Abstract
BackgroundOwing to advances in the critical care of premature infants with bronchopulmonary dysplasia (BPD), BPD-associated pulmonary hypertension (PH) is becoming a growing concern. However, only few investigations were available on neurodevelopmental outcomes in preterm infants with PH. Therefore, this study aimed to identify the impact of PH on growth and neurodevelopment at 18–24 months of corrected age (CA).MethodsWe retrospectively analyzed the medical records of 394 infants (aged < 28 weeks of gestation) admitted to the neonatal intensive care unit between 2005 and 2014. Among the surviving infants, 123 returned for follow-up evaluations including the Bayley Scales of Infant and Toddler Development, third Edition (Bayley-III) screening tests and growth assessment at 18–24 months of CA. Among the 81 infants with moderate or severe BPD, 20 met the criteria for PH. Baseline characteristics and outcomes were compared in infants who developed BPD-associated PH (PH group, n = 20) and moderate or severe BPD infants who did not develop PH (non-PH group, n = 61).ResultsCompared to the non-PH group, the PH group showed significantly lower cognitive (85 vs. 95, p = 0.004), language (81 vs. 89, p = 0.040), and motor (88 vs. 94, p = 0.010) scores of the Bayley-III at 18–24 months of CA. Cognitive delay was found in 45.0% (9/20) of PH infants. In addition, z-scores of weight (− 1.4 ± 1.3 vs. -0.6 ± 1.1%, p = 0.011) and HC (− 1.2 ± 1.8 vs. 0.53 ± 1.0%, p = 0.035) were significantly lower in the BPD with PH group. With the subgroup analysis in infants with severe BPD only, the cognitive score was consistently lower and poorer and weight gain after discharge was identified in infants with PH and severe BPD.ConclusionPH was a worsening factor of non-optimal growth and poor neurodevelopmental outcome in preterm infants with BPD at 18–24 months of CA. Our findings suggest the importance of close developmental follow-up and recognition of that risk to help optimize the outcome of preterm infants with PH.
Highlights
Owing to advances in the critical care of premature infants with bronchopulmonary dysplasia (BPD), BPD-associated pulmonary hypertension (PH) is becoming a growing concern
We found that the body weight and HC were lower at 18–24 months of corrected age (CA) in the PH compared to non-PH group
The prevalence of small for gestational age (SGA) was not significantly different between the two groups, but poorer weight gain after discharge was identified in infants with PH and severe BPD compared to those with severe BPD only
Summary
Owing to advances in the critical care of premature infants with bronchopulmonary dysplasia (BPD), BPD-associated pulmonary hypertension (PH) is becoming a growing concern. Improved critical care management of premature infants has led to an increased survival rate of patients with bronchopulmonary dysplasia (BPD), which is the leading cause of late respiratory morbidity in preterm infants [1]. Recent efforts to identify PH in infants with BPD using echocardiography have shown that this modality may provide an opportunity for implementation of preventive or treatment strategies to improve long-term outcomes [5]. Several studies have reported cardiovascular outcomes of PH in preterm infants; no large longitudinal study that reported long-term pulmonary or neurodevelopmental outcomes in these infants is currently available [6, 7]
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