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Pulmonary Hypertension in Bronchopulmonary Dysplasia

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Respiratory Outcomes in Preterm Infants

Part of the book series: Respiratory Medicine ((RM))

Abstract

Pulmonary vascular disease (PVD) and related pulmonary hypertension (PH) contribute significantly to the pathogenesis, cardiorespiratory morbidities, and poor outcomes in preterm infants with BPD. Past studies have shown that persistent echocardiogram evidence of PH beyond the first few months of life is associated with up to 40 % mortality in infants with BPD. The association of PH with poor survival in BPD has continued into the recent era of the “new BPD,” especially in infants with severe disease who require prolonged support with mechanical ventilation. More recent studies have shown that adverse antenatal or early postnatal stimuli impair pulmonary vascular development and function, leading to disruption of angiogenesis and distal lung airspace growth. Consensus guidelines for the diagnosis, evaluation, and management of PH in infants with established BPD have recently been published by a consensus committee; however, clinical care remains controversial due to the lack of strong evidence-based data. Overall, understanding the pathogenesis and pathobiology of early PVD in BPD continues as an important challenge and may help to improve early and late cardiopulmonary outcomes after preterm birth. Future large-scale studies of interventions for the treatment of PH in established BPD are needed. In addition, strategies that specifically target the preservation of endothelial survival and function may also lead to novel approaches for the prevention of BPD and late PH.

Funding Source 

This work was supported in part by grants from the NHLBI HL085703 (S.H.A.), HL068702 (S.H.A.), and U01 HL102235 (S.H.A.). The author has no conflicts of interest with this work, but has received grant funding from Shire Pharmaceuticals for laboratory research

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Author information

Authors and Affiliations

  1. Pediatric Heart Lung Center, Sections of Pediatric Pulmonary Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, 80045, USA

    Steven H. Abman MD

  2. Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, 80045, USA

    Steven H. Abman MD

  3. Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Mail Stop B395, 13123 East 16th Avenue, Aurora, CO, 80045, USA

    Steven H. Abman MD

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  1. Steven H. Abman MD
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Correspondence to Steven H. Abman MD .

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Editors and Affiliations

  1. Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA

    Anna Maria Hibbs

  2. Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA

    Marianne S. Muhlebach

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Abman, S.H. (2017). Pulmonary Hypertension in Bronchopulmonary Dysplasia. In: Hibbs, A., Muhlebach , M. (eds) Respiratory Outcomes in Preterm Infants. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-48835-6_12

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  • DOI: https://doi.org/10.1007/978-3-319-48835-6_12

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