Hypertension In Preterm Infants Research Articles

The Impact of Atrial Left-to-Right Shunt on Pulmonary Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) is a well-known complication of prematurity; however, the additional impact of a left-to-right interatrial shunt on this condition remains poorly understood. The aim of the present study was to identify the significance of atrial left-to-right shunt lesions in PH infants with moderate or severe BPD. The medical records of 383 preterm infants (gestational age of < 32 weeks) who were diagnosed with BPD between 2005 and 2013 were retrospectively reviewed. Baseline characteristics such as interatrial shunts and outcomes were compared between the infants who developed PH (n = 50) and infants who did not (n = 144). Infants with hemodynamically significant residual patent ductus arteriosus were excluded. Among the infants diagnosed with PH (n = 50), the outcomes were compared between the patients with (n = 21) and without atrial shunts (n = 29) at 36 weeks corrected postmenstrual age. Fifty (15%) preterm infants with BPD were diagnosed with PH. The number of infants with a history of atrial shunt lesions was significantly higher in the PH group than in the non-PH group (42% vs. 15.3%, respectively). The adjusted odds ratio for PH in the atrial shunt group was 3.8 (95% confidence interval, 1.8-8.0), compared to PH-BPD infants without an atrial shunt. The presence of an atrial left-to-right shunt was associated with PH in preterm infants with moderate or severe BPD. Close follow up is needed for infants with interatrial shunts, and a more tailored prognostic evaluation and treatment are recommended.

Pulmonary Hypertension in Preterm Infants: Prevalence and Association with Bronchopulmonary Dysplasia

To determine whether early pulmonary hypertension (PH) at 10-14 days of life in preterm infants is associated with bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA). This was a prospective observational cohort study of infants <28 weeks' gestation. Exclusion criteria were any major anomaly, genetic syndrome, or death before the initial echocardiogram. Echocardiograms were performed between 10 and 14 days of life and at 36 weeks' PMA to assess PH. BPD and its severity were determined at 36 weeks PMA by the National Institutes of Health workshop definition. From March 2011 to April 2013, of 146 consecutively admitted infants <28 weeks, 120 were enrolled. One infant was excluded, 17 did not consent, and 8 died before undergoing a study echocardiogram. At 10-14 days of life, 10 infants had early PH (8%). Male sex (56% vs 40%), gestational age (26(+2) ± 1(+2) vs 25(+6) ± 1(+4) weeks), birth weight (837 ± 205 g vs 763 ± 182 g), and small for gestational age (14% vs 20%) were not significantly different among infants with no PH and early PH, respectively. Infants with early PH required >0.3 fraction of inspired oxygen by day 10 of life (70% vs 27%, P < .01). Moderate/severe BPD or death was greater among infants with early PH (90%) compared with no PH (47%, relative risk 1.9, 95% CI 1.43-2.53). In this prospective, single-center cohort, early PH was associated with moderate/severe BPD or death at 36 weeks' PMA.

Pathogenesis of neonatal pulmonary hypertension in different stages

Objective To discuss the relationship between the clinical pathogenesis and progression in neonatal pulmonary hypertension in different stages. Methods Total 169 cases of pulmonary hypertension were admitted in our NICU from June 2006 to May 2012, all the cases were involved in this retrospective study. They were divided into two groups in chronological order: early group 79 cases (from June 2006 to May 2009) and late group 90 cases (from June 2009 to May 2012). The data records include gender, gestational age, protopathy, echocardiography examination results. Furthermore, the cause and development of neonatal pulmonary hypertension were analyzed in different stages. Results The admission time in the early group was later than the late group [(2.15±1.2) d vs (1.41±0.70) d]. Meconium aspiration syndrome in the early group were 25 cases (31.6%) and the late group were 14 cases (15.6%). Other complications, such as congenital diaphragmatic hernia, neonatal respiratory distress syndrome, aspiration pneumonia, wet lung/sepsis, neonatal asphyxia, neonatal infectious pneumonia had no difference between the two groups (P>0.05). Neonatal pulmonary hypertension in two groups had no statistical difference between term and post term patients, but premature in the early group (11 cases, 13.9%) were less than the late group (23 cases, 25.6%). Echocardiography was recorded after admission, mild and moderate pulmonary hypertension had no statistical differences in the two groups (P>0.05). The severe pulmonary hypertension cases in the early group were more than those in the late group (26 cases vs 17 cases). Conclusion Along with the improvement of perinatal monitoring and resuscitation technology in different stages, the cases of meconium aspiration syndrome with pulmonary hypertension are fallen down and the patients transferred to the superior hospital decreased. The amount of pulmonary hypertension in preterm infants increases, and the admission time of patients with neonatal pulmonary hypertension are shortened. The amount of severe pulmonary hypertension are less than those in the early time. It plays a positive role in best approach to improving treatment and outcomes. Key words: Pulmonary hypertension; Pathogenesis; Neonate

Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, is a significant contributor to perinatal morbidity and mortality. Premature birth disrupts pulmonary vascular growth and initiates a cascade of events that result in impaired gas exchange, abnormal vasoreactivity, and pulmonary vascular remodeling that may ultimately lead to pulmonary hypertension (PH). Even infants who appear to have mild BPD suffer from varying degrees of pulmonary vascular disease (PVD). Although recent studies have enhanced our understanding of the pathobiology of PVD and PH in BPD, much remains unknown with respect to how PH should be properly defined, as well as the most accurate methods for the diagnosis and treatment of PH in infants with BPD. This article will provide neonatologists and primary care providers, as well as pediatric cardiologists and pulmonologists, with a review of the pathophysiology of PH in preterm infants with BPD and a summary of current clinical recommendations for managing PH in this population.

B-type natriuretic peptide is a biomarker for pulmonary hypertension in preterm infants with bronchopulmonary dysplasia

B-type natriuretic peptide is a biomarker for pulmonary hypertension in preterm infants with bronchopulmonary dysplasia Alain Cuna,1 Jegen Kandasamy,1 Naomi Fineberg,2 Brian Sims1 1Department of Pediatrics, Division of Neonatology, 2Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA Background: B-type natriuretic peptide (BNP) is a cardiac biomarker useful in screening for pulmonary hypertension (PH) in adults. It is possible that BNP may also be useful in detecting PH among preterm infants with bronchopulmonary dysplasia (BPD). Objective: To determine the utility of BNP for identification of PH among preterm infants with BPD. Methods: We retrospectively identified preterm infants with BPD who underwent screening echocardiography for suspected PH and had serum BNP levels measured within 10 days before or after echocardiography. Eligible infants were classified based on echocardiographic diagnosis of either PH or no PH. Median and interquartile ranges (IQR) of BNP values were compared, and area under the curve (AUC) of receiver operator characteristic (ROC) analysis was used to determine the optimum threshold value for detection of PH. Results: Twenty-five preterm infants with BPD (mean gestational age 26.5 ± 1.7 weeks, mean birth weight 747 ± 248 g) were identified. The median difference in days between echocardiography and BNP measurement was 1 day (IQR 0–3, range 0–10 days). Based on echocardiography, 16 were diagnosed with PH and nine without PH. No significant difference in terms of gestational age, birth weight, sex, race, or respiratory support was found between the two groups. Median (IQR) BNP values of those with PH were higher than those without PH (413 [212–1178] pg/mL versus 55 [21–84] pg/mL, P < 0.001). AUC of ROC analysis showed that a BNP value of 117 pg/mL had 93.8% sensitivity and 100% specificity for detecting PH. Conclusion: BNP estimation may be useful for screening of PH in infants with BPD. Keywords: B-type natriuretic peptide, pulmonary hypertension, bronchopulmonary dysplasia, biological markers, prematurity

Fetal growth restriction and pulmonary hypertension in premature infants with bronchopulmonary dysplasia.

ObjectiveTo identify the association between birth weight (BW)-for-gestational age (GA) and pulmonary hypertension (PHTN) at 36 weeks in infants with moderate-severe bronchopulmonary dysplasia (BPD).Study DesignIn this retrospective cohort study, we followed 138 premature infants (≤28wks) with moderate and severe BPD (NIH consensus definition) born at Prentice Women’s Hospital between 2005 and 2009. BW percentiles were calculated using the Fenton growth curve for premature infants. PHTN was determined using a standardized algorithm of echocardiogram review at 36 weeks. Logistic regression was used to evaluate the associations between BW percentile subgroups and PHTN, taking into account antenatal and neonatal factors that were related to PHTN.ResultsPHTN was associated with small BW-for-GA, ranging from thresholds of <10th to <25th percentile (P<0.001). These associations remained significant when comparing BW <25th percentile to the reference group (50–89th percentile); after adjustment for GA, gender, multiple gestation, race/ethnicity (OR=4.2; 95% CI=1.5, 12.1); and after further adjustment for maternal vascular disease, intrauterine infection, oligohydramnios, and relevant postnatal factors (OR=5.7; 95% CI=1.5, 21.2). Longitudinal follow-up of this cohort showed a trend towards higher morbidity and death among PHTN infants with BW <25th percentile.ConclusionBW-for-GA is an important predictor of PHTN in premature infants with moderate/severe BPD. Our findings contribute to the growing evidence supporting fetal mechanisms of later onset pulmonary vascular disease.

