Early pulmonary hypertension is a risk factor for bronchopulmonary dysplasia-associated late pulmonary hypertension in extremely preterm infants

Won Soon Park,Hye Seon Kim,Hyun Ho Kim,Yea Seul Han,Se In Sung,So Yoon Ahn,Mi Sun Yang,Ga Won Jeon,Yun Sil Chang

doi:10.1038/s41598-021-90769-4

Abstract

This study evaluated whether early pulmonary hypertension (PH) in extremely preterm infants (EPIs) at 22–27 weeks of gestation detected clinically with echocardiography at 4–7 postnatal days (PND) is a risk factor for death before 36 weeks post-menstrual age (PMA) or late PH in moderate or severe (m/s) bronchopulmonary dysplasia (BPD) (BPD-PH). We analyzed risk factors for death before 36 weeks PMA or BPD-PH. Among 247 EPIs enrolled, 74 (30.0%) had early PH. Twenty-one (28.4%) infants with early PH and 18 (10.4%) without early PH died before 36 weeks PMA; 14 (18.9%) infants with early PH and 9 (5.2%) without early PH had BPD-PH at 36–38 weeks PMA. Multivariate analysis revealed that early PH (adjusted odds ratio, 6.55; 95% confidence interval, 3.10–13.82, P < 0.05), clinical chorioamnionitis (2.50; 1.18–5.31), intraventricular hemorrhage (grade 3–4) (3.43; 1.26–9.37), and late sepsis (6.76; 3.20–14.28) independently increased the risk of development of death before 36 weeks PMA or BPD-PH. Subgroup analysis among m/s BPD patients revealed that early PH (4.50; 1.61–12.58) and prolonged invasive ventilator care (> 28 days) (4.91; 1.02–23.68) increased the risk for late PH independently. In conclusion, EPIs with early PH at 4–7 PND should be monitored for BPD-associated late PH development.

Highlights

Pulmonary hypertension (PH) is associated with significant mortality and morbidity in extremely preterm infants (EPIs)
If early PH detected by early echocardiography during the first week of life is confirmed as a significant risk factor for the development of late PH associated with bronchopulmonary dysplasia (BPD), appropriate strategies for the screening, prevention, and treatment of late PH occurring in BPD patients (BPDPH) can be developed for EPIs at high risk of BPD
This study aimed to evaluate whether early PH clinically detected by echocardiography performed at [4,5,6,7] postnatal days (PND) after a transitional period is an independent risk factor for the development of late PH detected by echocardiographic screening in moderate or severe (m/s) BPD infants (BPD-PH) as well as death before 36 weeks postmenstrual age (PMA), which is a competing outcome for BPD-PH in EPIs born at < 28 weeks of gestation

Summary

Introduction

Pulmonary hypertension (PH) is associated with significant mortality and morbidity in extremely preterm infants (EPIs). Better strategies are needed to improve survival in this vulnerable group of preterm infants To develop such strategies, better insight into the occurrence of PH in EPIs, including identification of risk factors, is strongly required. Echocardiographic screening for late PH after 36 weeks PMA for confirmed BPD patients in the NICU with an emphasis on the increased risk for late PH in established BPD infants is becoming a common clinical practice in N ICUs10,11 In these clinical settings, if early PH detected by early echocardiography during the first week of life is confirmed as a significant risk factor for the development of late PH associated with BPD, appropriate strategies for the screening, prevention, and treatment of late PH occurring in BPD patients (BPDPH) can be developed for EPIs at high risk of BPD. This study aimed to evaluate whether early PH clinically detected by echocardiography performed at [4,5,6,7] postnatal days (PND) after a transitional period is an independent risk factor for the development of late PH detected by echocardiographic screening in moderate or severe (m/s) BPD infants (BPD-PH) as well as death before 36 weeks PMA, which is a competing outcome for BPD-PH in EPIs born at < 28 weeks of gestation

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