White AM, Wang Y, Biko DM, Nilan K, Fraga MV, Mercer-Rosa L, Zhang H, Kirpalani H. Characterization of Disease Phenotype in Very Preterm Infants with Severe Bronchopulmonary Dysplasia. Am J Respir Crit Care Med 2020; 201:1398-1406. [PMID: 31995403 DOI: 10.1164/rccm.201907-1342oc] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Bronchopulmonary dysplasia (BPD) is a heterogenous condition with poorly characterized disease subgroups.Objectives: To define the frequency of three disease components: moderate-severe parenchymal disease, pulmonary hypertension (PH), or large airway disease, in a referral cohort of preterm infants with severe BPD. The association between each component and a primary composite outcome of death before hospital discharge, tracheostomy, or home pulmonary vasodilator therapy was assessed.Methods: This was a retrospective, single-center cohort study of infants born at <32 weeks' gestation with severe BPD who underwent both chest computed tomography with angiography (CTA) and echocardiography between 40 and 50 weeks postmenstrual age between 2011 and 2015. Moderate-severe parenchymal lung disease was defined as an Ochiai score ≥8 on CTA. PH was diagnosed by echocardiogram using standard criteria. Large airway disease was defined as tracheomalacia or bronchomalacia on bronchoscopy and/or tracheoscopy or CTA.Measurements and Main Results: Of 76 evaluated infants, 73 (96%) were classifiable into phenotypic subgroups: 57 with moderate-severe parenchymal disease, 48 with PH, and 44 with large airway disease. The presence of all three disease components was most common (n = 23). Individually, PH and large airway disease, but not moderate-severe parenchymal disease, were associated with increased risk for the primary study outcome. Having more disease components was associated with an incremental increase in the risk for the primary outcome (2 vs. 1: odds ratio, 4.9; 95% confidence interval, 1.4-17.2 and 3 vs. 1: odds ratio, 12.8; 95% confidence interval, 2.4-70.0).Conclusions: Infants with severe BPD are variable in their predominant pathophysiology. Disease phenotyping may enable better risk stratification and targeted therapeutic intervention.
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Affiliation(s)
| | | | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Yan Wang
- Division of Pediatric Cardiology, Department of Pediatrics, and
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | | | | | - Huayan Zhang
- Division of Neonatology.,Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou, China
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Critser PJ, Higano NS, Lang SM, Kingma PS, Fleck RJ, Hirsch R, Taylor MD, Woods JC. Cardiovascular magnetic resonance imaging derived septal curvature in neonates with bronchopulmonary dysplasia associated pulmonary hypertension. J Cardiovasc Magn Reson 2020; 22:50. [PMID: 32698897 PMCID: PMC7376717 DOI: 10.1186/s12968-020-00643-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) associated with pulmonary hypertension (PH) is a significant source of morbidity and mortality in premature infants. Recent advances have allowed the use of cardiovascular magnetic resonance (CMR) in the assessment of respiratory and cardiac disease in infants with BPD. In adults and older pediatric patients, decreased CMR interventricular septal curvature correlates with increased mean pulmonary artery pressure and pulmonary vascular resistance. The current study sought to determine the relationship of CMR derived septal curvature in neonates with BPD and BPD-PH with a need for PH therapy. METHODS Forty moderate or severe BPD and 12 mild BPD or control infants were imaged without contrast between 38 and 47 weeks post-menstrual age on a neonatal-sized, neonatal intensive care unit-sited 1.5 T CMR scanner. CMR indices including eccentricity index (CMR-EI) and septal curvature were measured and compared to BPD severity and clinical outcomes including hospital length of stay (LOS), duration of respiratory support, respiratory support level at discharge and PH therapy. RESULTS CMR-EI was directly associated and septal curvature was inversely associated with BPD severity. In a univariate analysis, CMR-EI and septal curvature were associated with increased hospital LOS, duration of respiratory support, respiratory support at hospital discharge, and need for PH therapy. In multivariable analysis CMR-EI was associated with hospital LOS and duration of respiratory support and septal curvature was associated with respiratory support at hospital discharge. Septal curvature was the only clinical or CMR variable associated with need for PH therapy (R2 = 0.66, p = 0.0014) in multivariable analysis demonstrating improved discrimination beyond CMR-EI. CONCLUSIONS CMR derived septal curvature correlates significantly with clinical outcomes including hospital LOS, duration of respiratory support, respiratory support level at hospital discharge, and PH therapy in neonates with BPD and BPD-PH. Further, CMR derived septal curvature demonstrated improved discrimination of need for PH therapy and respiratory support at discharge compared to clinical variables and other CMR indices, supporting septal curvature as a non-invasive marker of PH in this population with potential to guide management strategies.