Risk Factors of Pulmonary Hypertension in Preterm Infants with Chronic Lung Disease

목적: 폐동맥 고혈압증은 미숙아 사망의 주요 인자로서, 낮은 재태주령과 출생체중, 장기간의 산소 사용, 낮은 아프가 점수, 양수 과소증 등이 관련된다고 보고된다. 이에 저자들은 만성폐질환을 가진 미숙아에서 폐동맥고혈압증의 위험인자를 알아보고자 하였다. 방법: 2006년 7월부터 2011년 6월까지 세브란스 어린이병원...

Risk Factors for Pulmonary Artery Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

Background: Despite the potential importance of pulmonary artery hypertension (PAH) in preterm infants with bronchopulmonary dysplasia (BPD), little is known about the risk factors for PAH. Objectives: To investigate the risk factors for PAH in preterm infants with BPD. Methods: Infants diagnosed with BPD were assigned to the PAH group or non-PAH group except for infants with mild BPD who had no PAH. PAH was diagnosed on the basis of echocardiograms demonstrating elevated right ventricle pressure beyond the postnatal age of 2 months. Logistic regression analysis was done for the multivariate assessment of the risk factors for PAH in preterm infants with moderate or severe BPD. Results: A total of 98 infants among 145 infants with BPD were divided into a PAH group (n = 25) or non-PAH group (n = 73), while the remaining 47 infants had mild BPD with no PAH. Among the study patients, survival rate of the PAH group was significantly lower than that of the non-PAH group. Infants with PAH had more severe cases of BPD and underwent longer durations of oxygen therapy, conventional or high-frequency ventilation, and hospitalization compared to those without PAH. Low 5-min Apgar scores (≤6; relative risk (RR) 6.2; 95% confidence interval (CI) 1.4–28.0; p = 0.017) and oligohydramnios (RR 7.7; 95% CI 2.0–29.6; p = 0.030) were found to be significant risk factors for PAH according to multivariate analysis. Conclusions: The present study shows that oligohydramnios is a specific risk factor for PAH in preterm infants with moderate or severe BPD.

Cytochrome P450 genotype and hypertension in preterm infants

Very preterm infants are at high risk of developing hypertension, generally late during their initial hospitalization or soon after discharge. Infants with bronchopulmonary dysplasia (BPD) are a particularly high-risk group. Intra-aortic catheters are associated with some cases of hypertension, presumably as a result of microemboli that damage the kidneys. However, there is no good explanation for hypertension in most of these infants. In this issue of The Journal, Dagle et al report that the genotype of the cytochrome P450 (CYP2D6) correlates with the development of hypertension in an at-risk population enriched for BPD.

Pulmonary Hypertension in Preterm Infants With Bronchopulmonary Dysplasia

Background and ObjectivesWith the increasing survival of preterm infants, pulmonary hypertension (PH) related to bronchopulmonary dysplasia (BPD) has become an important complication. The aim of this study was to investigate the characteristics and outcome of PH in preterm infants with BPD and to identify the risk factors for PH.Subjects and MethodsWe reviewed the records of 116 preterm infants with BPD cared for at a single tertiary center between 2004 and 2008.ResultsTwenty-nine (25%) infants had PH >2 months after birth. PH occurred initially at a median age of 65 days (range, 7-232 days). Severe BPD, a birth weight <800 g, long-term ventilator care and oxygen supplementation, a high ventilator setting, infection, and a patent ductus arteriosus (PDA) were related to PH based on univariate analysis (p<0.05). The infants who had longer oxygen supplementation were significantly more likely to have PH (odds ratio, 18.5; 95% confidence interval, 4.1-84.6; p<0.001). PH was improved in 76% of infants after a median of 85 days (range, 20-765 days). Four infants (14%) died. The death of 3 infants was attributed to PH.ConclusionBPD was frequently complicated by PH. Although PH resolved in the majority of infants, PH in preterm infants with BPD can be fatal. Regular screening for PH and adequate management are required.

