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Observational Study
. 2022 Jun;42(6):781-787.
doi: 10.1038/s41372-022-01374-w. Epub 2022 Apr 1.

Extremely premature infants born at 23-25 weeks gestation are at substantial risk for pulmonary hypertension

Hannes Sallmon #  1   2   3 , Martin Koestenberger #  4   5 , Alexander Avian  6 , Friedrich Reiterer  7 , Bernhard Schwaberger  7 , Katharina Meinel  4   5 , Gerhard Cvirn  8 , Stefan Kurath-Koller  4   5 , Andreas Gamillscheg  5 , Georg Hansmann  4   9
Affiliations
Observational Study

Extremely premature infants born at 23-25 weeks gestation are at substantial risk for pulmonary hypertension

Hannes Sallmon et al. J Perinatol. 2022 Jun.

Abstract

Objective: Extremely low gestational age newborns (ELGANs) represent an especially vulnerable population. Herein, we aimed to determine incidence and severity of pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH) in extremely immature ELGANs (gestational age: 230/6-256/7 weeks).

Methods: In this prospective observational cohort study, we assessed BPD-PH by means of several echocardiography markers and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 3 and 12 months of chronological age. In addition, we analyzed incidence and efficacy of pharmacologic treatment for BPD-PH.

Results: At 3 months 15/34 ELGANs had echocardiographic evidence of BPD-PH, while at 12 months of age 6/34 still had PH. PH-targeted therapy consisted of sildenafil monotherapy in 11 and dual oral combination therapy (sildenafil and macitentan) in four ELGANs at 3 and 12 months.

Conclusion: 44% (15/34) of ELGANs developed BPD-PH. All received PH-targeted pharmacotherapy at 3 months, leading to hemodynamic improvements at 12 months in most infants.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Study flow chart.
BPD-PH pulmonary hypertension associated with bronchopulmonary dysplasia, ELGANs extremely low gestational age newborns.
Fig. 2
Fig. 2. RVSP, TAPSE, RVSP/TAPSE, PAAT, LVesEI, and RV/LV ratio at 3 months and 12 months of chronological age in ELGANs without PH (n =  19, green boxes), ELGANs with BPD-PH at 3 months who showed resolution of PH at 12 months of age (n  =  9, light blue boxes), and patients who still had BPD-PH at 12 months of chronological age (n  =  6, blue boxes), *p value < 0.05.
BPD-PH pulmonary hypertension associated with bronchopulmonary dysplasia, LVesEI left ventricular end-systolic eccentricity index, PAAT pulmonary arterial acceleration time, RV/LV ratio ratio of the RV basal diameter of the LV basal diameter, RVSP right ventricular systolic pressure, TAPSE tricuspid annular plane systolic excursion.
Fig. 3
Fig. 3. Changes in NT-proBNP at 3 months and 12 months of chronological age in ELGANs without PH (n  = 9, green boxes), ELGANs with BPD-PH at 3 months who showed resolution of PH at 12 months of age (n  = 9, light blue boxes), and patients who still had BPD-PH at 12 months of chronological age (n  =  6, blue boxes); *p value < 0.05.
BPD-PH pulmonary hypertension associated with bronchopulmonary dysplasia, NT-proBNP N-terminal pro-B-type natriuretic peptide.
See this image and copyright information in PMC

Comment in

  • Reply.
    Evers PD, Yang E, Critser PJ. Evers PD, et al. J Pediatr. 2022 Nov;250:110-112. doi: 10.1016/j.jpeds.2022.07.051. Epub 2022 Aug 6. J Pediatr. 2022. PMID: 35944715 No abstract available.

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