1
|
Michel-Macías C, Hébert A, Altit G. Optimizing management of chronic pulmonary hypertension in preterm infants: strategies for a complex population. Curr Opin Pediatr 2024; 36:581-590. [PMID: 38957100 DOI: 10.1097/mop.0000000000001383] [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] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Pulmonary hypertension (PH) is commonly observed in premature infants with bronchopulmonary dysplasia (BPD) and is associated with poor outcomes and increased mortality. This review explores the management of this intricate condition of the pulmonary vasculature, which exhibits heterogeneous effects and may involve both arterial and postcapillary components. RECENT FINDINGS Current management of BPD-PH should focus on optimizing ventilatory support, which involves treatment of underlying lung disease, transitioning to a chronic phase ventilation strategy and evaluation of the airway. Data on management is limited to observational studies. Diuretics are considered a part of the initial management, particularly in infants with right ventricular dilation. In many cases, pulmonary vasodilator therapy is required to induce pulmonary arterial vasodilation, reduce right ventricular strain, and prevent coronary ischemia and heart failure. Echocardiography plays a pivotal role in guiding treatment decisions and monitoring disease progression. SUMMARY BPD-PH confers a heightened risk of mortality and long-term cardio-respiratory adverse outcomes. Echocardiography has been advocated for screening, while catheterization allows for confirmation in select more complex cases. Successful management of BPD-PH requires a multidisciplinary approach, focusing on optimizing BPD treatment and addressing underlying pathologies.
Collapse
Affiliation(s)
- Carolina Michel-Macías
- Universidad Autónoma de Querétaro, Facultad de Medicina, Querérato, Mexico
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| | - Audrey Hébert
- Division of Neonatology, CHU de Québec, Université Laval, Quebec City
| | - Gabriel Altit
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Din MAU, Wan A, Chu Y, Zhou J, Yan Y, Xu Z. Therapeutic role of extracellular vesicles from human umbilical cord mesenchymal stem cells and their wide therapeutic implications in inflammatory bowel disease and other inflammatory disorder. Front Med (Lausanne) 2024; 11:1406547. [PMID: 39139783 PMCID: PMC11319305 DOI: 10.3389/fmed.2024.1406547] [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: 03/25/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
The chronic immune-mediated inflammatory condition known as inflammatory bowel disease (IBD) significantly affects the gastrointestinal system. While the precise etiology of IBD remains elusive, extensive research suggests that a range of pathophysiological pathways and immunopathological mechanisms may significantly contribute as potential factors. Mesenchymal stem cells (MSCs) have shown significant potential in the development of novel therapeutic approaches for various medical conditions. However, some MSCs have been found to exhibit tumorigenic characteristics, which limit their potential for medical treatments. The extracellular vesicles (EVs), paracrine factors play a crucial role in the therapeutic benefits conferred by MSCs. The EVs consist of proteins, microRNAs, and lipids, and are instrumental in facilitating intercellular communication. Due to the ease of maintenance, and decreased immunogenicity, tumorigenicity the EVs have become a new and exciting option for whole cell treatment. This review comprehensively assesses recent preclinical research on human umbilical cord mesenchymal stem cell (hUC-MSC)-derived EVs as a potential IBD therapy. It comprehensively addresses key aspects of various conditions, including diabetes, cancer, dermal injuries, neurological disorders, cardiovascular issues, liver and kidney diseases, and bone-related afflictions.