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Affiliation(s)
- Paul J Critser
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nara S Higano
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Paul S Kingma
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert J Fleck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5033, Cincinnati, OH, 45229, USA
| | - Russel Hirsch
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Michael D Taylor
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5033, Cincinnati, OH, 45229, USA.
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Seedorf G, Kim C, Wallace B, Mandell EW, Nowlin T, Shepherd D, Abman SH. rhIGF-1/BP3 Preserves Lung Growth and Prevents Pulmonary Hypertension in Experimental Bronchopulmonary Dysplasia. Am J Respir Crit Care Med 2020; 201:1120-1134. [PMID: 32101461 PMCID: PMC7193843 DOI: 10.1164/rccm.201910-1975oc] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/25/2020] [Indexed: 12/03/2022] Open
Abstract
Rationale: Antenatal factors, such as chorioamnionitis, preeclampsia, and postnatal injury, are associated with an increased risk for bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) after preterm birth. IGF-1 (insulin-like growth factor-1) is markedly decreased in normal preterm infants, but whether IGF-1 treatment can prevent BPD or PH is unknown.Objectives: To evaluate whether postnatal treatment with rhIGF-1 (recombinant human IGF-1)/BP3 (binding peptide 3) improves lung growth and prevents PH in two antenatal models of BPD induced by intraamniotic exposure to endotoxin (ETX) or sFlt-1 (soluble fms-like tyrosine kinase 1), and in a postnatal model due to prolonged hyperoxia.Methods: ETX or sFlt-1 were administered into the amniotic sac of pregnant rats at Embryonic Day 20 to simulate antenatal models of chorioamnionitis and preeclampsia, respectively. Pups were delivered by cesarean section at Embryonic Day 22 and treated with rhIGF-1/BP3 (0.02-20 mg/kg/d intraperitoneal) or buffer for 2 weeks. Study endpoints included radial alveolar counts (RACs), vessel density, and right ventricular hypertrophy (RVH). Direct effects of rhIGF-1/BP3 (250 ng/ml) on fetal lung endothelial cell proliferation and tube formation and alveolar type 2 cell proliferation were studied by standard methods in vitro.Measurements and Main Results: Antenatal ETX and antenatal sFlt-1 reduced RAC and decreased RVH in infant rats. In both models, postnatal rhIGF-1/BP3 treatment restored RAC and RVH to normal values when compared with placebo injections. rhIGF-1/BP3 treatment also preserved lung structure and prevented RVH after postnatal hyperoxia. In vitro studies showed that rhIGF-1/BP3 treatment increased lung endothelial cell and alveolar type 2 cell proliferation.Conclusions: Postnatal rhIGF-1/BP3 treatment preserved lung structure and prevented RVH in antenatal and postnatal BPD models. rhIGF-1/BP3 treatment may provide a novel strategy for the prevention of BPD in preterm infants.
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Affiliation(s)
| | - Christina Kim
- Pediatric Heart Lung Center
- Department of Surgery, and
| | | | | | | | - Douglas Shepherd
- Pediatric Heart Lung Center
- Department of Pharmacology, University of Colorado Anschutz Medical Center and Children’s Hospital Colorado, Aurora, Colorado; and
- Department of Physics, Center for Biological Physics, Arizona State University, Tempe, Arizona
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Segar JL. Rethinking furosemide use for infants with bronchopulmonary dysplasia. Pediatr Pulmonol 2020; 55:1100-1103. [PMID: 32176837 DOI: 10.1002/ppul.24722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/01/2020] [Indexed: 12/27/2022]
Abstract
Diuretics are commonly administered to infants with bronchopulmonary dysplasia (BPD) to improve respiratory function despite the absence of prospective data demonstrating long term benefits. While many potentially adverse effects of furosemide are known to clinicians, its direct and indirect impact on multiple pathophysiological processes need to be understood. While furosemide likely has a role in the management of infants with BPD, clinicians are encouraged to recognize these potential complications associated with furosemide administration. Specifically, a deeper understanding of the impact of diuretics on sodium metabolism neurohumoral regulation of cardiopulmonary physiology is required.
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Affiliation(s)
- Jeffrey L Segar
- Division of Neonatology, Departments of Pediatrics and Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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