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Li Z, Mu X, Lv X, Guo Y, Si S, Wu H. Patent ductus arteriosus and the association between lung ultrasound score and bronchopulmonary dysplasia: a secondary analysis of a prospective study. Eur J Pediatr 2024; 183:4309-4317. [PMID: 39073470 DOI: 10.1007/s00431-024-05702-4] [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: 04/10/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
Moderate-to-large patent ductus arteriosus (PDA) has been linked to increased risk of bronchopulmonary dysplasia (BPD), while lung ultrasound score (LUS) has been demonstrated to accurately predict BPD. We aimed to investigate the correlation of LUS as a marker of interstitial pulmonary edema and the severity of the ductal shunt in predicting future BPD development in very preterm infants. This secondary analysis of a prospective study recruited preterm infants with gestational age < 30 weeks. LUS on postnatal days 7 and 14, and echocardiographic data [PDA diameter and left atrium-to-aortic root ratio (LA/Ao)] near LUS acquisition were collected. Correlation coefficient, logistics regression analysis, and the area under the receiver operating characteristic (AUROC) procedure were used. A statistically significant and positive correlation existed between LUS and PDA diameter (ρ = 0.415, ρ = 0.581, and p < 0.001) and LA/Ao (ρ = 0.502, ρ = 0.743, and p < 0.001) at postnatal days 7 and 14, respectively, and the correlations of LUS and echocardiographic data were generally stronger in the non-BPD group. In the prediction of BPD, LUS incorporating echocardiographic data at postnatal days 7 obtained significantly higher predictive performance compared to LUS alone (AUROC 0.878 [95% CI 0.801-0.932] vs. AUROC 0.793 [95% CI 0.706-0.865]; Delong test, p = 0.013). CONCLUSIONS There is a statistically significant correlation between LUS and echocardiographic data, suggesting their potential role as early predictors for respiratory outcomes in very preterm infants. WHAT IS KNOWN • Lung ultrasound score (LUS) has shown good reliability in predicting bronchopulmonary dysplasia (BPD) development. • Some echocardiographic data that characterized ventricular function was reported to be used to predict severe BPD. WHAT IS NEW • There is a positive and statistically significant correlation between LUS and echocardiographic data at postnatal days 7 and 14. • The integrated use of LUS and echocardiographic data may have potential value in predicting BPD.
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Affiliation(s)
- Zhenyu Li
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xin Mu
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xiaoming Lv
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yiyi Guo
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Shuyu Si
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Hui Wu
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China.
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Avitabile CM, Zhang X, Ampah S, Wang Y, Ash D, Nilan K, Tingo JE, Frank DB, Jensen EA, Lingappan K, Gibbs KA. Elevated pulmonary capillary wedge pressure, higher blood pressure, and lower cardiac index in infants with bronchopulmonary dysplasia. Int J Cardiol 2024; 411:132246. [PMID: 38851539 DOI: 10.1016/j.ijcard.2024.132246] [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: 01/18/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Left ventricular diastolic dysfunction indicated by elevated pulmonary capillary wedge pressure (ePCWP) may worsen cardiorespiratory status in bronchopulmonary dysplasia (BPD), but the scope of ePCWP by cardiac catheterization is not well described. METHODS This single-center retrospective cohort study included infants with BPD without congenital heart disease, significant intracardiac shunts, or pulmonary vein stenosis who underwent cardiac catheterization from 2010 to 2021. ePCWP was defined as >10 mmHg. Quantitative measures of ventricular systolic and diastolic function were performed on existing echocardiograms. Patients with and without ePCWP were compared using the Chi-squared or Wilcoxon rank-sum tests. Associations between catheterization hemodynamics and echocardiographic parameters were assessed by simple linear regression. RESULTS Seventy-one infants (93% Grade 2 or 3 BPD) met inclusion criteria, and 30 (42%) had ePCWP. Patients with ePCWP were older at catheterization (6.7 vs. 4.5 months, p < 0.001), more commonly underwent tracheostomy (66.7% vs. 29.3%, p = 0.003), and had higher mean systemic blood pressure [64.5 (56.0, 75.0) vs. 47.0 (43.0, 55.0) mm Hg, p < 0.001], higher systemic vascular resistance [11.9 (10.4, 15.6) vs. 8.7 (6.7, 11.2) WU*m2, p < 0.001), and lower cardiac index [3.9 (3.8, 4.9) vs. 4.7 (4.0, 6.3) L/min/m2, p = 0.03] at catheterization. Mean pulmonary artery pressure, pulmonary vascular resistance, and mortality were similar between the groups. Echocardiographic indices of left ventricular diastolic dysfunction did not correlate with PCWP. CONCLUSIONS ePCWP was common in infants with severe BPD who underwent cardiac catheterization in this cohort. The association between ePCWP and higher systemic blood pressure supports further study of afterload reduction in this population.
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Affiliation(s)
- Catherine M Avitabile
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Echocardiography Laboratory Research Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Xuemei Zhang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steve Ampah
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yan Wang
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Echocardiography Laboratory Research Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Devon Ash
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Echocardiography Laboratory Research Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen Nilan
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer E Tingo
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David B Frank
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erik A Jensen
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Krithika Lingappan
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen A Gibbs
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Varghese NP, Austin ED, Galambos C, Mullen MP, Yung D, Guillerman RP, Vargas SO, Avitabile CM, Chartan CA, Cortes-Santiago N, Ibach M, Jackson EO, Jarrell JA, Keller RL, Krishnan US, Patel KR, Pogoriler J, Whalen EC, Wikenheiser-Brokamp KA, Villafranco NM, Hopper RK, Usha Raj J, Abman SH. An interdisciplinary consensus approach to pulmonary hypertension in developmental lung disease. Eur Respir J 2024; 64:2400639. [PMID: 39147412 PMCID: PMC11424926 DOI: 10.1183/13993003.00639-2024] [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: 04/12/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024]
Abstract
It is increasingly recognised that diverse genetic respiratory disorders present as severe pulmonary hypertension (PH) in the neonate and young infant, but many controversies and uncertainties persist regarding optimal strategies for diagnosis and management to maximise long-term outcomes. To better define the nature of PH in the setting of developmental lung disease (DEVLD), in addition to the common diagnoses of bronchopulmonary dysplasia and congenital diaphragmatic hernia, we established a multidisciplinary group of expert clinicians from stakeholder paediatric specialties to highlight current challenges and recommendations for clinical approaches, as well as counselling and support of families. In this review, we characterise clinical features of infants with DEVLD/DEVLD-PH and identify decision-making challenges including genetic evaluations, the role of lung biopsies, the use of imaging modalities and treatment approaches. The importance of working with team members from multiple disciplines, enhancing communication and providing sufficient counselling services for families is emphasised to create an interdisciplinary consensus.
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Affiliation(s)
- Nidhy P Varghese
- Department of Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Eric D Austin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Csaba Galambos
- Department of Pathology and Laboratory Medicine, University of Colorado and Pediatric Heart Lung Center, Children's Hospital Colorado, Aurora, CO, USA
| | - Mary P Mullen
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Delphine Yung
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - R Paul Guillerman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara O Vargas
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Catherine M Avitabile
- Division of Cardiology, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Corey A Chartan
- Department of Pediatrics, Divisions of Critical Care Medicine and Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | - Michaela Ibach
- Section of Palliative Care, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emma O Jackson
- Heart Center, Pulmonary Hypertension Program, Seattle Children's Hospital, Seattle, WA, USA
| | - Jill Ann Jarrell
- Division of Palliative Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Roberta L Keller
- Department of Pediatrics/Neonatology, University of California San Francisco and Benioff Children's Hospital, San Francisco, CA, USA
| | - Usha S Krishnan
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center and Morgan Stanley Children's Hospital of New York Presbyterian Hospital, New York, NY, USA
| | - Kalyani R Patel
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, TX, USA
| | - Jennifer Pogoriler
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elise C Whalen
- Department of Pediatrics, Division of Pulmonology, Advanced Practice Providers, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Kathryn A Wikenheiser-Brokamp
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine and Division of Pathology & Laboratory Medicine and The Perinatal Institute Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natalie M Villafranco
- Department of Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Rachel K Hopper
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Usha Raj
- Department of Pediatrics, Division of Neonatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Steven H Abman
- Department of Pediatrics, University of Colorado and Pediatric Heart Lung Center, Children's Hospital Colorado, Aurora, CO, USA
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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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6
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Li B, Qu SS, Li LX, Zhou N, Liu N, Wei B. Risk factors and clinical outcomes of pulmonary hypertension associated with bronchopulmonary dysplasia in extremely premature infants: A systematic review and meta-analysis. Pediatr Pulmonol 2024. [PMID: 39177287 DOI: 10.1002/ppul.27220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/20/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024]
Abstract
This systematic review and meta-analysis evaluated the risk factors for bronchopulmonary dysplasia associated pulmonary hypertension (BPD-PH) in extremely premature infants (gestational age < 32 weeks) and its impact on outcomes. A computerized search of eight databases was performed, from the time of library construction to February 2024. The quality of the included studies was assessed with the Newcastle‒Ottawa scale. Statistical analyses were performed using RevMan 5.4.1 and Stata 16.0 software. Meta-analysis of 2137 extremely premature infants revealed that oligohydramnios (OR = 2.21, 95% CI 1.06-4.61), low gestational age (SMD = -0.36, 95% CI -0.47 to -0.24), low birth weight (SMD = -0.54, 95% CI -0.74 to -0.35), small for gestational age (OR = 1.61, 95% CI 1.06-2.44), neonatal respiratory distress syndrome (OR = 2.05, 95% CI 1.45-2.91), grade III bronchopulmonary dysplasia (OR = 4.67, 95% CI 1.34-16.30), and sepsis (OR = 2.25, 95% CI 1.69-4.66) were risk factors for BPD-PH, whereas antenatal steroids (OR = 0.66, 95% CI 0.49-0.88) were protective factors. BPD-PH led to the extension of oxygen therapy (SMD = 0.67, 95% CI 0.42-0.92) and hospital stay (SMD = 0.77, 95% CI 0.14-1.40), and elevated the risk of discharged on oxygen (OR = 2.77, 95% CI 1.35-5.70) and death (OR = 4.38, 95% CI 2.21-8.69). BPD-PH is a multifactorial disease. In this study, a total of seven risk factors, and one protective factor for BPD-PH were identified in extremely premature infants. By managing and mitigating these factors, it is possible to decrease the occurrence of BPD-PH. Furthermore, BPD-PH may increase the risk of a poor prognosis in extremely premature infants.