Collapse
Affiliation(s)
- Muhammad Azhar Ud Din
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Wujin Hospital Affiliated with Jiangsu University, Jiangsu University, Changzhou, China
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine Jiangsu University, Zhenjiang, China
| | | | - Ying Chu
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Wujin Hospital Affiliated with Jiangsu University, Jiangsu University, Changzhou, China
| | - Jing Zhou
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Wujin Hospital Affiliated with Jiangsu University, Jiangsu University, Changzhou, China
| | - Yongmin Yan
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Wujin Hospital Affiliated with Jiangsu University, Jiangsu University, Changzhou, China
| | - Zhiliang Xu
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Wujin Hospital Affiliated with Jiangsu University, Jiangsu University, Changzhou, China
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Varghese NP, Altit G, Gubichuk MM, Siddaiah R. Navigating Diagnostic and Treatment Challenges of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia. J Clin Med 2024; 13:3417. [PMID: 38929946 PMCID: PMC11204350 DOI: 10.3390/jcm13123417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
Advances in perinatal intensive care have significantly enhanced the survival rates of extremely low gestation-al-age neonates but with continued high rates of bronchopulmonary dysplasia (BPD). Nevertheless, as the survival of these infants improves, there is a growing awareness of associated abnormalities in pulmonary vascular development and hemodynamics within the pulmonary circulation. Premature infants, now born as early as 22 weeks, face heightened risks of adverse development in both pulmonary arterial and venous systems. This risk is compounded by parenchymal and airway abnormalities, as well as factors such as inflammation, fibrosis, and adverse growth trajectory. The presence of pulmonary hypertension in bronchopulmonary dysplasia (BPD-PH) has been linked to an increased mortality and substantial morbidities, including a greater susceptibility to later neurodevelopmental challenges. BPD-PH is now recognized to be a spectrum of disease, with a multifactorial pathophysiology. This review discusses the challenges associated with the identification and management of BPD-PH, both of which are important in minimizing further disease progression and improving cardiopulmonary morbidity in the BPD infant.
Collapse
Affiliation(s)
- Nidhy P. Varghese
- Department of Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children’s Hospital, 6701 Fannin St., Ste 1040, Houston, TX 77030, USA
| | - Gabriel Altit
- Division of Neonatology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Megan M. Gubichuk
- Division of Pulmonary and Sleep Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
| | - Roopa Siddaiah
- Department of Pediatrics, Penn State Health Children’s Hospital, Hershey, PA 17033, USA;
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
McNamara PJ, Abman SH, Levy PT. Reengagement with Physiology in Neonatal Heart and Lung Care: A Priority for Training and Practice. J Pediatr 2024; 268:113947. [PMID: 38336199 DOI: 10.1016/j.jpeds.2024.113947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Patrick J McNamara
- Department of Pediatrics, The University of Iowa Stead Family, Iowa City, IA; Internal Medicine, The University of Iowa Stead Family, Iowa City, IA.
| | - Steven H Abman
- Department of Pediatrics and Pediatric Heart Lung Center, University of Colorado Anschutz Medical School and Children's Hospital Colorado, Aurora, CO
| | - Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics Harvard Medical School, Boston, MA
| |
Collapse
|
7
|
Gopagondanahalli KR, Abdul Haium AA, Vora SJ, Sundararaghavan S, Ng WD, Choo TLJ, Ang WL, Binte Mohamad Taib NQ, Wijedasa NHY, Rajadurai VS, Yeo KT, Tan TH. Serial tissue Doppler imaging in the evaluation of bronchopulmonary dysplasia-associated pulmonary hypertension among extremely preterm infants: a prospective observational study. Front Pediatr 2024; 12:1349175. [PMID: 38646509 PMCID: PMC11026596 DOI: 10.3389/fped.2024.1349175] [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: 12/04/2023] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives To evaluate serial tissue Doppler cardiac imaging (TDI) in the evolution of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) among extremely preterm infants. Design Prospective observational study. Setting Single-center, tertiary-level neonatal intensive care unit. Patients Infant born <28 weeks gestation. Main outcome measures Utility of TDI in the early diagnosis and prediction of BPD-PH and optimal timing for screening of BPD-PH. Results A total of 79 infants were included. Of them, 17 (23%) had BPD-PH. The mean gestational age was 25.9 ± 1.1 weeks, and mean birth weight was 830 ± 174 g. The BPD-PH group had a high incidence of hemodynamically significant patent ductus arteriosus (83% vs. 56%, p < 0.018), longer oxygen days (96.16 ± 68.09 vs. 59.35 ± 52.1, p < 0.008), and prolonged hospital stay (133.8 ± 45.9 vs. 106.5 ± 37.9 days, p < 0.005). The left ventricular eccentricity index (0.99 ± 0.1 vs. 1.1 ± 0.7, p < 0.01) and the ratio of acceleration time to right ventricular ejection time showed a statistically significant trend from 33 weeks (0.24 ± 0.05 vs. 0.28 ± 0.05, p < 0.05). At 33 weeks, the BPD-PH group showed prolonged isovolumetric contraction time (27.84 ± 5.5 vs. 22.77 ± 4, p < 0.001), prolonged isovolumetric relaxation time (40.3 ± 7.1 vs. 34.9 ± 5.3, p < 0.003), and abnormal myocardial performance index (0.39 ± 0.05 vs. 0.32 ± 0.03, p < 0.001). These differences persisted at 36 weeks after conceptional gestational age. Conclusions TDI parameters are sensitive in the early evolution of BPD-PH. Diagnostic accuracy can be increased by combining the TDI parameters with conventional echocardiographic parameters. BPD-PH can be recognizable as early as 33-34 weeks of gestation.
