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Pulmonary hypertension in a neonatologist-performed echocardiographic follow-up of bronchopulmonary dysplasia

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Abstract

Neonatologist-performed echocardiography (NPE) is an established tool for bedside hemodynamic evaluation, including pulmonary hypertension (PH). PH may complicate bronchopulmonary dysplasia (BPD) course. Aims of this retrospective study were to assess the feasibility of NPE follow-up of infants with BPD and to describe the course of PH of infants with moderate/severe BPD. Preterm infants <32 gestational weeks or birthweight ≤1500 g with moderate/severe BPD underwent NPE follow-up, from 36 weeks postmenstrual age up to 8 months postnatal age. Twenty-three preemies were included (birth weight 840 (213) g, gestational age 26.8 (2.3) weeks); 12/23 developed mild PH, 2/12 after discharge. PH resolved at 8.9 (3.9) months. Clinical and echocardiographic variables did not differ between infants with and without PH, except pulmonary artery acceleration time (PAAT) and PAAT/right ventricle ejection time (RVET) ratio (PAAT: 36 weeks, 68.9 (11.9) vs 52.0 (19.1), p = 0.0443; 6 months: 83.9 (38.9) vs 74.8 (16.9), p = 0.0372). No deaths or admissions for PH were reported. Neonatologist’s Image Quality Assessment score attributed by the cardiologist assumed as gold standard was adequate or optimal (9.5/14 total score); inter-rater agreement was excellent (ICC 0.974).

Conclusions: NPE follow-up seems to be feasible and safe in both intensive care and outpatient clinic. Mild PH is frequently detected in moderate/severe BPD, with good prognosis.

What is Known:

• Preterm infants with bronchopulmonary dysplasia (BPD) may develop pulmonary hypertension (PH) and have a late diagnosis.

• Neonatologist-performed echocardiography (NPE) is an established tool for bedside hemodynamic evaluation of the neonate.

What is New:

• To our knowledge this is the first study of NPE follow-up of moderate/severe BPD, describing the course of mild PH from diagnosis to its resolution.

• NPE follow-up of BPD seems to be safe and practicable, in both intensive care and outpatient clinic, as long as neonatologists maintain a sound collaboration with pediatric cardiologists.

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Abbreviations

BPD:

Bronchopulmonary dysplasia

CHD:

Congenital heart disease

E’:

Peak early diastolic tissue velocity

LV:

Left ventricle

NICU:

Neonatal intensive care unit

NPE:

Neonatologist-performed echocardiography

PA:

Postnatal age

PAAT:

Pulmonary artery acceleration time

PDA:

Patent ductus arteriosus

PH:

Pulmonary hypertension

PMA:

Postmenstrual age

PVD:

Pulmonary vascular disease

RV:

Right ventricle

RVET:

Right ventricle ejection time

TV:

Tricuspid valve

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy

    Marilena Savoia, Francesca Rech Morassutti, Paola Freschi, Luigi Cattarossi & Antonio Tonutti

  2. Institute Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Udine, Italy

    Luigi Castriotta

  3. Cardiology Department, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Udine, Italy

    Daisy Pavoni

  4. Pediatric Heart Lung Center, Children’s Hospital Colorado, Aurora, CO, USA

    Peter M. Mourani

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  1. Marilena Savoia
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  2. Francesca Rech Morassutti
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  3. Luigi Castriotta
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  4. Daisy Pavoni
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  5. Peter M. Mourani
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Contributions

MS designed the study, performed the data collection and analysis, drafted the manuscript, and approved the final manuscript as submitted. LC performed statistical analysis and participated to data analysis. AT, FRM, DP, PF, and LC participated to data collection and were involved in data analysis. PM participated to study design and made critical revisions to the final manuscript. All authors were involved in the production of the manuscript and approved the final version.

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Correspondence to Marilena Savoia.

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The authors declare that they have no conflict of interest.

Ethics approval

The study received approval from the Ethical Committee of the Friuli Venezia Giulia region, Udine, Italy (Approval No. CEUR-2018-OS-119-ASUIUD).

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Additional information

Communicated by Daniele De Luca

There are no prior publications or submissions with any overlapping information, including studies and patients. Preliminary results were presented as abstract at the 6th Congress of the European Academy of Pediatric Societies (EAPS 2016), Geneva (Switzerland) October 21–25, 2016.

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Savoia, M., Morassutti, F.R., Castriotta, L. et al. Pulmonary hypertension in a neonatologist-performed echocardiographic follow-up of bronchopulmonary dysplasia. Eur J Pediatr 180, 1711–1720 (2021). https://doi.org/10.1007/s00431-021-03954-y

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