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Affiliation(s)
- Bo Li
- Department of Neonatology, General Hospital of Northern Theater Command, Shenyang, China
- Post-graduate College, China Medical University, Shenyang, China
| | - Shuang-Shuang Qu
- Department of Neonatology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ling-Xue Li
- Department of Neonatology, General Hospital of Northern Theater Command, Shenyang, China
| | - Nan Zhou
- Department of Neonatology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ning Liu
- Department of Neonatology, General Hospital of Northern Theater Command, Shenyang, China
| | - Bing Wei
- Department of Neonatology, General Hospital of Northern Theater Command, Shenyang, China
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7
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McArthur E, Murthy K, Zaniletti I, Sharma M, Lagatta J, Ball M, Porta N, Grover T, Levy P, Padula M, Hamrick S, Vyas-Read S. Neonatal Risk Factors for Pulmonary Vein Stenosis in Infants Born Preterm with Severe Bronchopulmonary Dysplasia. J Pediatr 2024; 275:114252. [PMID: 39181320 DOI: 10.1016/j.jpeds.2024.114252] [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] [Received: 05/23/2024] [Revised: 08/06/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To evaluate associations between neonatal risk factors and pulmonary vein stenosis (PVS) among infants born preterm with severe bronchopulmonary dysplasia (sBPD). STUDY DESIGN We performed a case-control study of infants born from 2010 to 2022 at <32 weeks' gestation with sBPD among 46 neonatal intensive care units in the Children's Hospitals Neonatal Consortium. Cases with PVS were matched to controls using epoch of diagnosis (2010-2016; 2017-2022) and hospital. Multivariable logistic regression analyses were utilized to evaluate PVS association with neonatal risk factors. RESULTS From 10 171 preterm infants with sBPD, we identified 109 cases with PVS and matched those to 327 controls. The prevalence of PVS (1.07%) rose between epochs (0.8% in 2010-2016 to 1.2% in 2017-2022). Relative to controls, infants with PVS were more likely to be <500 g at birth, to be small for gestational age <10th%ile, or have surgical necrotizing enterocolitis, atrial septal defects, or pulmonary hypertension. In multivariable models, these associations persisted, and small for gestational age, surgical necrotizing enterocolitis, atrial septal defects, and pulmonary hypertension were each independently associated with PVS. Among infants on respiratory support at 36 weeks' postmenstrual age, infants with PVS had 4.3-fold higher odds of receiving mechanical ventilation at 36 weeks' postmenstrual age. Infants with PVS also had 3.6-fold higher odds of in-hospital mortality relative to controls. CONCLUSIONS In a large cohort of preterm infants with sBPD, multiple independent, neonatal risk factors are associated with PVS. These results lay important groundwork for the development of targeted screening to guide the diagnosis and management of PVS in preterm infants with sBPD.
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Affiliation(s)
- Erica McArthur
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Karna Murthy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Megha Sharma
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR
| | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Molly Ball
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Nationwide Children's Hospital, Columbus, OH
| | - Nicolas Porta
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Theresa Grover
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Philip Levy
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Michael Padula
- Department of Pediatrics, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Shannon Hamrick
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Shilpa Vyas-Read
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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8
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Bjorkman KR, Miles KG, Bellew LE, Schneider KA, Magness SM, Higano NS, Ollberding NJ, Hoyos Cordon X, Hirsch RM, Hysinger E, Woods JC, Critser PJ. Patent Ductus Arteriosus and Lung Magnetic Resonance Imaging Phenotype in Moderate and Severe Bronchopulmonary Dysplasia-Pulmonary Hypertension. Am J Respir Crit Care Med 2024; 210:318-328. [PMID: 38568735 PMCID: PMC11348976 DOI: 10.1164/rccm.202310-1733oc] [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] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 08/02/2024] Open
Abstract
Rationale: Hemodynamically significant patent ductus arteriosus (hsPDA) in premature infants has been associated with bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). However, these associations remain incompletely understood. Objectives: To assess the associations between hsPDA duration and clinical outcomes, PH, and phenotypic differences on lung magnetic resonance imaging (MRI). Methods: In this retrospective cohort study, we identified all infants with BPD at <32 weeks' gestation who also underwent research lung MRI at <48 weeks' postmenstrual age (PMA) from 2014 to 2022. Clinical echocardiograms were reviewed for hsPDA and categorized as no hsPDA, hsPDA 1-60 days, and hsPDA >60 days. Outcome variables included BPD severity, PH at 36 weeks' PMA, PH after 36 weeks' PMA in the absence of shunt (PH-pulmonary vascular disease [PVD]), tracheostomy or death, and lung phenotype by MRI via modified Ochiai score, indexed total lung volume, and whole-lung hyperdensity. Logistic regression and ANOVA were used. Measurements and Main Results: In total, 133 infants born at 26.2 ± 1.9 weeks, weighing 776 ± 276 g, were reviewed (47 with no hsPDA, 44 with hsPDA 1-60 days, and 42 with hsPDA >60 d). hsPDA duration > 60 days was associated with BPD severity (P < 0.01), PH at 36 weeks' PMA (adjusted odds ratio [aOR], 9.7 [95% confidence interval (CI), 3.3-28.4]), PH-PVD (aOR, 6.5 [95% CI, 2.3-18.3]), and tracheostomy or death (aOR, 3.0 [95% CI, 1.0-8.8]). Duration of hsPDA > 60 days was associated with higher Ochiai score (P = 0.03) and indexed total lung volume (P = 0.01) but not whole-lung hyperdensity (P = 0.91). Conclusions: In infants with moderate or severe BPD, prolonged exposure to hsPDA is associated with BPD severity, PH-PVD, and increased parenchymal lung disease by MRI.
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Affiliation(s)
| | | | | | | | | | - Nara S. Higano
- Center for Pulmonary Imaging Research, and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Nicholas J. Ollberding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | | | - Russel M. Hirsch
- The Heart Institute
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Erik Hysinger
- Pulmonary Medicine
- Center for Pulmonary Imaging Research, and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Paul J. Critser
- The Heart Institute
- Center for Pulmonary Imaging Research, and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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9
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Pharande P, Sehgal A, Menahem S. Cardiovascular Sequelae of Bronchopulmonary Dysplasia in Preterm Neonates Born before 32 Weeks of Gestational Age: Impact of Associated Pulmonary and Systemic Hypertension. J Cardiovasc Dev Dis 2024; 11:233. [PMID: 39195141 DOI: 10.3390/jcdd11080233] [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: 06/02/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common respiratory disorder of prematurity for infants born before 32 weeks of gestational age (GA). Early and prolonged exposure to chronic hypoxia and inflammation induces pulmonary hypertension (PH) with the characteristic features of a reduced number and increased muscularisation of the pulmonary arteries resulting in an increase in the pulmonary vascular resistance (PVR) and a fall in their compliance. BPD and BPD-associated pulmonary hypertension (BPD-PH) together with systemic hypertension (sHTN) are chronic cardiopulmonary disorders which result in an increased mortality and long-term problems for these infants. Previous studies have predominantly focused on the pulmonary circulation (right ventricle and its function) and developing management strategies accordingly for BPD-PH. However, recent work has drawn attention to the importance of the left-sided cardiac function and its impact on BPD in a subset of infants arising from a unique pathophysiology termed postcapillary PH. BPD infants may have a mechanistic link arising from chronic inflammation, cytokines, oxidative stress, catecholamines, and renin-angiotensin system activation along with systemic arterial stiffness, all of which contribute to the development of BPD-sHTN. The focus for the treatment of BPD-PH has been improvement of the right heart function through pulmonary vasodilators. BPD-sHTN and a subset of postcapillary PH may benefit from afterload reducing agents such as angiotensin converting enzyme inhibitors. Preterm infants with BPD-PH are at risk of later cardiac and respiratory morbidities as young adults. This paper reviews the current knowledge of the pathophysiology, diagnosis, and treatment of BPD-PH and BPD-sHTN. Current knowledge gaps and emerging new therapies will also be discussed.