Collapse
Affiliation(s)
- Krishna Revanna Gopagondanahalli
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Abdul Alim Abdul Haium
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Shrenik Jitendrakumar Vora
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Sreekanthan Sundararaghavan
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Wei Di Ng
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Tze Liang Jonathan Choo
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Wai Lin Ang
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| | | | | | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
| | - Teng Hong Tan
- Yong Loo Ling Schoolof Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke—NUS Medical School, Singapore, Singapore
- Department of Paediatric Cardiology, KK Women’s and Children’s Hospital, Singapore, Singapore
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Geisinger R, Rios DR, McNamara PJ, Levy PT. Asphyxia, Therapeutic Hypothermia, and Pulmonary Hypertension. Clin Perinatol 2024; 51:127-149. [PMID: 38325938 DOI: 10.1016/j.clp.2023.11.007] [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
Neonates with a perinatal hypoxic insult and subsequent neonatal encephalopathy are at risk of acute pulmonary hypertension (aPH) in the transitional period. The phenotypic contributors to aPH following perinatal asphyxia include a combination of hypoxic vasoconstriction of the pulmonary vascular bed, right heart dysfunction, and left heart dysfunction. Therapeutic hypothermia is the standard of care for neonates with moderate-to-severe hypoxic ischemic encephalopathy. This review summarizes the underlying risk factors, causes of aPH in neonates with perinatal asphyxia, discusses the unique phenotypical contributors to disease, and explores the impact of the initial insult and subsequent therapeutic hypothermia on aPH.
Collapse
Affiliation(s)
- Regan Geisinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Danielle R Rios
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 436, Boston, MA 02115, USA.
| |
Collapse
|
10
|
Fike CD, Aschner JL, Avachat C, Birnbaum AK, Sherwin CMT. Multi-dose enteral L-citrulline administration in premature infants at risk of developing pulmonary hypertension associated with bronchopulmonary dysplasia. J Perinatol 2024; 44:280-287. [PMID: 37907796 PMCID: PMC10844094 DOI: 10.1038/s41372-023-01809-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: 05/31/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Information is needed to guide the design of randomized controlled trials (RCTs) evaluating L-citrulline therapy for premature infants with pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH). Based on our single-dose pharmacokinetic study, we evaluated the ability of a multi-dose enteral L-citrulline strategy to achieve a target trough steady-state L-citrulline plasma concentration and its tolerability in premature infants. STUDY DESIGN Plasma L-citrulline concentrations were measured in six premature infants receiving 60 mg/kg L-citrulline every 6 h for 72 h before the first and last L-citrulline doses. L-citrulline concentrations were compared to concentration-time profiles from our previous study. RESULTS Target trough plasma L-citrulline concentrations were achieved in 2/6 subjects. No serious adverse events occurred. CONCLUSIONS Multi-dose L-citrulline was well tolerated. These results will assist in the design of phase II RCTs evaluating L-citrulline dosage strategies to achieve target plasma L-citrulline concentrations in infants at risk for BPD-PH. CLINICAL TRIALS gov ID: NCT03542812.
