Abstract
BackgroundTo assess the prognostic value of early echocardiographic indices of right ventricular function and vasoactive peptides for prediction of bronchopulmonary dysplasia (BPD) or death in very preterm infants.MethodsProspective study involving 294 very preterm infants (median [IQR] gestational age 28.4 [26.4–30.4] weeks, birth weight 1065 [800–1380] g), of whom 57 developed BPD (oxygen supplementation at 36 weeks postmenstrual age) and 10 died. Tricuspid annular plane systolic excursion (TAPSE), right ventricular index of myocardial performance (RIMP), plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) and C-terminal pro-endothelin-1 (CT-proET1) were measured on day 7 of life.ResultsRIMP was significantly increased (median [IQR] 0.3 [0.23–0.38] vs 0.22 [0.15–0.29]), TAPSE decreased (median [IQR] 5.0 [5.0–6.0] vs 6.0 [5.4–7.0] mm), MR-proANP increased (median [IQR] 784 [540–936] vs 353 [247–625] pmol/L), and CT-proET1 increased (median [IQR] 249 [190–345] vs 199 [158–284] pmol/L) in infants who developed BPD or died, as compared to controls. All variables showed significant but weak correlations with each other (rS -0.182 to 0.359) and predicted BPD/death with similar accuracy (areas under receiver operator characteristic curves 0.62 to 0.77). Multiple regression revealed only RIMP and birth weight as independent predictors of BPD or death.ConclusionsVasoactive peptide concentrations and echocardiographic assessment employing standardized measures, notably RIMP, on day 7 of life are useful to identify preterm infants at increased risk for BPD or death.
Highlights
Despite major advances in perinatal care, the prevalence of bronchopulmonary dysplasia (BPD) remains high, presumably due to the improved survival of extremely low gestational age infants [1,2,3]
Recognizing the important role of early pulmonary vascular disease in BPD pathophysiology, we aimed to explore the role of vasoactive peptides implicated in pulmonary hypertension and echocardiographic markers of right ventricular (RV) function in preterm infants
We confirmed the hypothesis that the echocardiographic indices right ventricular index of myocardial performance (RIMP) and Tricuspid annular plane systolic excursion (TAPSE) as well as the vasoactive peptides MR-proANP and CT-proET1 on day of life (DOL) 7 are associated with BPD/death in very preterm infants
Summary
Despite major advances in perinatal care, the prevalence of bronchopulmonary dysplasia (BPD) remains high, presumably due to the improved survival of extremely low gestational age infants [1,2,3]. BPD is associated with long-term respiratory morbidity, reflected by prolonged need of supplemental oxygen, recurrent respiratory infections, reduced exercise capacity, and increased risk of asthma-like symptoms in childhood [4,5,6]. Prognostication of the BPD risk is desirable in order to adapt clinical management and to identify high-risk infants potentially eligible for inclusion in early-phase therapeutic trials. Prediction of BPD development is difficult due to the complex pathophysiology of the disease including genetic and perinatal risk factors. To assess the prognostic value of early echocardiographic indices of right ventricular function and vasoactive peptides for prediction of bronchopulmonary dysplasia (BPD) or death in very preterm infants
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