Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation.

Fahad M.S. Arattu Thodika,Anne Greenough,Aaron Bell,Mahesh Nanjundappa,Theodore Dassios

doi:10.1515/jpm-2021-0366

Abstract

Pulmonary hypertension (PH) is a complication of bronchopulmonary dysplasia (BPD) and associated with increased mortality and morbidity. Our aim was to identify, in infants with BPD, the effect of PH on health-care utilisation and health related cost of care. An electronic data recording system was used to identify infants≤32weeks of gestation who developed BPD. PH was classified as early (≤28days after birth) or late (>28days after birth). In the study period, 182 infants developed BPD; 22 (12.1%) developed late PH. Development of late PH was associated with a lower gestational age [24.6 (23.9-26.9) weeks, p=0.001] and a greater need for positive pressure ventilation on day 28 after birth (100%) compared to infants without late PH (51.9%) (odds ratio (OR) 19.5, 95% CI: 2.6-148), p<0.001. Late PH was associated with increased mortality (36.4%) compared those who did not develop late PH (1.9%) after adjusting for gestational age and ventilation duration (OR: 26.9, 95% CI: 3.8-189.4), p<0.001. In infants who survived to discharge, late PH development was associated with a prolonged duration of stay [147 (118-189) days] compared to the infants that did not develop late PH [109 (85-149) days] (p=0.03 after adjusting for gestational age). Infants who had late PH had a higher cost of stay compared to infants with BPD who did not develop late PH (median £113,494 vs. £78,677, p=0.016 after adjusting for gestational age). Development of late PH was associated with increased mortality, a prolonged duration of stay and higher healthcare cost.

Highlights

The survival rates of extremely premature infants have improved significantly in the last few decades, but are associated with long term morbidities [1,2,3]
Development of late Pulmonary hypertension (PH) was associated with a lower gestational age [24.6 (23.9–26.9) weeks, p=0.001] and a greater need for positive pressure ventilation on day 28 after birth (100%) compared to infants without late PH (51.9%) (odds ratio (OR) 19.5, 95% CI: 2.6–148), p
A total of 428 premature infants were admitted to the neonatal unit during the study period, 211 (49.3%) subsequently developed bronchopulmonary dysplasia (BPD); 189 infants were included in the analysis and 29 infants were excluded (Figure 1)

Summary

Introduction

The survival rates of extremely premature infants have improved significantly in the last few decades, but are associated with long term morbidities [1,2,3]. One of the significant contributory factors for morbidity and mortality in infants with BPD is the development of pulmonary hypertension (PH) [5]. The incidence of pulmonary hypertension in infants with BPD ranges from 17 to 37% [6,7,8]. The pathogenesis of pulmonary vascular disease associated with BPD is multifactorial and can be attributed to the interaction of maternal, genetic and postnatal factors. The lungs are exposed to prolonged ventilation and high oxygen levels along with hemodynamic and inflammatory stressors. This causes pulmonary arterial remodelling leading to fibrosis of the vessel walls [10]. The risk factors associated with the development of pulmonary hypertension include intrauterine growth restriction, preeclampsia, maternal

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