Collapse
Affiliation(s)
- Candice D Fike
- Department of Pediatrics, the University of Utah Health, Salt Lake City, UT, USA.
| | - Judy L Aschner
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Charul Avachat
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angela K Birnbaum
- Department of Pediatrics, the University of Utah Health, Salt Lake City, UT, USA
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Catherine M T Sherwin
- Department of Pediatrics, the University of Utah Health, Salt Lake City, UT, USA
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
- Dayton Children's Hospital, Dayton, OH, USA
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| |
Collapse
|
11
|
Villamor E, van Westering-Kroon E, Gonzalez-Luis GE, Bartoš F, Abman SH, Huizing MJ. Patent Ductus Arteriosus and Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension: A Bayesian Meta-Analysis. JAMA Netw Open 2023; 6:e2345299. [PMID: 38015504 PMCID: PMC10685885 DOI: 10.1001/jamanetworkopen.2023.45299] [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: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Bronchopulmonary dysplasia (BPD) is often associated with pulmonary vascular disease and secondary pulmonary hypertension (PH). The pathogenesis of BPD-associated PH (BPD-PH) is complex and involves prenatal and postnatal factors that disrupt pulmonary vascular development, and patent ductus arteriosus (PDA) is a factor potentially associated with risk of BPD-PH that has been identified in very recent studies. Objective To explore the association of PDA with BPD-PH using a bayesian model-averaged (BMA) meta-analysis of studies. Data Sources PubMed and Embase were searched up to April 2023. Key search terms included BPD and PH. Study Selection Studies examining infants with gestational age 32 weeks or less and reporting data on PDA and risk of BPD-PH. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-Analysis of Observational Studies in Epidemiology reporting guidelines. Two independent reviewers extracted data, with a third reviewer checking for accuracy and completeness. Data pooling and effect size calculations were performed by BMA. Main Outcomes and Measures The primary outcome was BPD-PH. BMA was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1, association of PDA with BPD-HP) over the probability of the data under the null hypothesis (H0). Results A total of 32 studies (8513 infants) were included. BMA showed that the evidence in favor of H1 was weak for any PDA (BF10 = 2.90; 10 studies), moderate for hemodynamically significant PDA (BF10 = 3.77; 3 studies), and extreme for surgically ligated or catheter-occluded PDA (BF10 = 294.9; 16 studies). In contrast, the evidence in favor of H0 was weak for medically treated PDA (BF10 = 0.55; 6 studies). In addition, BMA found strong evidence in favor of H1 when prolonged exposure to PDA was analyzed as a dichotomous variable (BF10 = 11.80; 6 studies) and extreme evidence (BF10 = 113.60; 3 studies) when PDA exposure time was analyzed as a continuous variable. Conclusions and Relevance In this bayesian meta-analysis, the data suggest that prolonged exposure to PDA might be associated with increased risk of pulmonary vascular disease in extremely preterm infants. This highlights the need to monitor for PH in high-risk preterm infants with prolonged exposure to PDA and to incorporate PH risk into clinical decisions regarding PDA management.
Collapse
Affiliation(s)
- Eduardo Villamor
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - Elke van Westering-Kroon
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - Gema E. Gonzalez-Luis
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - František Bartoš
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven H. Abman
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children’s Hospital Colorado, Aurora
| | - Maurice J. Huizing
- Division of Neonatology, Department of Pediatrics, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
12
|
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common complication of premature birth, imposing a significant and potentially life-long burden on patients and their families. Despite advances in our understanding of the mechanisms that contribute to patterns of lung injury and dysfunctional repair, current therapeutic strategies remain non-specific with limited success. Contemporary definitions of BPD continue to rely on clinician prescribed respiratory support requirements at specific time points. While these criteria may be helpful in broadly identifying infants at higher risk of adverse outcomes, they do not offer any precise information regarding the degree to which each compartment of the lung is affected. In this review we will outline the different pulmonary phenotypes of BPD and discuss important features in the pathogenesis, clinical presentation, and management of these frequently overlapping scenarios.
Collapse
Affiliation(s)
- Margaret Gilfillan
- Division of Neonatology, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, PA, USA
| | - Vineet Bhandari
- Division of Neonatology, The Children's Regional Hospital at Cooper/Cooper Medical School of Rowan University, Camden, NJ 08103, USA.