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Affiliation(s)
- Pramod Pharande
- Monash Newborn, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia
- Department of Pediatrics, Monash University, Melbourne, VIC 3800, Australia
| | - Arvind Sehgal
- Monash Newborn, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia
- Department of Pediatrics, Monash University, Melbourne, VIC 3800, Australia
| | - Samuel Menahem
- Department of Pediatrics, Monash University, Melbourne, VIC 3800, Australia
- Paediatric and Foetal Cardiac Units, Monash Medical Centre, Melbourne, VIC 3168, Australia
- Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC 3052, Australia
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10
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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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11
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Savoia M, Busolini E, Ibarra Rios D, Thomas B, Ruoss JL, McNamara PJ. Integrated Lung Ultrasound and Targeted Neonatal Echocardiography Evaluation in Infants Born Preterm. J Pediatr 2024; 275:114200. [PMID: 39032769 DOI: 10.1016/j.jpeds.2024.114200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Marilena Savoia
- Neonatal Intensive Care Unit, S Maria della Misericordia Hospital, Udine, Italy.
| | - Eva Busolini
- Neonatal Intensive Care Unit, S Maria della Misericordia Hospital, Udine, Italy
| | - Daniel Ibarra Rios
- Division of Neonatology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, Mexico, Mexico
| | - Brady Thomas
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - J Lauren Ruoss
- Neonatal Intensive Care Unit, Winnie Palmer Hospital/Orlando Health Regional Hospital, Orlando, Fl
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
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12
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Yang J, Wang Y, Wu Y, Fan H, Jin O, Tang L, Tung TH, Zhang M, Wang L. Association of cord blood Ang-1 and sCD105 levels with bronchopulmonary dysplasia in preterm infants. BMC Pediatr 2024; 24:451. [PMID: 39010003 PMCID: PMC11247901 DOI: 10.1186/s12887-024-04932-7] [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: 01/31/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND To investigate the relationship between cord blood levels of Angiopoietin-1 (Ang-1) and S-endoglin (sCD105) and bronchopulmonary dysplasia (BPD) in preterm infants. METHODS Sixty-one preterm infants admitted to the neonatal intensive care unit of the study hospital between July 2021 and September 2022 were included. Cord blood was collected after the birth of premature infants. Ang-1 and sCD105 levels were quantified using the vascular endothelial growth factor enzyme-linked immunosorbent assay. Preterm infants were divided into BPD and non-BPD groups, and differences in Ang-1 and sCD105 levels between the two groups were compared. A binary logistic model was used to assess the association between low and high levels Ang-1 and BPD in preterm infants. RESULTS In the study, there were 20 preterm infants with BPD (32.8%) and 41 preterm infants with non-BPD (67.2%). Ang-1 concentration levels were lower in the BPD group than in the non-BPD group (7105.43 (5617.01-8523.00) pg/ml vs. 10488.03 (7946.19-15962.77) pg/ml, P = 0.027). However, the sCD105 concentration levels were not significantly different between the BPD and non-BPD groups (P = 0.246). A median Ang-1 concentration of 8800.40 pg/ml was calculated. Logistic regression analysis showed that after adjusting for gestational age, birth weight, and maternal prenatal steroid hormone application, the odds ratio (OR) was 8.577 for the risk of BPD in preterm infants with Ang-1 concentrations of ≤ 8800.40 pg/ml compared to those with Ang-1 concentrations of > 8800.40 pg/ml (OR: 8.577, 95% confidence interval: 1.265-58.155, P = 0.028). CONCLUSION Our study indicated that Ang-1 levels in the cord blood of preterm infants may be associated the risk of BPD. In the future, we will continue to conduct study with large samples.
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Affiliation(s)
- Jingyun Yang
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China
| | - Yun Wang
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China
| | - Yixin Wu
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China
| | - Hailing Fan
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China
| | - Ouxuan Jin
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China
| | - Liwei Tang
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, 317000, China
| | - Meixian Zhang
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China.
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, 317000, China.
| | - Lizhen Wang
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, 317000, China.
- Department of Pediatrics, Taizhou Enze Medical Center (Group), Enze Hospital, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 318050, China.
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13
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Hicks TD, Cameron J, Wang S, Ashrafi A, Szmuszkovicz J, Iyer N, Bansal M. Assessing the role of tracheostomy placement in bronchopulmonary dysplasia with pulmonary hypertension. J Perinatol 2024; 44:988-994. [PMID: 38316933 DOI: 10.1038/s41372-024-01881-y] [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: 05/11/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth and is associated with abnormal vasculature that contributes to pulmonary hypertension (PH). We evaluated how a tracheostomy may alter PH in these patients. METHODS A retrospective chart review over 15-years identified 17 patients with BPD and PH who underwent tracheostomy. Each patient had four echocardiograms re-reviewed and scored for tricuspid valve regurgitation velocity (TR), tricuspid annular plane systolic excursion (TAPSE), right atrial cross-sectional area (RACA), and left ventricle eccentricity indices (EI). RESULT There was improvement in TR, TAPSE, RACA, and left ventricle EI indicating reduction in PH after tracheostomy. CONCLUSION PH improves over time though role of tracheostomy in PH needs to be further defined. The EI may be a sensitive marker to follow over time in these patients.
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Affiliation(s)
- Timothy D Hicks
- Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Children's Hospital Orange County, Orange, CA, USA.
| | | | - Shuo Wang
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Amir Ashrafi
- Children's Hospital Orange County, Orange, CA, USA
| | | | - Narayan Iyer
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Manvi Bansal
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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14
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Wymore EM, Lynch AM, Singh JK, Thevarajah TS, Hodges JK, Kinsella JP, Auer E, Wagner BD. The relationship between severe hypertensive diseases of pregnancy and moderate-severe bronchopulmonary dysplasia. J Perinatol 2024; 44:935-940. [PMID: 38431755 DOI: 10.1038/s41372-024-01910-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Determine the association between severe hypertensive disease of pregnancy (HDP) with moderate-severe bronchopulmonary dysplasia (BPD) in preterm infants (< 31 weeks' gestation). STUDY DESIGN Preterm birth cohort study of 693 mother-infant dyads. Severe HDP was defined as severe preeclampsia, HELLP syndrome or eclampsia. The outcome was moderate-severe BPD classified at 36 weeks corrected gestational age, per the NICHD Consensus statement. RESULTS 225 (32%) mothers developed severe HDP and 234 (34%) infants had moderate-severe BPD. There was an interaction between severe HDP and gestational age (p = 0.03). Infants born at < 25 weeks gestation to mothers with HDP had increased odds for moderate-severe BPD compared to infants of normotensive mothers delivering at the same gestational age. Infants born > 28 weeks to mothers with severe HDP had decreased odds for the outcome, though not statistically significant. CONCLUSIONS Severe HDP has a differential effect on the development of moderate-severe BPD based on gestational age.
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Affiliation(s)
- Erica M Wymore
- University of Colorado School of Medicine, Department of Pediatrics, Section of Neonatology, Aurora, CO, USA.
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tamara S Thevarajah
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer K Hodges
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - John P Kinsella
- University of Colorado School of Medicine, Department of Pediatrics, Section of Neonatology, Aurora, CO, USA
| | - Emily Auer
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
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15
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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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16
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Hébert A, McNamara PJ, Carvalho Nunes GD, Maltais-Bilodeau C, Leclerc MÈ, Wutthigate P, Simoneau J, Drolet C, Altit G. PDA management strategies and pulmonary hypertension in extreme preterm infants with bronchopulmonary dysplasia. Pediatr Res 2024:10.1038/s41390-024-03321-1. [PMID: 38898108 DOI: 10.1038/s41390-024-03321-1] [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: 01/23/2024] [Revised: 04/11/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Premature infants are at risk for developing pulmonary hypertension (PH) in the context of bronchopulmonary dysplasia (BPD). Studies suggest a potential link between prolonged patent ductus arteriosus (PDA) exposure and BPD-PH, though management strategies remain controversial. METHODS Retrospective echocardiographic evaluation of newborns <29 weeks gestational age with BPD at two distinct centers. Primary objective was to evaluate the relationship between center-specific PDA management strategies (interventional or conservative) and the prevalence of BPD-PH. BPD was defined as oxygen or respiratory support at 36 weeks post-menstrual age (PMA). The presence of PH was defined as either an estimated sPAP of ≥40 mmHg or sEI ≥1.3. Center A has a conservative PDA policy. Center B has a targeted interventional policy. RESULTS PH rates were similar between sites (21% vs 17%), while rates of PDA treatment was different (7% vs 81). Adjusted models did not demonstrate an association for center or PDA treatment exposure for PH and EI, although infants from Center A had echocardiography evidence of higher systolic eccentricity index (EI; 1.12 ± 0.19 vs 1.06 ± 0.15, p = 0.04). Markers of RV function (TAPSE and RV-FAC) were similar between groups. CONCLUSION In preterm infants <29 weeks with BPD, conservative PDA treatment policy was not associated with higher rate of pulmonary hypertension diagnosis. IMPACT The association between PDA-management approaches and the occurrence of BPD-associated pulmonary vascular disease in premature infants has sparsely been described. We found that a conservative policy, regarding the PDA, was not associated with an increase in pulmonary hypertension diagnosis. We identified that, in patients with BPD, echocardiographic metrics of LV performance were lower.
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Affiliation(s)
- Audrey Hébert
- Division of Neonatology, CHU de Québec, Université Laval, Quebec City, QC, Canada.
| | - Patrick J McNamara
- Division of Neonatology, University of Iowa Children's Hospital, University of Iowa, Iowa city, IA, USA
| | | | | | - Marie-Ève Leclerc
- Division of Neonatology, CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Punnanee Wutthigate
- Division of Neonatology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Jessica Simoneau
- Division of Neonatology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Christine Drolet
- Division of Neonatology, CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Gabriel Altit
- Division of Neonatology, McGill University Health Centre, McGill University, Montreal, QC, Canada
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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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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.
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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;
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Bae SP, Kim SS, Yun J, Lee H, Hahn WH, Park S. Neonatal outcomes of preterm infants with pulmonary hypertension: clustering based on prenatal risk factors. Pediatr Res 2024:10.1038/s41390-024-03232-1. [PMID: 38734814 DOI: 10.1038/s41390-024-03232-1] [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: 08/14/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND To investigate association of prenatal risk factors and neonatal outcomes of preterm infants with pulmonary hypertension (PH). METHODS A prospective cohort study of very-low-birth-weight infants born at 22-29 weeks' gestation who received PH-specific treatment during hospitalization. Infants were classified using a two-step cluster analysis based on gestational age (GA), small-for-gestational-age (SGA), exposure to antenatal corticosteroids (ACS), histologic chorioamnionitis (HCA), and oligohydramnios. RESULTS Among 910 infants, six clusters were identified: cluster A (HCA, n = 240), cluster B (oligohydramnios, n = 79), cluster C (SGA, n = 74), cluster D (no-ACS, n = 109), cluster E (no dominant parameter, n = 287), and cluster F (HCA and oligohydroamnios, n = 121). Cluster A was used as a reference group for comparisons among clusters. Compared to cluster A, cluster C (aHR: 1.63 [95% CI: 1.17-2.26]) had higher risk of overall in-hospital mortality. Clusters B (aHR: 1.52 [95% CI: 1.09-2.11]), D (aHR: 1.71 [95% CI: 1.28-2.30]), and F (aHR: 1.51 [95% CI: 1.12-2.03]) had higher risks of receiving PH-specific treatment within the first week of birth compared to cluster A. CONCLUSION These findings may provide a better understanding of prenatal risk factors contributing to the development of PH. IMPACT Pulmonary hypertension (PH), presenting as hypoxic respiratory failure, has complex etiologies in preterm infants. Although multifactorial risks for the development of PH in preterm infants are known, few studies have classified infants with similar etiologies for PH. Each cluster has distinct patterns of prenatal condition and neonatal outcome.
