Abstract：Objective To study the clinical features and prognosis of bronchopulmonary dysplasia (BPD) complicated by pulmonary hypertension (PH) in preterm infants. Methods A retrospective analysis was performed on the clinical data of 191 preterm infants with BPD. Results In the 191 preterm infants with BPD, 37 (19.4%), all with moderate or severe BPD, developed PH beyond 36 weeks' corrected age. The incidence rates of PH in infants with moderate and severe BPD were 5.7% (5/87) and 47.8% (32/67) respectively. Gestational age and birth weight were lower in infants with PH than in those without PH (P < 0.01). Infants with PH had higher incidence rates of small for gestational age (SGA), severe BPD, surgical ligation of patent ductus arteriosus (PDA), neonatal respiratory distress syndrome, hemodynamically significant PDA, and pneumonia than those without PH (P < 0.01). Durations of oxygen therapy, intubation, and positive pressure ventilation were longer in infants with PH than in those without PH (P < 0.01). Infants with PH had higher incidence rates of retinopathy of prematurity and extrauterine growth retardation, a higher mortality, and a longer length of hospital stay compared with those without PH (P < 0.01). In the 37 infants with PH (6 with mild PH, 14 with moderate PH, and 17 with severe PH), those with mild or moderate PH all survived; 15(88%) out of 17 infants with severe PH died. Conclusions The incidence of PH is high in preterm infants with moderate or severe BPD. Regular screening of pulmonary artery pressure is recommended for infants with BPD. Infants with low gestational age and birth weight, SGA, and severe BPD are more likely to develop PH. Infants with BPD complicated by PH have relatively high incidence rates of complications, high mortality, and poor prognosis.
WANG Chen-Hong,SHI Li-Ping,MA Xiao-Lu et al. Clinical features and prognosis of bronchopulmonary dysplasia complicated by pulmonary hypertension in preterm infants[J]. CJCP, 2018, 20(11): 893-896.
Jensen EA, Schmidt B. Epidemiology of bronchopulmonary dysplasia[J]. Birth Defects Res A Clin Mol Teratol, 2014, 100(3):145-157.
[2]
Mourani PM, Abman SH. Pulmonary hypertension and vascular abnormalities in bonchopulmonary dysplasia[J]. Clin Perinatol, 2015, 42(4):839-855.
[3]
Khemani E, McElhinney DB, Rhein L, et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia:clinical features and outcomes in the surfactant era[J]. Pediatrics, 2007, 120(6):1260-1269.
[4]
Jobe AH, Bancalari E. Bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2001, 163(7):1723-1729.
[5]
del Cerro MJ, Sabaté Rotés A, Cartón A, et al. Pulmonary hypertension in bronchopulmonary dysplasia:clinical findings, cardiovascular anomalies and outcomes[J]. Pediatr Pulmonol, 2014, 49(1):49-59.
[6]
Mirza H, Ziegler J, Ford S, et al. Pulmonary hypertension in preterm infants:prevalence and association with bronchopulmonary dysplasia[J]. J Pediatr, 2014, 165(5):909-914. e1.
[7]
An HS, Bae EJ, Kim GB, et al. Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia[J]. Korean Circ J, 2010, 40(3):131-136.
[8]
Kim DH, Kim HS, Choi CW, et al. Risk factors for pulmonary artery hypertension in preterm infants with moderate or severe bronchopulmonary dysplasia[J]. Neonatology, 2012, 101(1):40-46.
[9]
Slaughter JL, Pakrashi T, Jones DE, et al. Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation[J]. J Perinatol, 2011, 31(10):635-640.
[10]
Bruno CJ, Meerkov M, Capone C, et al. CRIB scores as a tool for assessing risk for the development of pulmonary hypertension in extremely preterm infants with bronchopulmonary dysplasia[J]. Am J Perinatol, 2015, 32(11):1031-1037.
[11]
Ali Z, Schmidt P, Dodd J, et al. Predictors of bronchopulmonary dysplasia and pulmonary hypertension in newborn children[J]. Dan Med J, 2013, 60(8):A4688.
[12]
Collaco JM, Dadlani GH, Nies MK, et al. Risk factors and clinical outcomes in preterm infants with pulmonary hypertension[J]. PLoS One, 2016, 11(10):e0163904.
[13]
Check J, Gotteiner N, Liu X, et al. Fetal growth restriction and pulmonary hypertension in premature infants with bronchopulmonary dysplasia[J]. J Perinatol, 2013, 33(7):553-557.
[14]
Bhat R, Salas AA, Foster C, et al. Prospective analysis of pulmonary hypertension in extremely low birth weight infants[J]. Pediatrics, 2012, 129(3):e682-e689.
[15]
Kim GB. Pulmonary hypertension in infants with bronchopulmonary dysplasia[J]. Korean J Pediatr, 2010, 53(6):688-693.
[16]
Krishnan U, Feinstein JA, Adatia I, et al. Evaluation and management of pulmonary hypertension in children with bronchopulmonary dysplasia[J]. J Pediatr, 2017, 188:24-34.e1.
[17]
Abman SH, Hansmann G, Archer SL, et al. Pediatric pulmonary hypertension guidelines from the American Heart Association and American Thoracic Society[J]. Circulation, 2015, 132(21):2037-2099.
[18]
Altit G, Dancea A, Renaud C, et al. Pathophysiology, screening and diagnosis of pulmonary hypertension in infants with bronchopulmonary dysplasia-a review of the literature[J]. Paediatr Respir Rev, 2017, 23:16-26.
[19]
Mourani PM, Abman SH. Pulmonary vascular disease in bronchopulmonary dysplasia:pulmonary hypertension and beyond[J]. Curr Opin Pediatr, 2013, 25(3):329-337.
