G9 Evaluating outcomes in infants diagnosed with pulmonary hypertension in bronchopulmonary dysplasia – a 4 year retrospective study

Abstract

Aims Chronic pulmonary hypertension (PH) is a complication of bronchopulmonary dysplasia (BPD), associated with increased morbidity and mortality. The aims of our study were to evaluate the outcomes of a cohort of patients with BPD alone, and with BPD complicated by PH. Methods A single centre retrospective observational study involving all infants admitted to NICU between 1/10/14 to 1/8/18 and diagnosed with BPD. Data was collected from electronic patient records. Infants with persistent pulmonary hypertension of the newborn were excluded. Results A total of 130 infants were diagnosed with BPD during this period, with 9 infants developing pulmonary hypertension (7%). Most patients who developed PH had severe BPD (table 1) and other severe comorbidities, such as extreme prematurity and sepsis. Echocardiography can be used to screen for PH in patients with BPD. 91% of all patients with BPD had an echocardiogram during the initial hospital stay, but only 25% had one at the recommended time of 36 weeks. 8/9 patients with PH were given sildenafil to treat PH, and there was improvement in 75% cases after starting treatment. However, this was a short-lasting effect in 4 infants, who later had deterioration of PH. The mortality in BPD patients without PH was 4% (5/121), whereas patients with BPD and PH had a higher mortality of 67% (6/9). All deaths occurred during the first year of life. In the BPD+PH group, 50% patients died from worsening PH, whilst the other 50% died from bronchiolitis or multiorgan failure, and all patients who died had severe BPD (table 1). 33% (3/9) patients were discharged from outpatient clinic. In BPD only patients, 31% (38/121) were discharged, 10% (12/121) are being followed up, and 55% (66/121) were transferred back to local hospitals. Conclusion Pulmonary hypertension is a serious complication of BPD, with high morbidity and mortality. There is an urgent need to implement a screening programme for early detection of PH in infants with BPD and study of their outcomes prospectively.