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Multicenter Study
. 2018 Dec:203:218-224.e3.
doi: 10.1016/j.jpeds.2018.07.035. Epub 2018 Aug 29.

The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year

Joanne M Lagatta  1 , Erik B Hysinger  2 , Isabella Zaniletti  3 , Erica M Wymore  4 , Shilpa Vyas-Read  5 , Sushmita Yallapragada  6 , Leif D Nelin  7 , William E Truog  8 , Michael A Padula  9 , Nicolas F M Porta  10 , Rashmin C Savani  6 , Karin P Potoka  11 , Steven M Kawut  12 , Robert DiGeronimo  13 , Girija Natarajan  14 , Huayan Zhang  9 , Theresa R Grover  4 , William A Engle  15 , Karna Murthy  10 ; Children's Hospital Neonatal Consortium Severe BPD Focus Group
Affiliations
Multicenter Study

The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year

Joanne M Lagatta et al. J Pediatr. 2018 Dec.

Abstract

Objectives: To assess the effect of pulmonary hypertension on neonatal intensive care unit mortality and hospital readmission through 1 year of corrected age in a large multicenter cohort of infants with severe bronchopulmonary dysplasia.

Study design: This was a multicenter, retrospective cohort study of 1677 infants born <32 weeks of gestation with severe bronchopulmonary dysplasia enrolled in the Children's Hospital Neonatal Consortium with records linked to the Pediatric Health Information System.

Results: Pulmonary hypertension occurred in 370 out of 1677 (22%) infants. During the neonatal admission, pulmonary hypertension was associated with mortality (OR 3.15, 95% CI 2.10-4.73, P < .001), ventilator support at 36 weeks of postmenstrual age (60% vs 40%, P < .001), duration of ventilation (72 IQR 30-124 vs 41 IQR 17-74 days, P < .001), and higher respiratory severity score (3.6 IQR 0.4-7.0 vs 0.8 IQR 0.3-3.3, P < .001). At discharge, pulmonary hypertension was associated with tracheostomy (27% vs 9%, P < .001), supplemental oxygen use (84% vs 61%, P < .001), and tube feeds (80% vs 46%, P < .001). Through 1 year of corrected age, pulmonary hypertension was associated with increased frequency of readmission (incidence rate ratio [IRR] = 1.38, 95% CI 1.18-1.63, P < .001).

Conclusions: Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.

Keywords: bronchopulmonary dysplasia; epidemiology; outcomes; pulmonary hypertension.

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Conflict of interest statement

None

Figures

Figure 1.
Figure 1.. Inter-center variation in prevalence of sBPD-associated PH and use of echocardiogram.
Numbers on the x axis indicate individual centers participating in CHND. There was no correlation between center prevalence of sBPD-associated PH and use of echocardiogram at ≥ 34 weeks’ corrected age, with a linear trend equation of 0.51x+0.5 and R2 of 0.09. PH = pulmonary hypertension.
See this image and copyright information in PMC

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