| |
Collapse
|
13
|
El-Saie A, Varghese NP, Webb MK, Villafranco N, Gandhi B, Guaman MC, Shivanna B. Bronchopulmonary dysplasia - associated pulmonary hypertension: An updated review. Semin Perinatol 2023; 47:151817. [PMID: 37783579 PMCID: PMC10843293 DOI: 10.1016/j.semperi.2023.151817] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is the leading cause of chronic lung disease in infants and the commonest complication of prematurity. Advances in respiratory and overall neonatal care have increased the survival of extremely low gestational age newborns, leading to the continued high incidence of BPD. Pulmonary hypertension (PH) represents the severe form of the pulmonary vascular disease associated with BPD, and affects almost one-third of infants with moderate to severe BPD. PH responds suboptimally to pulmonary vasodilators and increases morbidity and mortality in BPD infants. An up-to-date knowledge of the pathogenesis, pathophysiology, diagnosis, treatment, and outcomes of BPD-PH can be helpful to develop meaningful and novel strategies to improve the outcomes of infants with this disorder. Therefore, our multidisciplinary team has attempted to thoroughly review and summarize the latest advances in BPD-PH in preventing and managing this morbid lung disorder of preterm infants.
Collapse
Affiliation(s)
- Ahmed El-Saie
- Section of Neonatology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Nidhy P Varghese
- Division of Pulmonology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Melissa K Webb
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Natalie Villafranco
- Division of Pulmonology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Bheru Gandhi
- Division of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Milenka Cuevas Guaman
- Division of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Binoy Shivanna
- Division of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
14
|
Aschner J, Avachat C, Birnbaum A, Sherwin C, Fike C. Multi-dose enteral L-citrulline administration in premature infants at risk of developing pulmonary hypertension associated with bronchopulmonary dysplasia. RESEARCH SQUARE 2023:rs.3.rs-3006963. [PMID: 37333204 PMCID: PMC10275028 DOI: 10.21203/rs.3.rs-3006963/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Objective Information is needed to guide the design of randomized controlled trials (RCTs) evaluating L-citrulline as a therapy for premature infants with pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH). Our goal was to evaluate the tolerability and ability to achieve a target steady-state L-citrulline plasma concentration in prematures treated enterally with a multi-dose L-citrulline strategy based on our single-dose pharmacokinetic study. Study Design Six prematures received 60 mg/kg of L-citrulline every 6 hours for 72 hours. Plasma L-citrulline concentrations were measured before the first and last L-citrulline doses. L-citrulline concentrations were compared to concentration-time profiles from our previous study. Results Plasma L-citrulline concentrations agreed with the simulated concentration-time profiles. No serious adverse events occurred. Conclusions Simulations based on single-doses can be used to predict target multi-dose plasma L-citrulline concentrations. These results assist the design of RCTs evaluating the safety and effectiveness of L-citrulline therapy for BPD-PH. Clinical trials.gov ID: NCT03542812.
Collapse
|
15
|
Siddaiah R, Oji‐Mmuo C, Aluquin VPR, Kawasawa YI, Donnelly A, Rousselle D, Fuentes N, Austin ED, Silveyra P. Multiomics endotyping of preterm infants with bronchopulmonary dysplasia and pulmonary hypertension-A pilot study. Pulm Circ 2023; 13:e12232. [PMID: 37123538 PMCID: PMC10142061 DOI: 10.1002/pul2.12232] [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: 02/24/2023] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 05/02/2023] Open
Abstract
Pulmonary hypertension associated with bronchopulmonary dysplasia is a severe complication of preterm birth resulting in high mortality of up to 50% within the first 2 years of life. There is a direct relationship between bronchopulmonary dysplasia severity and incidence of associated pulmonary hypertension. However, it is challenging to clinically characterize severe bronchopulmonary dysplasia with and without pulmonary hypertension and there is need for better understanding of the two entities. Our main objective is to identify markers to help understand biological processes and characterize infants with pulmonary hypertension associated with bronchopulmonary dysplasia using tracheal aspirates. We conducted an unbiased multiomic analysis of tracheal aspirates via microRNA (miRNA) polymerase chain reaction arrays, RNA sequencing, and mass spectrometry proteomics in preterm infants with severe bronchopulmonary dysplasia with and without pulmonary hypertension (n = 46). Our pilot study analysis revealed 12 miRNAs (hsa-miR-29a, has-miR-542-3p, has-miR-624, has-miR-183, hsa-miR-501-3p, hsa-miR-101, hsa-miR-3131, hsa-miR-3683, hsa-miR-3193, hsa-miR-3672, hsa-miR-3128, and hsa-miR-1287), 6 transcripts (IL6, RPL35P5, HSD3B7, RNA5SP215, OR2A1-AS1, and RNVU1-19), and 5 proteins (CAPS, AAT, KRT5, SFTPB, and LGALS3BP) with significant differential expression in preterm infants with severe lung disease with pulmonary hypertension when compared with infants with severe lung disease but no pulmonary hypertension. Pathway analysis of the integrated multiomic expression signatures revealed NFkB, VEGF, SERPINA1, IL6, and ERK1/2 as target molecules and cellular development, cellular growth and proliferation, and cellular movement as key affected molecular functions. Our multiomic analysis of tracheal aspirates revealed a comprehensive thumbprint of miRNAs, mRNAs, and proteins that could help endotype infants with severe lung disease and pulmonary hypertension.