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Affiliation(s)
- Seong Phil Bae
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
| | - Jungha Yun
- Department of Pediatrics, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
| | - Hanbyul Lee
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Won-Ho Hahn
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea
| | - Suyeon Park
- Department of Biostatistics, Academic Research Office, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
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20
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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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21
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Duggal M, Moore SS, Simoneau J, Girard G, Gernet IB, Oettingen JEV, Sant'Anna G, Altit G. Pulmonary Hypertension and Necrotizing Enterocolitis in Neonates Treated with Diazoxide. Am J Perinatol 2024; 41:e1435-e1444. [PMID: 36882098 DOI: 10.1055/s-0043-1764385] [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: 03/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the prevalence of adverse outcomes, specifically pulmonary hypertension (PH) and suspected or confirmed necrotizing enterocolitis (NEC), and their associated risk factors, in neonates treated with diazoxide. STUDY DESIGN A retrospective study in infants born ≥ 316/7 weeks and admitted between January 2014 and June 2020. Combined adverse outcomes possibly associated to diazoxide were PH (systolic pulmonary pressure of ≥40 mm Hg or an eccentricity index ≥1.3) and suspected or confirmed NEC (suspected: stop feeds and antibiotics and confirmed: modified Bell stage ≥2). Echocardiography data extractors were masked to infants' characteristics. RESULTS A total of 63 infants were included; 7 (11%) with suspected and 1 (2%) with confirmed NEC. Of the 36 infants with an available echocardiography after initiation of diazoxide treatment, 12 (33%) had PH. All infants with suspected or confirmed NEC were males (p = 0.01), whereas PH occurred mostly in females (75%, p = 0.02). The combined adverse outcome occurred in 14/26 (54%) infants exposed to >10 mg/kg/day, compared to 6/37 (16%) exposed to ≤10 mg/kg/day (p = 0.006). This association remained significant after adjustment for sex, small for gestational age status, and gestational age at birth (odds ratio: 6.1, 95% confidence interval: 1.7-21.7, p = 0.005). Left ventricular dysfunction was found in 19 infants (30%) but was not discriminative for the combined outcome. CONCLUSION PH and suspected or confirmed NEC were identified frequently in neonates treated with diazoxide. A total dose >10 mg/kg/day was associated with an increased occurrence of these complications. KEY POINTS · PH and suspected or confirmed NEC were frequently found in neonates treated with diazoxide.. · A total dose >10 mg/kg/day was associated with an increased occurrence of these complications.. · Echocardiography screening should be considered in neonates exposed to diazoxide..
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Affiliation(s)
- Mounya Duggal
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Shiran S Moore
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Jessica Simoneau
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Gabrielle Girard
- Department of Pharmacy, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Irène B Gernet
- Department of Pharmacy, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julia E Von Oettingen
- Division of Endocrinology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Guilherme Sant'Anna
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Gabriel Altit
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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Sikdar O, Harris C, Greenough A. Improving early diagnosis of bronchopulmonary dysplasia. Expert Rev Respir Med 2024; 18:283-294. [PMID: 38875260 DOI: 10.1080/17476348.2024.2367584] [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: 02/07/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Bronchopulmonary disease (BPD) is associated with long-term neurodevelopmental and cardiorespiratory complications, often requiring significant use of resources. To reduce this healthcare burden, it is essential that those at high risk of BPD are identified early so that strategies are introduced to prevent disease progression. Our aim was to discuss potential methods for improving early diagnosis in the first week after birth. AREAS COVERED A narrative review was undertaken. The search strategy involved searching PubMed, Embase and Cochrane databases from 1967 to 2024. The results of potential biomarkers and imaging modes are discussed. Furthermore, the value of scoring systems is explored. EXPERT OPINION BPD occurs as a result of disruption to pulmonary vascular and alveolar development, thus abnormal levels of factors regulating those processes are promising avenues to explore with regard to early detection of high-risk infants. Data from twin studies suggests genetic factors can be attributed to 82% of the observed difference in moderate to severe BPD, but large genome-wide studies have yielded conflicting results. Comparative studies are required to determine which biomarker or imaging mode may most accurately diagnose early BPD development. Models which include the most predictive factors should be evaluated going forward.
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Affiliation(s)
- Oishi Sikdar
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christopher Harris
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, 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
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23
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Ciora OA, Seegmüller T, Fischer JS, Wirth T, Häfner F, Stoecklein S, Flemmer AW, Förster K, Kindt A, Bassler D, Poets CF, Ahmidi N, Hilgendorff A. Delineating morbidity patterns in preterm infants at near-term age using a data-driven approach. BMC Pediatr 2024; 24:249. [PMID: 38605404 PMCID: PMC11010410 DOI: 10.1186/s12887-024-04702-5] [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: 11/07/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Long-term survival after premature birth is significantly determined by development of morbidities, primarily affecting the cardio-respiratory or central nervous system. Existing studies are limited to pairwise morbidity associations, thereby lacking a holistic understanding of morbidity co-occurrence and respective risk profiles. METHODS Our study, for the first time, aimed at delineating and characterizing morbidity profiles at near-term age and investigated the most prevalent morbidities in preterm infants: bronchopulmonary dysplasia (BPD), pulmonary hypertension (PH), mild cardiac defects, perinatal brain pathology and retinopathy of prematurity (ROP). For analysis, we employed two independent, prospective cohorts, comprising a total of 530 very preterm infants: AIRR ("Attention to Infants at Respiratory Risks") and NEuroSIS ("Neonatal European Study of Inhaled Steroids"). Using a data-driven strategy, we successfully characterized morbidity profiles of preterm infants in a stepwise approach and (1) quantified pairwise morbidity correlations, (2) assessed the discriminatory power of BPD (complemented by imaging-based structural and functional lung phenotyping) in relation to these morbidities, (3) investigated collective co-occurrence patterns, and (4) identified infant subgroups who share similar morbidity profiles using machine learning techniques. RESULTS First, we showed that, in line with pathophysiologic understanding, BPD and ROP have the highest pairwise correlation, followed by BPD and PH as well as BPD and mild cardiac defects. Second, we revealed that BPD exhibits only limited capacity in discriminating morbidity occurrence, despite its prevalence and clinical indication as a driver of comorbidities. Further, we demonstrated that structural and functional lung phenotyping did not exhibit higher association with morbidity severity than BPD. Lastly, we identified patient clusters that share similar morbidity patterns using machine learning in AIRR (n=6 clusters) and NEuroSIS (n=8 clusters). CONCLUSIONS By capturing correlations as well as more complex morbidity relations, we provided a comprehensive characterization of morbidity profiles at discharge, linked to shared disease pathophysiology. Future studies could benefit from identifying risk profiles to thereby develop personalized monitoring strategies. TRIAL REGISTRATION AIRR: DRKS.de, DRKS00004600, 28/01/2013. NEuroSIS: ClinicalTrials.gov, NCT01035190, 18/12/2009.
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Affiliation(s)
| | - Tanja Seegmüller
- Center for Comprehensive Developmental Care (CDeC(LMU)) at the Social Pediatric Center (iSPZ Hauner), LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | | | - Theresa Wirth
- Fraunhofer Institute for Cognitive Systems IKS, Munich, Germany
| | - Friederike Häfner
- Center for Comprehensive Developmental Care (CDeC(LMU)) at the Social Pediatric Center (iSPZ Hauner), LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Lung Research Center (DZL), Munich, Germany
| | - Sophia Stoecklein
- Department of Radiology, LMU University Hospital, Ludwig-Maximilians-Universität München, Member of the German Lung Research Center (DZL), Munich, Germany
| | - Andreas W Flemmer
- Division of Neonatology, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kai Förster
- Center for Comprehensive Developmental Care (CDeC(LMU)) at the Social Pediatric Center (iSPZ Hauner), LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Lung Research Center (DZL), Munich, Germany
- Division of Neonatology, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alida Kindt
- Metabolomics and Analytics Centre, LACDR, Leiden University, Leiden, Netherlands
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Narges Ahmidi
- Fraunhofer Institute for Cognitive Systems IKS, Munich, Germany
| | - Anne Hilgendorff
- Center for Comprehensive Developmental Care (CDeC(LMU)) at the Social Pediatric Center (iSPZ Hauner), LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Lung Research Center (DZL), Munich, Germany
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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.
