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

Rachel D. Torok; Robert A. Gardner; Piers C.A. Barker; Andrew W. McCrary; Jennifer S. Li; Christoph P. Hornik; Matthew M. Laughon; Wesley M. Jackson

doi:10.1055/s-0044-1786544

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(16): 2206-2213
DOI: 10.1055/s-0044-1786544

Original Article

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

Authors

Rachel D. Torok

¹Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
Robert A. Gardner

²Division of Pediatric Pulmonology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Piers C.A. Barker

¹Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
Andrew W. McCrary

¹Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
Jennifer S. Li

¹Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina

³Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
Christoph P. Hornik

³Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina

⁴Division of Pediatric Critical Care, Duke University Medical Center, Durham, North Carolina
Matthew M. Laughon

⁵Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Wesley M. Jackson

⁵Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

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.

Keywords

pulmonary hypertension - echocardiography - bronchopulmonary dysplasia - outcomes

Full Text

References

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