Conditions Associated with Hypertension in a High-risk Premature Infant

Hypertension is an uncommon but significant problem in high-risk neonates and infants, and the spectrum of potential causes is broad. Here, we describe an extremely premature infant (birth weight, 728 g; gestational age, 27 weeks) with multiple complications and hypertension. During admission, umbilical artery catheters were used for a period of time, and he suffered from respiratory distress syndrome, intraventricular hemorrhage, pulmonary hemorrhage, patent ductus arteriosus, pericardial effusion, heart failure, repeated sepsis, anemia, thrombocytopenia, chronic lung disease, and progressive liver damage. He was treated with multiple medications, including erythropoietin, indomethacin, epinephrine, dopamine, aminophylline, multiple antibiotics, amphotericin B, and total parenteral nutrition. Hypertension was first noted when he was 41 days old, with spontaneous remission. It then recurred, reaching higher than 100 mmHg when he was almost 4 months old. After stopping erythropoietin, hypertension subsided for a short period of time and went up again. Multiple factor-related hypertension in this premature infant was considered. Related literature on hypertension in premature infants is reviewed. In conclusion, multiple factors can influence blood pressure and may induce hypertension in high-risk premature infants. Thus, blood pressure should be closely monitored in high-risk premature infants. Judicious use of all medications and interventions are crucial to decrease the incidence of hypertension in high-risk premature infants.

Transient Increase in Intraocular Pressure during a Dose-Tapering Regime of Systemic Dexamethasone in Preterm Infants

To determine the intraocular pressure (IOP) profile during and after systemic dexamethasone treatment in preterm very low birth weight (VLBW; <1500 g) infants. A cohort study at a university-affiliated tertiary neonatal center. Twenty-seven VLBW infants who received a 3-week dose-tapering course of systemic dexamethasone for treatment of bronchopulmonary dysplasia were consecutively enrolled over a period of 32 months. Intraocular pressure was assessed using a handheld tonometer immediately before (week 0), during (weeks 1 and 3), and after (weeks 5, 7, and 9) commencement of the dexamethasone course. The mixed-effects models were used to evaluate the longitudinal IOP measurements at different time points. To assess the magnitude and duration of increase in IOP during systemic corticosteroid treatment. The IOP at week 1, while the infants were receiving the maximum dose of dexamethasone (0.6 mg/kg/day), was significantly higher than (1) the pretreatment IOP at week 0 (mean [+/- standard deviation]: 19.7 [+/-3.7] vs. 16.4 [+/-3.7] mmHg, respectively) (P<0.0001), (2) the IOP when the infants were receiving the minimum dose of dexamethasone (0.15 mg/kg/day) at week 3 (19.7 [+/-3.7] vs. 15.8 [+/-4.3] mmHg) (P<0.0001), and (3) the IOP after the dexamethasone course had been stopped between week 5 and week 9 (19.7 [+/-3.7] vs. 16.0 [+/-4.0], 15.3 [+/-3.5], and 14.5 [+/-3.3] mmHg for weeks 5, 7, and 9, respectively) (P<0.0001 for all comparisons). In contrast, there was no significant difference between the pretreatment IOP (week 0) and IOP at week 3, 5, 7, or 9 (P = 0.07-0.62) and in the IOP between week 3 and week 5, 7, or 9 (P = 0.27-0.75). The use of a dose-tapering regime of dexamethasone is associated with transient increase of IOP. As IOP was significantly raised during the high-dose but not the low-dose treatment period, we speculate that the physiologic or stress dose of corticosteroids commonly advocated for treatment of serious neonatal conditions should be safe and unlikely to cause significant ocular hypertension in preterm infants.

Persistent pulmonary hypertension in preterm infants with respiratory distress syndrome

Persistent pulmonary hypertension in preterm infants with respiratory distress syndrome

Persistent pulmonary hypertension in preterm infants with respiratory distress syndrome

Persistent pulmonary hypertension in preterm infants with respiratory distress syndrome

Intravenous nicardipine in hypertensive preterm infants

Eight preterm infants were given intravenous nicardipine, a calcium channel blocker, to treat systemic hypertension (renal artery thrombosis (n=3); dexamethasone for management of bronchopulmonary dysplasia (n=2); unexplained (n=3)). Nicardipine doses...