Pulmonary hypertension among preterm infants born at 22 through 32 weeks gestation in France: Prevalence, survival, morbidity and management in the EPIPAGE-2 cohort study

Abstract

ObjectiveTo determine the prevalence, short-term prognosis and pharmacologic management of pulmonary hypertension (PH) among very preterm infants born before 32 weeks gestation (WG). Study designIn the EPIPAGE-2 French national prospective population-based cohort of preterm infants born in 2011, those presenting with PH were identified and prevalence was estimated using multiple imputation. The primary outcome was survival without severe morbidity at discharge and was compared between infants with or without PH after adjusting for confounders, using generalized estimating equations models. Subgroup analysis was performed according to gestational age (GA) groups. ResultsAmong 3383 eligible infants, 3222 were analyzed. The prevalence of PH was 6.0 % (95 % CI, 5.2–6.9), 14.5 % in infants born at 22–27+6 WG vs 2.7 % in infants born at 28–31+6 WG (P < .001). The primary outcome (survival without severe morbidity at discharge) occurred in 30.2 % of infants with PH vs 80.2 % of infants without PH (P < .001). Adjusted incidence rate ratios for survival without severe morbidity among infants with PH were 0.42 (0.32–0.57) and 0.52 (0.39–0.69) in infants born at 22–27+6 weeks gestation and those born at 28–31+6 weeks, respectively. Among infants with PH, 92.2 % (95 % CI, 87.7–95.2) received sedation and/or analgesia, 63.5 % (95 % CI, 56.6–69.9) received inhaled NO and 57.6 % (95 % CI, 50.9–64.0) received hemodynamic treatments. ConclusionIn this population-based cohort of very preterm infants, the prevalence of PH was 6 %. PH was associated with a significant decrease of survival without severe morbidity in this population.