Abstract
Hypothesis
Premature infants with bronchopulmonary dysplasia (BPD) are at increased risk of secondary pulmonary hypertension (BPD-PH). Prior studies yielded mixed results on the utility of echocardiographic screening at 36 weeks post-menstrual age (PMA). We present our experience using echocardiographic screening at the time of BPD diagnosis to identify infants at highest risk of BPD-PH at discharge.
Materials and Methods
Retrospective cohort analysis of clinical/ demographic data and screening echocardiograms in patients with BPD. Discharge echocardiograms identified infants with or without BPD-PH at discharge. 36 weeks PMA screening echocardiograms and clinical data were then reviewed to identify which factors were associated with increased odds of BPD-PH at discharge. Associations between echocardiographic findings were evaluated with 2- and 3-variable models to predict increased risk of BPD-PH at discharge.
Results
In our cohort of 64 infants with severe BPD, BPD-PH was present in 22/64 (34%) infants at discharge. There were no clinical differences at time of 36 weeks PMA screening evaluation (mean PMA 36.6 ± 2.9 weeks). PH at screening was poorly predictive of PH at discharge as PH at screening resolved in 49% of patients. However, having an ASD, RV dilation, hypertrophy, or reduced function on screening, especially in combination, were associated with BPD-PH at discharge.
Conclusion
In our cohort of premature infants with BPD, 36 weeks PMA screening echocardiogram identified patients at increased risk for BPD-PH at discharge when ASD, RVH, or impaired RV function were present. Larger prospective studies are indicated to validate these findings.
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Data Availability
All data were obtained retrospectively in a de-identified manner from the medical record of included patients in accordance to guidance provided by the University of Virginia bioethics committee (IRB).
Code Availability
Not applicable.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by (BAM), (MAM), and (MRC). The first draft of the manuscript was written by (BAM) and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This research study was conducted retrospectively from data obtained for clinical purposes. We consulted with the bioethics committee of University of Virginia who determined that consent to participate was not required due to its retrospective nature posing minimal risk to participants.
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of University of Virginia approved this study.
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Madden, B.A., Conaway, M.R., Zanelli, S.A. et al. Screening Echocardiography Identifies Risk Factors for Pulmonary Hypertension at Discharge in Premature Infants with Bronchopulmonary Dysplasia. Pediatr Cardiol 43, 1743–1751 (2022). https://doi.org/10.1007/s00246-022-02911-2
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DOI: https://doi.org/10.1007/s00246-022-02911-2