Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;41(16):2206-2213.
doi: 10.1055/s-0044-1786544. Epub 2024 May 2.

Correlating Severity of Pulmonary Hypertension by Echocardiogram with Mortality in Premature Infants with Bronchopulmonary Dysplasia

Rachel D Torok  1 , Robert A Gardner  2 , Piers C A Barker  1 , Andrew W McCrary  1 , Jennifer S Li  1   3 , Christoph P Hornik  3   4 , Matthew M Laughon  5 , Wesley M Jackson  5
Affiliations

Correlating Severity of Pulmonary Hypertension by Echocardiogram with Mortality in Premature Infants with Bronchopulmonary Dysplasia

Rachel D Torok et al. Am J Perinatol. 2024 Dec.

Abstract

Objective: Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth. Infants with BPD are at increased risk for pulmonary hypertension (PH). Cardiac catheterization is the gold standard for diagnosing PH, but cardiac catheterization is challenging to perform in small, sick, premature infants. The utility of echocardiography for diagnosing PH and predicting outcomes in extremely premature infants has not been clearly defined. Therefore, we sought to use predefined criteria to diagnose PH by echocardiogram and relate PH severity to mortality in extremely premature infants with BPD.

Study design: Echocardiograms from 46 infants born ≤28 weeks' postmenstrual age with a diagnosis of BPD were assessed for PH by three pediatric cardiologists using predefined criteria, and survival times among categories of PH patients were compared. A total of 458 echocardiograms were reviewed, and 15 (33%) patients were found to have at least moderate PH. Patients with at least moderate PH had similar demographic characteristics to those with no/mild PH.

Results: Ninety percent of infants without moderate to severe PH survived to hospital discharge, compared with 67% of infants with at least moderate PH (p = 0.048). Patients with severe PH had decreased survival to hospital discharge (38%) compared with moderate (100%) and no/mild PH (90%) groups. Kaplan-Meier survival curves also differed among PH severity groups (Wilcoxon p < 0.001).

Conclusion: Using predefined criteria for PH, premature infants with BPD can be stratified into PH severity categories. Patients diagnosed with severe PH by echocardiogram have significantly reduced survival.

Key points: · A composite score definition of PH by echocardiogram showed high inter- and intrarater reliability.. · Infants with severe PH by echocardiogram had decreased survival rates.. · Early diagnosis of PH by echocardiogram dictates treatment which may improve outcomes..

PubMed Disclaimer

Conflict of interest statement

C.P.H. receives salary support for research from National Institute for Child Health and Human Development (NICHD; R13HD102136; RL1HD107784), the National Heart Lung and Blood Institute (NHLBI; R61/R33HL147833), the U.S. Food and Drug Administration (R01-FD006099, PI Laughon; U18-FD006298), the U.S. Government for his work in pediatric clinical pharmacology (Government Contract HHSN275201800003I, PI: Benjamin under the Best Pharmaceuticals for Children Act), the nonprofit Burrhoughs Wellcome Fund, and other sponsors for drug development in adults and children ( https://dcri.org/about-us/conflict-of-interest/ ).W.M.J. received an early career award #14934 from the Thrasher Research Fund.

Similar articles

See all similar articles

Cited by

References

    1. Krishnan U, Feinstein JA, Adatia I, et al.; Pediatric Pulmonary Hypertension Network (PPHNet) Evaluation and management of pulmonary hypertension in children with bronchopulmonary dysplasia. J Pediatr 2017;188:24–34.e1 - PubMed
    1. Stoll BJ, Hansen NI, Bell EF, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010;126(03):443–456 - PMC - PubMed
    1. Abman SH, Ivy DD, Archer SL, Wilson K Committee AAJGfPPH. Executive Summary of the American Heart Association and American Thoracic Society Joint Guidelines for Pediatric Pulmonary Hypertension. Am J Respir Crit Care Med 2016;194(07):898–906 - PMC - PubMed
    1. Tracy MK, Berkelhamer SK. Bronchopulmonary dysplasia and pulmonary outcomes of prematurity. Pediatr Ann 2019;48(04):e148–e153 - PubMed
    1. Wu KY, Jensen EA, White AM, et al. Characterization of disease phenotype in very preterm infants with severe bronchopulmonary dysplasia. Am J Respir Crit Care Med 2020;201(11):1398–1406 - PMC - PubMed