Collapse
Affiliation(s)
- Roopa Siddaiah
- Department of PediatricsPenn State Health Children's HospitalHersheyPennsylvaniaUSA
| | - Christiana Oji‐Mmuo
- Department of PediatricsPenn State Health Children's HospitalHersheyPennsylvaniaUSA
| | | | - Yuka Imamura Kawasawa
- Department of PharmacologyPenn State Health Children's HospitalHersheyPennsylvaniaUSA
| | - Ann Donnelly
- Department of Respiratory TherapyPenn State Health Children's HospitalHersheyPennsylvaniaUSA
| | - Dustin Rousselle
- Department of Environmental and Occupational HealthIndiana University School of Public HealthBloomingtonIndianaUSA
| | - Nathalie Fuentes
- Department of PediatricsPenn State Health Children's HospitalHersheyPennsylvaniaUSA
| | - Eric D. Austin
- Department of PediatricsVanderbilt UniversityNashvilleTennesseeUSA
| | - Patricia Silveyra
- Department of PediatricsPenn State Health Children's HospitalHersheyPennsylvaniaUSA
- Department of Environmental and Occupational HealthIndiana University School of Public HealthBloomingtonIndianaUSA
| |
Collapse
|
16
|
Yung D, Jackson EO, Blumenfeld A, Redding G, DiGeronimo R, McGuire JK, Riker M, Tressel W, Berkelhamer S, Eldredge LC. A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension. Front Pediatr 2023; 11:1077422. [PMID: 37063675 PMCID: PMC10098720 DOI: 10.3389/fped.2023.1077422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Objective To describe our multidisciplinary bronchopulmonary dysplasia (BPD) consult team's systematic approach to BPD associated pulmonary hypertension (PH), to report our center outcomes, and to evaluate clinical associations with outcomes. Study design Retrospective cohort of 60 patients with BPD-PH who were referred to the Seattle Children's Hospital BPD team from 2018 to 2020. Patients with critical congenital heart disease were excluded. Demographics, comorbidities, treatments, closure of hemodynamically relevant intracardiac shunts, and clinical outcomes including time to BPD-PH resolution were reviewed. Results Median gestational age of the 60 patients was 25 weeks (IQR: 24-26). 20% were small for gestational age (SGA), 65% were male, and 25% received a tracheostomy. With aggressive cardiopulmonary management including respiratory support optimization, patent ductus arteriosus (PDA) and atrial septal defect (ASD) closure (40% PDA, 5% ASD, 3% both), and limited use of pulmonary vasodilators (8%), all infants demonstrated resolution of PH during the follow-up period, including three (5%) who later died from non-BPD-PH morbidities. Neither SGA status nor the timing of PH diagnosis (<36 vs. ≥36 weeks PMA) impacted the time to BPD-PH resolution in our cohort [median 72 days (IQR 30.5-166.5)]. Conclusion Our multidisciplinary, systematic approach to BPD-PH management was associated with complete resolution of PH with lower mortality despite less sildenafil use than reported in comparable cohorts. Unique features of our approach included aggressive PDA and ASD device closure and rare initiation of sildenafil only after lack of BPD-PH improvement with respiratory support optimization and diagnostic confirmation by cardiac catheterization.