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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
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25
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Zafar A, Hall M. Types of home respiratory support in children with bronchopulmonary dysplasia and factors determining its duration: A scoping review. Pediatr Pulmonol 2024; 59:834-844. [PMID: 38197530 DOI: 10.1002/ppul.26848] [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: 10/18/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/11/2024]
Abstract
Bronchopulmonary dysplasia also known as chronic lung disease of prematurity has changed as a disease entity over the last five decades and children with "new bronchopulmonary dysplasia (BPD)" have better survival rates. This necessitates strategies to prevent severe BPD and provide organized home support. Home respiratory support in these children varies from home oxygen to noninvasive ventilation and tracheostomy ventilation. This review was conducted utilizing Joanna Briggs Institute publications on evidence synthesis and presentation of results for a scoping review. The Preferred Reporting Items for Systematic Review and Meta-Analyses were used to report the results. The risk of bias assessment was done using "The Cochrane Handbook for Systematic Reviews tool for interventional studies." After screening for the duplication of results and applying inclusion and exclusion criteria, twenty-seven studies were assessed by reading the full texts. Out of these, eleven were finally included in this systematic review. The total sample size from all studies was 4794, including 2705 males. The 4/11 studies home oxygen, one study reported continuous positive airway pressure/bilevel positive airway pressure and seven studies used tracheostomy or tracheostomy ventilation. The median duration of post-natal invasive ventilation was higher in those discharged on home oxygen compared to those who did not need oxygen at discharge. There is a significant proportion of children who are tracheostomy ventilated (8.65%) at home. In the absence of established guidelines, these children are vulnerable when it comes to care at home and the timing of decannulation. For home oxygen alone, guidelines by ERS, ATS and BTS have streamlined weaning protocols and the need for having a multi-disciplinary team to care for these children.
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Affiliation(s)
- Adnan Zafar
- Pediatric Pulmonology, John Hopkins Aramco Healthcare, Saudi Arabia
| | - Michael Hall
- Neonatology, University of Southampton, Southampton, UK
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26
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Zheng S, Ye L. Hemodynamic Melody of Postnatal Cardiac and Pulmonary Development in Children with Congenital Heart Diseases. BIOLOGY 2024; 13:234. [PMID: 38666846 PMCID: PMC11048247 DOI: 10.3390/biology13040234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Hemodynamics is the eternal theme of the circulatory system. Abnormal hemodynamics and cardiac and pulmonary development intertwine to form the most important features of children with congenital heart diseases (CHDs), thus determining these children's long-term quality of life. Here, we review the varieties of hemodynamic abnormalities that exist in children with CHDs, the recently developed neonatal rodent models of CHDs, and the inspirations these models have brought us in the areas of cardiomyocyte proliferation and maturation, as well as in alveolar development. Furthermore, current limitations, future directions, and clinical decision making based on these inspirations are highlighted. Understanding how CHD-associated hemodynamic scenarios shape postnatal heart and lung development may provide a novel path to improving the long-term quality of life of children with CHDs, transplantation of stem cell-derived cardiomyocytes, and cardiac regeneration.
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Affiliation(s)
- Sixie Zheng
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, National Children’s Medical Center, Shanghai 200127, China;
- Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, National Children’s Medical Center, Shanghai 200127, China
| | - Lincai Ye
- Department of Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, National Children’s Medical Center, Shanghai 200127, China;
- Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, National Children’s Medical Center, Shanghai 200127, China
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27
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Anh NTH, Minh Dien T, Thi Ha L, Thao Nguyen P, Thi Hai Van D. Factors in the Neonatal Period Associated With Pulmonary Hypertension at 28 Days of Life in Broncho-Pulmonary Dysplasia. Glob Pediatr Health 2024; 11:2333794X241234571. [PMID: 38440333 PMCID: PMC10910877 DOI: 10.1177/2333794x241234571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/04/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
Objectives. To identify factors associated with pulmonary hypertension (PH) at 28 days of life in preterm infants with bronchopulmonary dysplasia (BPD). Methods. This observational study included 128 premature infants with BPD between January 2022 and February 2023 from the neonatal intensive care unit of Vietnam National Children's Hospital. Results. PH was observed using echocardiography in 29 patients (22.66%). The prevalence of severe BPD in the PH group (62.07%) was significantly higher than that in the non-PH group (18.18%). The multivariate logistic regression showed 2 predictors of PH in BPD: invasive mechanical ventilation up to 28 days of life (odds ratio [OR]:9.440; 95% confidence interval [CI]: 3.090-28.833; P < .001) and history of shock (OR: 2.962; 95% CI: 1.067-8.225; P = .037). Conclusion. We found 2 predictors of PH at 28 days of life in BPD: invasive mechanical ventilation up to 28 days of life and history of shock.
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Affiliation(s)
| | | | - Le Thi Ha
- Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Pham Thao Nguyen
- Ha Noi Medical University, Hanoi, Vietnam
- Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Dang Thi Hai Van
- Ha Noi Medical University, Hanoi, Vietnam
- Vietnam National Children’s Hospital, Hanoi, Vietnam
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28
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Joye S, Bhattacharya S, Kharrat A, Jasani B, Giesinger RE, McNamara PJ, Jain A. Shape of Pulmonary Artery Doppler Flow Profile and Right Ventricular Hemodynamics in Neonates. J Pediatr 2024; 266:113864. [PMID: 38052293 DOI: 10.1016/j.jpeds.2023.113864] [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: 06/20/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES To characterize pulmonary artery Doppler flow profile (PAFP) patterns among infants receiving care in neonatal intensive care units and to examine the association of PAFP patterns with pulmonary and right ventricular (RV) hemodynamics. STUDY DESIGN This is a retrospective study at 2 tertiary intensive care units over 4 years that included neonates who demonstrated a complete tricuspid regurgitation envelope on targeted neonatal echocardiography. Separate personnel reviewed TNEs to characterize PAFP patterns, divide cohort into PAFP groups, and measure quantitative indices of RV hemodynamics (RV systolic pressure, pulmonary artery acceleration time and its ratio with RV ejection time, tricuspid annular plane systolic excursion, and RV output), for intergroup comparisons. RESULTS We evaluated TNEs from 186 neonates with median gestational age of 28.5 weeks (IQR, 25.9-35.9 weeks). Four distinct PAFP patterns were identified (A) near-isosceles triangle (22%), (B) right-angled triangle (29%), (C) notching (40%), and (D) low peak velocity (<0.4 m/s; 9%). Groups A-C demonstrated a stepwise worsening in all indices of PH, whereas pattern D was associated with lower tricuspid annular plane systolic excursion and RV output. Using common definitions of pulmonary hypertension (PH), pattern A performed best to rule out PH (sensitivity range, 81%-90%) and pattern C for diagnosing PH (specificity range, 63%-78%). CONCLUSIONS Inspection of PAFP is a simple bedside echocardiography measure that provides clinically meaningful information on underlying RV hemodynamics and may aid in screening and monitoring of patients for PH in intensive care units.
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Affiliation(s)
- Sébastien Joye
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Ashraf Kharrat
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Bonny Jasani
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Division of Neonatology, The Hospital of Sick Children, Toronto, ON, Canada
| | | | | | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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29
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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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30
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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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31
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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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32
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Young KC, Schmidt AF, Tan AW, Sbragia L, Elsaie A, Shivanna B. Pathogenesis and Physiologic Mechanisms of Neonatal Pulmonary Hypertension: Preclinical Studies. Clin Perinatol 2024; 51:21-43. [PMID: 38325942 DOI: 10.1016/j.clp.2023.11.004] [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
Neonatal pulmonary hypertension (PH) is a devastating disorder of the pulmonary vasculature characterized by elevated pulmonary vascular resistance and mean pulmonary arterial pressure. Occurring predominantly because of maldevelopment or maladaptation of the pulmonary vasculature, PH in neonates is associated with suboptimal short-term and long-term outcomes because its pathobiology is unclear in most circumstances, and it responds poorly to conventional pulmonary vasodilators. Understanding the pathogenesis and pathophysiology of neonatal PH can lead to novel strategies and precise therapies. The review is designed to achieve this goal by summarizing pulmonary vascular development and the pathogenesis and pathophysiology of PH associated with maladaptation, bronchopulmonary dysplasia, and congenital diaphragmatic hernia based on evidence predominantly from preclinical studies. We also discuss the pros and cons of and provide future directions for preclinical studies in neonatal PH.
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Affiliation(s)
- Karen C Young
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Batchelor Children's Research Institute, 1580 North West 10th Avenue, RM-345, Miami, Fl 33136, USA.
| | - Augusto F Schmidt
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Batchelor Children's Research Institute, 1580 North West 10th Avenue, RM-345, Miami, Fl 33136, USA
| | - April W Tan
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Batchelor Children's Research Institute, 1580 North West 10th Avenue, RM-345, Miami, Fl 33136, USA
| | - Lourenco Sbragia
- Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes 3900, 10th Floor, Monte Alegre14049-900, Ribeirao Preto SP, Brazil
| | - Ahmed Elsaie
- Ascension Via Christi St.Joseph Hospital, 3rd Floor, section of Neonatology, 3600 East Harry StreetWichita, KS 67218, USA; Department of Pediatrics, Cairo University, Cairo 11956, Egypt
| | - Binoy Shivanna
- Division of Neonatology, Department of Pediatrics, 6621 Fannin Street, MC: WT 6-104, Houston, TX 77030, USA
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33
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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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34
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Tanghöj G, Naumburg E. Risk factors for isolated atrial septal defect secundum morbidity. Sci Rep 2024; 14:4757. [PMID: 38413680 PMCID: PMC10899192 DOI: 10.1038/s41598-024-55446-2] [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: 04/13/2023] [Accepted: 02/23/2024] [Indexed: 02/29/2024] Open
Abstract
Atrial septal defect secundum is a common type of congenital heart defect and even more common among children born premature. The aim of this study was to assess premature birth as a potential associated risk factors for cardiac morbidity in children with isolated ASD II. In this retrospective national registry-based case-control study all children born in Sweden between 2010 and 2015 with an isolated ASD II diagnosis were included. Association between premature birth and cardiac morbidity in children with isolated ASD II was assessed by different outcomes-models using conditional logistic regression and adjustments were made for confounding factors. Overall, 11% of children with an isolated ASD II received treatment for heart failure. Down syndrome was the only independent risk factors for associated with cardiac morbidity in children with ASD II (OR = 2.25 (95%CI 1.25-4.07). Preterm birth in children was not associated with an increased risk of ASD II cardiac morbidity.
