Abstract
Pulmonary hypertension (PH) is a frequent complication in extremely preterm born infants that seriously affects outcome. We aimed to describe the prevalence of PH in extremely preterm infants and the policy on screening and follow-up in the ten Dutch intensive care units (NICUs). We performed a retrospective cohort study at the University Medical Centre Groningen on infants with gestational age < 30 weeks and/or birthweight < 1000 g, born between 2012 and 2013. Additionally, we carried out a survey among the Dutch NICUs covering questions on the awareness of PH, the perceived prevalence, and policy regarding screening and following PH in extremely preterm infants. Prevalence of early-onset PH in our study was 26% and 5% for late-onset PH. PH was associated with poor survival and early-onset PH was associated with subsequent development of bronchopulmonary dysplasia (BPD). All the NICUs completed the questionnaire and we found that no standardized policy existed regarding screening and following PH in extremely preterm infants.Conclusion: Despite the frequent occurrence of PH and its clinically important consequences, (inter-)national standardized guidelines regarding screening and following of PH in extremely preterm infants are lacking. Standardizing screening and follow-up will enable early identification of infants with late-onset PH and allow for earlier treatment. Additionally, greater clarity is required regarding the prevalence of early PH as are new preventive treatment strategies to combat BPD.What is known? • Pulmonary hypertension (PH) substantially impairs the survival of extremely preterm infants. • PH is associated with bronchopulmonary dysplasia (BPD): Early-onset PH predicts the development of BPD. Late-onset PH is prevalent in infants with severe BPD.What is new? • Pulmonary hypertension (PH) is prevalent in preterm infants. Its consequences for morbidity and mortality justify a standardized policy aimed at early detection to improve prevention and treatment. • No structured policy exists in the Netherlands regarding screening/follow-up for PH in extremely preterm infants.
Highlights
During the past decades, the mortality of extremely preterm infants has decreased significantly
Pulmonary hypertension (PH) was associated with poor survival and early-onset PH was associated with subsequent development of bronchopulmonary dysplasia (BPD)
PH is associated with bronchopulmonary dysplasia (BPD): Early-onset PH predicts the development of BPD
Summary
The mortality of extremely preterm infants has decreased significantly. These infants are at substantial risk for debilitating comorbidities and increased mortality in early childhood, the latter being as high as 35% for infants with a gestational age of less than 25 weeks [1,2,3,4]. Bronchopulmonary dysplasia (BPD), the chronic lung disease of infancy, remains such a complication of extreme preterm birth that, on account of infants’ increasingly younger gestational ages, is associated with very early disruption of normal development of the lungs. Severe lung disease associated with preterm birth may lead to early mortality before the designation of BPD at 36 weeks PMA. An international neonatal consortium emphasized that BPD is part of an overarching condition called chronic pulmonary insufficiency of prematurity (CPIP)
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