Collapse
Affiliation(s)
- Delphine Yung
- Division of Cardiology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Emma O. Jackson
- Heart Center, Seattle Children’s Hospital, Seattle, WA, United States
| | - Alyssa Blumenfeld
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Gregory Redding
- Division of Pulmonology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Robert DiGeronimo
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, and Seattle Children’s Hospital, Seattle, WA, United States
| | - John K. McGuire
- Division of Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Meredith Riker
- Heart Center, Seattle Children’s Hospital, Seattle, WA, United States
| | - William Tressel
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Sara Berkelhamer
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, and Seattle Children’s Hospital, Seattle, WA, United States
| | - Laurie C. Eldredge
- Division of Pulmonology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Hasan H, Hysko K, Jack T, Dingemann J, Wetzke M, Hansmann G. Case report: Rescue treatment with add-on selexipag in a preterm infant with suprasystemic pulmonary hypertension, pulmonary capillary hemangiomatosis, and isolated pulmonary vein stenosis. Front Cardiovasc Med 2022; 9:984698. [PMID: 36568561 PMCID: PMC9788526 DOI: 10.3389/fcvm.2022.984698] [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: 07/02/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022] Open
Abstract
An extremely dystrophic, premature female infant, born at 25 3/7 weeks of gestational age (birth weight: 430 g) with severe pulmonary hypertension (PH), was admitted to our neonatal intensive care unit (ICU) requiring cardiorespiratory support, including mechanical ventilation and pulmonary vasodilators such as inhaled nitric oxide (iNO) and continuous intravenous sildenafil infusions. The diagnosis of bronchopulmonary dysplasia (BPD) was made. A hemodynamically relevant, persistent ductus arteriosus (PDA) was surgically ligated after failed pharmacologic PDA closure using indomethacin and ibuprofen. The patient was discharged with an estimated 2/3 systemic pulmonary artery pressure. One month after hospital discharge, on low-flow oxygen supplementation (0.5 L/min FiO2 100%), at the corrected age of 16 weeks, she was readmitted to our emergency department with signs of respiratory distress and circulatory decompensation. Echocardiography demonstrated suprasystemic PH. Severe PH persisted despite initiated invasive mechanical ventilation, triple vasodilating therapy [iNO, macitentan, and continuous intravenous (IV) sildenafil], as well as levosimendan, milrinone, and norepinephrine for recompensation from cardiac shock. Thus, we started off-label oral selexipag therapy (oral IP receptor agonist) in the smallest patient reported so far (4 kg body weight). Subsequently, RV systolic pressure decreased to half-systemic, allowing successful weaning of iNO, norepinephrine, and milrinone, and extubation of the patient over 4 days. The infant was discharged 4 weeks after pediatric intensive care unit (PICU) admission in stable cardiorespiratory condition, with an oral, specific, triple antihypertensive PAH-targeted therapy using selexipag, macitentan, and sildenafil as well as oxygen therapy at low-flow (0.5 l/min) and spironolactone. The first cardiac catheterization at the age of 9 months under aforementioned triple PAH-targeted therapy revealed mild PH with 35% systemic PA pressure (mPAP/mSAP = 0.35) and isolated pulmonary vein stenosis. A transthoracic biopsy at the age of 12 months confirmed the diagnosis of BPD and further showed pulmonary interstitial glycogenosis and severe pulmonary capillary hemangiomatosis, without involvement of the pulmonary venules (chILD A2, A3, and B4 according to the Deutsch-Classification). The patient is currently in stable cardiorespiratory condition undergoing triple PH-targeted therapy including selexipag. This report highlights the potential benefits of the oral prostacyclin mimetic selexipag as an early add-on PH-targeted drug in chronic PH of infancy (cPHi).
Collapse
Affiliation(s)
- Hosan Hasan
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Klea Hysko
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pulmonology, Hannover Medical School, Hannover, Germany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany,*Correspondence: Georg Hansmann,
| |
Collapse
|
19
|
Çataltepe S, Cox LA. DDR1 Deficiency in Mice: A Spontaneous Model of Bronchopulmonary Dysplasia-associated Pulmonary Hypertension? Am J Respir Cell Mol Biol 2022; 67:518-519. [PMID: 35969163 PMCID: PMC9651196 DOI: 10.1165/rcmb.2022-0312ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sule Çataltepe
- Department of Pediatric Newborn MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBoston, Massachusetts
| | - Laura A. Cox
- Department of Internal MedicineWake Forest University Health SciencesWinston-Salem, North Carolina
| |
Collapse
|