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Affiliation(s)
- Gustaf Tanghöj
- Unit of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Estelle Naumburg
- Unit of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
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35
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Gao N, Lv Y, Cui Y, Wang P, He X. Bosentan in the treatment of persistent pulmonary hypertension in newborns: a systematic review and meta-analysis. Cardiol Young 2024:1-8. [PMID: 38329072 DOI: 10.1017/s1047951123004456] [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: 02/09/2024]
Abstract
BACKGROUND Persistent pulmonary hypertension of the newborn is a life-threatening condition that affects about 1-2 per 1,000 live births worldwide. Bosentan is an oral dual endothelin receptor antagonist that may have a beneficial effect on persistent pulmonary hypertension of the newborn by reducing pulmonary vascular resistance and improving oxygenation. However, its role in persistent pulmonary hypertension of the newborn remains unclear. OBJECTIVES To systematically evaluate the efficacy and safety of bosentan as an adjuvant therapy for persistent pulmonary hypertension of the newborn in newborns. METHODS We searched six English and two Chinese databases from their inception to 1 January 2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomised controlled trials and retrospective studies that compared bosentan with placebo or other drugs for persistent pulmonary hypertension of the newborn in newborns. We performed a meta-analysis using random-effects models and assessed the risk of bias and heterogeneity in the included studies. RESULTS We included 10 studies with a total of 550 participants. Bosentan significantly reduced the treatment failure rate (relative risk = 0.25, P < 0.001), pulmonary artery pressure (mean difference = -11.79, P < 0.001), and length of hospital stay (mean difference = -1.04, P = 0.003), and increased the partial pressure of oxygen (mean difference = 10.02, P < 0.001) and blood oxygen saturation (SpO2) (mean difference = 8.24, P < 0.001) compared with a placebo or other drugs. The occurrence of adverse reactions was not significantly different between bosentan and a placebo or other drugs. CONCLUSIONS Bosentan is effective in the treatment of persistent pulmonary hypertension of the newborn but adverse reactions such as abnormal liver function should be observed when using it.
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Affiliation(s)
- Ning Gao
- Neonatology Department, Baoding No.1 Central Hospital, Baoding, China
| | - Yuanyuan Lv
- Infection control office, Baoding No.1 Central Hospital, Baoding, China
| | - Yanbin Cui
- Emergency Department, Baoding No.3 Central Hospital, Baoding, China
| | - Pengchun Wang
- Neonatology Department, Baoding No.1 Central Hospital, Baoding, China
| | - Xin He
- Neonatology Department, Baoding No.1 Central Hospital, Baoding, China
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36
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Beer L, Rivera BK, Jama W, Slaughter JL, Backes CH, Conroy S, Kielt MJ. Association of the respiratory severity score with bronchopulmonary dysplasia-associated pulmonary hypertension in infants born extremely preterm. J Perinatol 2024; 44:294-300. [PMID: 37853090 DOI: 10.1038/s41372-023-01798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To test the hypothesis that elevations in the respiratory severity score (RSS) are associated with increased probability of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH). STUDY DESIGN Retrospective cohort study of infants born extremely preterm admitted to a BPD center between 2010 and 2018. Echocardiograms obtained ≥ 36 weeks' post-menstrual age (PMA) were independently adjudicated by two blinded cardiologists to determine the presence/absence of BPD-PH. Multivariable logistic regression estimated the association between RSS and BPD-PH. RESULT BPD-PH was observed in 68/223 (36%) of subjects. The median RSS at time of echocardiography was 3.04 (Range 0-18.3). A one-point increase in the RSS was associated with BPD-PH, aOR 1.3 (95% CI 1.2-1.4), after adjustment for gestational age and PMA at time of echocardiography. CONCLUSION Elevations in the RSS were associated with a greater probability of BPD-PH. Prospective studies are needed to determine the validity and performance of RSS as a clinical susceptibility/risk biomarker for BPD-PH.
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Affiliation(s)
- Lindsey Beer
- Ohio Perinatal Research Network, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian K Rivera
- Ohio Perinatal Research Network, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Waceys Jama
- Ohio Perinatal Research Network, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jonathan L Slaughter
- Ohio Perinatal Research Network, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Carl H Backes
- Ohio Perinatal Research Network, Nationwide Children's Hospital, Columbus, OH, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sara Conroy
- Ohio Perinatal Research Network, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
- Biostatistics Resource at Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Matthew J Kielt
- Ohio Perinatal Research Network, Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA.
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, USA.
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Ismail R, Vorhies E, Mohammad K, Soraisham A, Scott J, Stritzke A. Persistent pulmonary hypertension and short-term neurological outcomes in infants with moderate to severe hypoxic ischemic encephalopathy. J Neonatal Perinatal Med 2024; 17:597-605. [PMID: 39213094 DOI: 10.3233/npm-230032] [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: 09/04/2024]
Abstract
BACKGROUND Our aim was to investigate the relationship between persistent pulmonary hypertension of the newborn (PPHN), short-term brain injury or death, and clinical parameters in infants with moderate to severe hypoxic ischemic encephalopathy (HIE). METHODS Retrospective single-center cohort study of 274 HIE infants, 230 underwent Therapeutic Hypothermia (TH). Primary outcome was severe HIE brain injury on MRI and/or death within the first month of life in relation to presence and severity of PPHN (clinical or echocardiographic). Secondary outcomes were HIE brain injury pattern, abnormal electroencephalogram (EEG), seizures, clinical, and laboratory differences. A logistic regression model was performed to evaluate PPHN presence and severity as risk factor for brain injury or death. RESULTS The combined outcome of severe brain injury or death was higher in the clinical PPHN group vs non-PPHN (32.6 vs 22.8%, p = 0.014). There was no difference in brain injury, seizure burden or EEG abnormalities associated with PPHN, despite those with PPHN being sicker with higher ventilation needs and worse laboratory values than those without. Mortality had a strong correlation with echocardiographic PPHN with the highest incidence in severe (36%) vs moderate (7.7%) vs mild PPHN (10%, p = 0.002). Highest mortality had those with 'early exit' who did not complete 72 hours of TH (71.4%). CONCLUSIONS In infants with HIE, PPHN was not associated with increased risk of brain injury as evident on MRI, nor seizure burden, despite being sicker with worse laboratory values. However, mortality rates were higher the worse the PPHN, especially with early exit from TH.
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Affiliation(s)
- R Ismail
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, Calgary, Canada
| | - E Vorhies
- Department of Pediatrics, Section of Pediatric Cardiology, Cumming School of Medicine, Calgary, Canada
| | - K Mohammad
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, Calgary, Canada
| | - A Soraisham
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - J Scott
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - A Stritzke
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, Canada
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Moore SS, De Carvalho Nunes G, Dancea A, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna G, Altit G. Early cardiac function and death, severe bronchopulmonary dysplasia and pulmonary hypertension in extremely preterm infants. Pediatr Res 2024; 95:293-301. [PMID: 37726544 DOI: 10.1038/s41390-023-02817-6] [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: 01/20/2023] [Revised: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Association between early cardiac function and neonatal outcomes are scarcely reported. The aim of the current study was to describe this association with death, severe bronchopulmonary dysplasia (BPD) and BPD-related pulmonary hypertension (PH). METHODS Retrospective cohort study of infants <29 weeks born between 2015 and 2019. Infants with clinically acquired echocardiography at ≤21 days after birth were included and data were extracted by an expert masked to outcomes. RESULTS A total of 176 infants were included. Echocardiogram was performed at a median of 9 days (IQR 5-13.5). Of these, 31 (18%) had death/severe BPD and 59 (33.5%) had death/BPD-related PH. Infants with death/severe BPD were of lower birth weight (745 [227] vs 852 [211] grams, p = 0.01) and more exposed to invasive ventilation, late-onset sepsis, inotropes and/or postnatal steroids. Early echocardiograms demonstrated decreased right ventricular [Tricuspid Annular Plane Systolic Excursion: 5.2 (1.4) vs 6.2 (1.5) cm, p = 0.03] and left ventricular function [Ejection fraction 53 (14) vs 58 (10) %, p = 0.03]. Infants with death/BPD-related PH had an increased Eccentricity index (1.35 [0.20] vs 1.26 [0.19], p = 0.02), and flat/bowing septum (19/54 [35%] vs 20/109 [18%], p = 0.021). CONCLUSIONS In extremely premature infants, altered ventricular function and increased pulmonary pressure indices within the first 21 days after birth, were associated with the combined outcome of death/severe BPD and death/BPD-related PH. IMPACT Decreased cardiac function on echocardiography performed during first three weeks of life is associated with severe bronchopulmonary dysplasia in extremely premature infants. In extreme preterm infants, echocardiographic signs of pulmonary hypertension in early life are associated with later BPD-related pulmonary hypertension close to 36 weeks post-menstrual age. Early cardiac markers should be further studied as potential intervention targets in this population. Our study is adding comprehensive analysis of echocardiographic data in infants born below 29 weeks gestational age.
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Affiliation(s)
- Shiran S Moore
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
- Neonatology-Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabriela De Carvalho Nunes
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Adrian Dancea
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | | | - Jessica Simoneau
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Guilherme Sant'Anna
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Gabriel Altit
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada.
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Osman A. The early use of inhaled nitric oxide in premature infants requiring respiratory support. Ann Med 2023; 55:2266633. [PMID: 38079494 PMCID: PMC10880562 DOI: 10.1080/07853890.2023.2266633] [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: 08/08/2022] [Accepted: 09/28/2023] [Indexed: 12/18/2023] Open
Abstract
Background: Earlier studies on the use of inhaled nitric oxide (iNO) for premature infants born at <34 weeks of gestation requiring respiratory support did not provide conclusive evidence of benefit. National guidelines generally discouraged the use in this population. More recent national guidelines endorsed the use of iNO in premature infants with hypoxic respiratory failure (HRF) associated with persistent pulmonary hypertension of the newborn (PPHN).Recent Studies: Two recently published observational studies evaluated the effect of administering iNO on oxygenation in the first week of life. These studies compared premature infants born at the gestational age (GA) of <34 weeks with HRF associated with PPHN to term and late preterm infants born at the GA of ≥34 weeks who received iNO. Both studies showed a similar effect of iNO on oxygenation in the two infant cohorts. The response rate in the premature infant cohort was 59% in the first study and 90% in the second. The mean response time was 9.2 h and 10.3 h, and the mean duration of therapy was 3.5 days and 8.2 days, respectively.Conclusion: The results of these studies support a trial of iNO in premature infants with persistent hypoxia despite optimum respiratory support. Obtaining a timely echocardiogram to exclude cardiac diseases and diagnose PPHN is logistically challenging for many clinicians, thus, a clinical diagnosis of PPHN might have to be made in these situations. Questions remain regarding the optimum dose of iNO and the duration of the initial iNO trial in these patients.KEY MESSAGESIn the most recently published studies, the improvement of oxygenation in iNO-treated infants born at <34 weeks of gestation with HRF and PPHN physiology was as effective as in infants born ≥34 weeks.These studies provide evidence supporting a trial of iNO in the subpopulation of premature infants with HRF associated with PPHN.
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Affiliation(s)
- Ahmed Osman
- The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, OH, USA
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40
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Häfner F, Kindt A, Strobl K, Förster K, Heydarian M, Gonzalez E, Schubert B, Kraus Y, Dalla Pozza R, Flemmer AW, Ertl-Wagner B, Dietrich O, Stoecklein S, Tello K, Hilgendorff A. MRI pulmonary artery flow detects lung vascular pathology in preterms with lung disease. Eur Respir J 2023; 62:2202445. [PMID: 37678954 PMCID: PMC10749508 DOI: 10.1183/13993003.02445-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/24/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Pulmonary vascular disease (PVD) affects the majority of preterm neonates with bronchopulmonary dysplasia (BPD) and significantly determines long-term mortality through undetected progression into pulmonary hypertension. Our objectives were to associate characteristics of pulmonary artery (PA) flow and cardiac function with BPD-associated PVD near term using advanced magnetic resonance imaging (MRI) for improved risk stratification. METHODS Preterms <32 weeks postmenstrual age (PMA) with/without BPD were clinically monitored including standard echocardiography and prospectively enrolled for 3 T MRI in spontaneous sleep near term (AIRR (Attention to Infants at Respiratory Risks) study). Semi-manual PA flow quantification (phase-contrast MRI; no BPD n=28, mild BPD n=35 and moderate/severe BPD n=25) was complemented by cardiac function assessment (cine MRI). RESULTS We identified abnormalities in PA flow and cardiac function, i.e. increased net forward volume right/left ratio, decreased mean relative area change and pathological right end-diastolic volume, to sensitively detect BPD-associated PVD while correcting for PMA (leave-one-out area under the curve 0.88, sensitivity 0.80 and specificity 0.81). We linked these changes to increased right ventricular (RV) afterload (RV-arterial coupling (p=0.02), PA mid-systolic notching (t2; p=0.015) and cardiac index (p=1.67×10-8)) and correlated echocardiographic findings. Identified in moderate/severe BPD, we successfully applied the PA flow model in heterogeneous mild BPD cases, demonstrating strong correlation of PVD probability with indicators of BPD severity, i.e. duration of mechanical ventilation (rs=0.63, p=2.20×10-4) and oxygen supplementation (rs=0.60, p=6.00×10-4). CONCLUSIONS Abnormalities in MRI PA flow and cardiac function exhibit significant, synergistic potential to detect BPD-associated PVD, advancing the possibilities of risk-adapted monitoring.
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Affiliation(s)
- Friederike Häfner
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- Center for Comprehensive Developmental Care (CDeCLMU) at the interdisciplinary Social Pediatric Center (iSPZ Hauner), Haunersches Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- F. Häfner and A. Kindt contributed equally to this study
| | - Alida Kindt
- Metabolomics and Analytics Centre, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
- F. Häfner and A. Kindt contributed equally to this study
| | - Kathrin Strobl
- Center for Comprehensive Developmental Care (CDeCLMU) at the interdisciplinary Social Pediatric Center (iSPZ Hauner), Haunersches Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Kai Förster
- Center for Comprehensive Developmental Care (CDeCLMU) at the interdisciplinary Social Pediatric Center (iSPZ Hauner), Haunersches Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- Division of Neonatology, University Children's Hospital Dr v. Hauner and Perinatal Center, University Hospital, Ludwig Maximilian University Munich, Munich Germany
| | - Motaharehsadat Heydarian
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Erika Gonzalez
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- Center for Comprehensive Developmental Care (CDeCLMU) at the interdisciplinary Social Pediatric Center (iSPZ Hauner), Haunersches Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Benjamin Schubert
- Institute of Computational Biology, Helmholtz Center Munich, Munich, Germany
| | - Yvonne Kraus
- Center for Comprehensive Developmental Care (CDeCLMU) at the interdisciplinary Social Pediatric Center (iSPZ Hauner), Haunersches Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Andreas W Flemmer
- Division of Neonatology, University Children's Hospital Dr v. Hauner and Perinatal Center, University Hospital, Ludwig Maximilian University Munich, Munich Germany
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
| | - Olaf Dietrich
- Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Anne Hilgendorff
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
- Center for Comprehensive Developmental Care (CDeCLMU) at the interdisciplinary Social Pediatric Center (iSPZ Hauner), Haunersches Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
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Hysinger EB, Critser P. How is preterm birth working out: cardiopulmonary response to exercise in extreme prematurity. Eur Respir J 2023; 62:2301787. [PMID: 37973173 DOI: 10.1183/13993003.01787-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Erik B Hysinger
- Division of Pulmonary Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul Critser
- The Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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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.
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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
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43
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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.
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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.
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de Waal K, Crendal E, Poon ACY, Latheef MS, Sachawars E, MacDougall T, Phad N. The association between patterns of early respiratory disease and diastolic dysfunction in preterm infants. J Perinatol 2023; 43:1268-1273. [PMID: 36823313 PMCID: PMC10541326 DOI: 10.1038/s41372-023-01608-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND This study aims to determine the association between clinical patterns of early respiratory disease and diastolic dysfunction in preterm infants. METHODS Preterm infants <29 weeks' gestation underwent cardiac ultrasounds around day 7 and 14-21. Respiratory dysfunction patterns were classified as stable (ST), respiratory deterioration (RD) or early persistent respiratory dysfunction (EPRD) according to oxygen need. Diastolic dysfunction was diagnosed using a multi-parameter approach including left atrial strain (LASR) to help differentiate between cardiac or pulmonary pathophysiology. RESULTS 98 infants (mean 27 weeks) were included. The prevalence of ST, RD and EPRD was 53%, 21% and 26% respectively. Diastolic dysfunction was more prevalent in the RD and EPRD groups with patent ductus arteriosus and significant growth restriction as risk factors. Not all infants with a PDA developed diastolic dysfunction. LASR was lower in the EPDR group. CONCLUSION Respiratory dysfunction patterns are associated with diastolic dysfunction in preterm infants.
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Affiliation(s)
- Koert de Waal
- John Hunter Children's Hospital, department of neonatology, Newcastle, NSW, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
| | - Edward Crendal
- John Hunter Children's Hospital, department of neonatology, Newcastle, NSW, Australia
- John Hunter Hospital, department of cardiology, Newcastle, NSW, Australia
| | | | | | - Elias Sachawars
- John Hunter Hospital, department of radiology, Newcastle, NSW, Australia
| | - Thomas MacDougall
- John Hunter Hospital, department of radiology, Newcastle, NSW, Australia
| | - Nilkant Phad
- John Hunter Children's Hospital, department of neonatology, Newcastle, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
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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.
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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.
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Häfner F, Johansson C, Schwarzkopf L, Förster K, Kraus Y, Flemmer AW, Hansmann G, Sallmon H, Felderhoff‐Müser U, Witt S, Schwettmann L, Hilgendorff A. Current diagnosis and treatment practice for pulmonary hypertension in bronchopulmonary dysplasia-A survey study in Germany (PUsH BPD). Pulm Circ 2023; 13:e12320. [PMID: 38144949 PMCID: PMC10739109 DOI: 10.1002/pul2.12320] [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: 09/08/2023] [Accepted: 11/25/2023] [Indexed: 12/26/2023] Open
Abstract
Pulmonary hypertension (PH) is the most severe complication in preterm infants with bronchopulmonary dysplasia (BPD) and associated with significant mortality. Diagnostic and treatment strategies, however, still lack standardization. By the use of a survey study (PH in BPD), we assessed clinical practice (diagnosis, treatment, follow-up) in preterm infants with early postnatal persistent pulmonary hypertension of the newborn (PPHN) as well as at risk for or with established BPD-associated PH between 06/2018 and 10/2020 in two-thirds of all German perinatal centers with >70 very low birthweight infants/year including their cardiology departments and outpatient units. Data were analyzed descriptively by measures of locations and distributional shares. In routine postnatal care, clinical presentation and echocardiography were reported as the main diagnostic modalities to screen for PPHN in preterm infants, whereas biomarkers brain natriuretic peptide/N-terminal pro b-type natriuretic peptide were infrequently used. For PPHN treatment, inhaled nitric oxide was used in varying frequency. The majority of participants agreed to prescribe diuretics and steroids (systemic/inhaled) for infants at risk for or with established BPD-associated PH and strongly agreed on recommending respiratory syncytial virus immunization and the use of home monitoring upon discharge. Reported oxygen saturation targets, however, varied in these patients in in- and outpatient care. The survey reveals shared practices in diagnostic and therapeutic strategies for preterms with PPHN and BPD-associated PH in Germany. Future studies are needed to agree on detailed echo parameters and biomarkers to diagnose and monitor disease next to a much-needed agreement on the use of pulmonary vasodilators, steroids, and diuretics as well as target oxygen saturation levels.
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Affiliation(s)
- Friederike Häfner
- Institute for Lung Health and Immunity and Comprehensive Pneumology CenterHelmholtz Munich, Member of the German Center for Lung Research (DZL)MunichGermany
- Center for Comprehensive Developmental Care (CDeCLMU) at the Interdisciplinary Social Pediatric CenterDr. von Hauner Children's Hospital, LMU University HospitalMunichGermany
| | - Caroline Johansson
- Center for Comprehensive Developmental Care (CDeCLMU) at the Interdisciplinary Social Pediatric CenterDr. von Hauner Children's Hospital, LMU University HospitalMunichGermany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care ManagementHelmholtz MunichNeuherbergGermany
- IFT Institute für TherapieforschungCentre for Mental Health and Addiction ResearchMunichGermany
| | - Kai Förster
- Center for Comprehensive Developmental Care (CDeCLMU) at the Interdisciplinary Social Pediatric CenterDr. von Hauner Children's Hospital, LMU University HospitalMunichGermany
- Division of NeonatologyDr. von Hauner Children's Hospital, LMU University HospitalMunichGermany
| | - Yvonne Kraus
- Center for Comprehensive Developmental Care (CDeCLMU) at the Interdisciplinary Social Pediatric CenterDr. von Hauner Children's Hospital, LMU University HospitalMunichGermany
| | - Andreas W. Flemmer
- Division of NeonatologyDr. von Hauner Children's Hospital, LMU University HospitalMunichGermany
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical CareHannover Medical SchoolHannoverGermany
| | - Hannes Sallmon
- Department of Congenital Heart Disease/Pediatric CardiologyDeutsches Herzzentrum der Charité (DHZC)BerlinGermany
- Division of Pediatric CardiologyMedical University of GrazGrazAustria
| | - Ursula Felderhoff‐Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital EssenUniversity of Duisburg‐EssenEssenGermany
| | - Sabine Witt
- Institute of Health Economics and Health Care ManagementHelmholtz MunichNeuherbergGermany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care ManagementHelmholtz MunichNeuherbergGermany
- Department of Health Services Research, Faculty VI Medicine and Health SciencesCarl von Ossietzky University of OldenburgOldenburgGermany
| | - Anne Hilgendorff
- Institute for Lung Health and Immunity and Comprehensive Pneumology CenterHelmholtz Munich, Member of the German Center for Lung Research (DZL)MunichGermany
- Division of NeonatologyDr. von Hauner Children's Hospital, LMU University HospitalMunichGermany
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47
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Ferzli GTE, Jebbia M, Miller AN, Nelin LD, Shepherd EG. Respiratory management of established severe bronchopulmonary dysplasia. Semin Perinatol 2023; 47:151816. [PMID: 37758578 DOI: 10.1016/j.semperi.2023.151816] [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] [Indexed: 09/29/2023]
Abstract
Respiratory management of infants with established severe BPD is difficult and there is little evidence upon which to base decisions. Nonetheless, the physiology of severe BPD is well described with a predominantly obstructive pattern. This pulmonary dysfunction results in prolonged exhalatory time constants and thus ventilator management must be focused on maintaining adequate oxygenation and ventilation through achieving full exhalation. This approach is often difficult to maintain in acute care settings and a culture of chronic care focused on slow change and steady progress is imperative. Once respiratory stability is achieved, the focus should shift to growth and development and avoidance of care practices and medications that impair neurodevelopment.
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Affiliation(s)
- George T El- Ferzli
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States; Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, United States
| | - Maria Jebbia
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States; Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, United States
| | - Audrey N Miller
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States; Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, United States
| | - Leif D Nelin
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States; Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, United States
| | - Edward G Shepherd
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States; Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, United States.
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48
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Wang X, Wang S, Chen M, Lv Y, Chen X, Yang C. The value of hematocrit for predicting bronchopulmonary dysplasia in very low birth weight preterm infants. Medicine (Baltimore) 2023; 102:e35056. [PMID: 37773858 PMCID: PMC10545317 DOI: 10.1097/md.0000000000035056] [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: 03/16/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023] Open
Abstract
To determine hematocrit (HCT) and to identify independent risk factors for predicting bronchopulmonary dysplasia (BPD) in preterm infants with very low birth weight (VLBW) infants. This retrospective study included 296 premature infants with VLBW in the neonatal intensive care unit of the First Affiliated Hospital of the University of Science and Technology of China between January 2015 and December 2019. Maternal pregnant information and clinical information as well as hematological parameters of preterm babies were collected and compared. Then the maximum area under the curve of receiver operating characteristic curve was developed to estimate the predictive indicator in the blood. Finally, differential variables together with the predictive index were screened for multiple logistic regression analysis to determine independent prognostic factors for BPD. Infants were divided into a BPD group (134 cases) and a non-BPD group (162 cases). The area under the curve of HCT at postnatal 1 week was 0.737 with the sensitivity of 52.30 % and the specificity of 86.00%. Birth weight (BW) <1.12 kg, gestational age <28.4 weeks, newborn respiratory distress syndrome, mechanical ventilation ≥ 7 days, ventilation associated pneumonia, patent arterial duct, PaO2/FiO2 <300 mm Hg and HCT <0.455 at postnatal 1 week were risk factors for BPD of VLBW infants. HCT levels below 0.455 at 1 week after birth serve as a valuable indicator for the potential development of BPD.
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Affiliation(s)
- Xuesong Wang
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, Cheeloo College of Medicine, Shandong University, Shenzhen, China
| | - Shushu Wang
- Department of Neonatology, The First Affiliated Hospital of USTC, Hefei, China
| | - Mingwu Chen
- Department of Neonatology, The First Affiliated Hospital of USTC, Hefei, China
| | - Yong Lv
- Department of Neonatology, The First Affiliated Hospital of USTC, Hefei, China
| | - Xueyu Chen
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, Cheeloo College of Medicine, Shandong University, Shenzhen, China
| | - Chuanzhong Yang
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, Cheeloo College of Medicine, Shandong University, Shenzhen, China
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49
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Wymore E, Lynch A, Singh J, Thevarajah T, Hodges J, Kinsella J, Auer E, Wagner B. The Relationship Between Severe Hypertensive Diseases of Pregnancy and Moderate-Severe Bronchopulmonary Dysplasia. RESEARCH SQUARE 2023:rs.3.rs-3373933. [PMID: 37841860 PMCID: PMC10571594 DOI: 10.21203/rs.3.rs-3373933/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Objective Determine the association between severe hypertensive disease of pregnancy (HDP) with moderate-severe bronchopulmonary dysplasia (BPD) in preterm infants (< 31 weeks' gestation). Study Design Preterm birth cohort study of 693 mother-infant dyads. Severe HDPwas defined as severe preeclampsia, HELLP syndrome or eclampsia. The outcome was moderate-severe BPD classified at 36 weeks corrected gestational age, based on the NICHD Consensusstatement. Results 225 (32%) mothers developed severe HDP and 234 (34%) infants hadmoderate-severe BPD. There was an interaction between severe HDP and gestational age (p=0.03). Infants born at earlier gestational ages to mothers with HDP had increased odds for moderate-severe BPD compared to infants of normotensive mothers delivering at the same gestational age. Infants born at later gestational ages to mothers with severe HDP had decreased odds for the outcome. Conclusions Severe HDP has a differential effect on the development of moderate-severe BPD based on gestational age.
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Affiliation(s)
| | - Anne Lynch
- University of Colorado School of Medicine
| | | | | | | | | | - Emily Auer
- University of Colorado School of Medicine
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50
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Carr H, Gunnerbeck A, Eisenlauer P, Johansson S, Cnattingius S, Ludvigsson JF, Edstedt Bonamy AK. Severity of preterm birth and the risk of pulmonary hypertension in childhood: A population-based cohort study in Sweden. Paediatr Perinat Epidemiol 2023; 37:630-640. [PMID: 37414733 DOI: 10.1111/ppe.12997] [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: 12/04/2022] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Preterm birth (<37 completed gestational weeks) has been linked to pulmonary hypertension (PH), but the relationship to severity of preterm birth has not been studied. OBJECTIVES We investigated associations between extremely (<28 weeks), very (28-31 weeks), moderately (32-36 weeks) preterm birth, early-term birth (37-38 weeks) and later PH. Additionally, we explored associations between birthweight for gestational age and PH. METHODS This registry-based cohort study followed 3.1 million individuals born in Sweden (1987-2016) from 1 up to a maximum of 30 years of age. The outcome was diagnosis or death from PH in national health registers. Adjusted hazard ratios (HR) were estimated using Cox regression analysis. Unadjusted and confounder-adjusted incidence rate differences were also calculated. RESULTS Of 3,142,812 individuals, there were 543 cases of PH (1.2 per 100,000 person-years), 153 of which in individuals without malformations. Compared with individuals born at 39 weeks, adjusted HRs with 95% confidence interval (CI) for PH for extremely, moderately, and very preterm birth were 68.78 (95% CI 49.49, 95.57), 13.86 (95% CI 9.27, 20.72) and 3.42 (95% CI 2.46, 4.74), respectively, and for early-term birth 1.74 (1.31, 2.32). HRs were higher in subjects without malformations. There were 90 additional cases of PH per 100,000 person-years in the extremely preterm group (50 after excluding malformations). Very small for gestational age (below 2 SD from estimated birthweight for gestational age and sex) was also associated with increased risk of PH (adjusted HR 2.02, 95% CI 1.14, 3.57). CONCLUSIONS We found an inverse association between gestational age and later PH, but the incidence and absolute risks are low. The severity of preterm birth adds clinically relevant information to the assessment of cardiovascular risks in childhood.
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Affiliation(s)
- Hanna Carr
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Gunnerbeck
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Eisenlauer
- Department of Neonatology, Karolinska University Hospital, Solna, Sweden
| | - Stefan Johansson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Anna-Karin Edstedt Bonamy
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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