scholarly journals Fate of pulmonary hypertension associated with bronchopulmonary dysplasia beyond 36 weeks postmenstrual age

2020 ◽  
Vol 106 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Sanne Arjaans ◽  
Meindina G Haarman ◽  
Marcus T R Roofthooft ◽  
Marian W F Fries ◽  
Elisabeth M W Kooi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Medical Center ◽  
Survival Rates ◽  
Patient Characteristics ◽  
University Hospital ◽  
Resolution Rate ◽  
Extremely Preterm ◽  
Postmenstrual Age ◽  
Preterm Born

ObjectiveTo determine the survival and evolution of pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD) in extremely premature born infants beyond 36 weeks postmenstrual age (PMA).DesignA single-centre retrospective cohort study from a university hospital.PatientsExtremely preterm (gestational age <30 weeks and/or birth weight <1000 g) infants, born between 2012 and 2017, in the University Medical Center Groningen with confirmed PH at/beyond 36 weeks PMA.Main outcome measuresSurvival, mortality rate and PH resolution. Patient characteristics, treatment, presence and evolution of PH were collected from patient charts.ResultsTwenty-eight infants were included. All had BPD, while 23 (82%) had severe BPD and 11 infants (39%) died. Survival rates at 1, 3 and 7 months from 36 weeks PMA were 89%, 70% and 58%, respectively. In 16 of the 17 surviving infants, PH resolved over time, with a resolution rate at 1 and 2 years corrected age of 47% and 79%, respectively. At 2.5 years corrected age, the resolution rate was 94%.ConclusionsThese extremely preterm born infants with PH-BPD had a survival rate of 58% at 6 months corrected age. Suprasystemic pulmonary artery pressure was associated with poor outcome. In the current study, infants surviving beyond the corrected age of 6 months showed excellent survival and resolution of PH in almost all cases. Prospective follow-up studies should investigate whether resolution of PH in these infants can be improved by multi-modal therapies, including respiratory, nutritional and cardiovascular treatments.

Bronchopulmonary dysplasia and postnatal growth following extremely preterm birth

2020 ◽  
pp. fetalneonatal-2020-320816
Author(s):  
Theodore Dassios ◽  
Emma E Williams ◽  
Ann Hickey ◽  
Catey Bunce ◽  
Anne Greenough
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Head Circumference ◽  
Outcome Measure ◽  
Postnatal Growth ◽  
Z Score ◽  
Main Outcome Measure ◽  
Extremely Preterm ◽  
Postmenstrual Age ◽  
Extremely Preterm Birth ◽  
Current Incidence

ObjectivesTo report the current incidence of bronchopulmonary dysplasia (BPD) and to compare changes in weight and head circumference between infants who developed BPD and infants who did not.DesignRetrospective, whole-population study.SettingAll neonatal units in England between 2014 and 2018.PatientsAll liveborn infants born <28 completed weeks of gestation.InterventionsThe change in weight z-score (ΔWz) was calculated by subtracting the birthweight z-score from the weight z-score at 36 weeks postmenstrual age (PMA) and at discharge. The change in head circumference z-score (ΔHz) was calculated by subtracting the birth head circumference z-score from the head circumference z-score at discharge.Main outcome measureBPD was defined as the need for any respiratory support at 36 weeks PMA.Results11 806 infants were included in the analysis. The incidence of BPD was 57.5%, and 18.9% of the infants died before 36 weeks PMA. The median (IQR) ΔWz from birth to 36 weeks PMA was significantly smaller in infants who developed BPD (−0.69 (−1.28 to −0.14), n=6105) than in those who did not develop BPD (−0.89 (−1.40 to −0.33), n=2390; adjusted p<0.001). The median (IQR) ΔHz from birth to discharge was significantly smaller in infants who developed BPD (−0.33 (−1.69 to 0.71)) than in those who did not develop BPD (−0.61 (−1.85 to 0.35); adjusted p<0.001).ConclusionsPostnatal growth was better in infants diagnosed with BPD compared with infants without BPD possibly due to more aggressive nutrition strategies.

scholarly journals Contemporary Patient Characteristics and Referral Patterns to a Pulmonary Hypertension Clinic at an Academic Medical Center

2017 ◽  
Vol 23 (8) ◽  
pp. S115
Author(s):  
William C. Harding ◽  
Manu Mysore ◽  
Jamie Kennedy ◽  
Andrew Mihalek ◽  
Kenneth Bilchick ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Characteristics ◽  
Referral Patterns ◽  
Hypertension Clinic ◽  
Academic Medical

scholarly journals Children with Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension Treated with Pulmonary Vasodilators—The Pediatric Cardiologist Point of View

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 326
Author(s):  
Anna Migdał ◽  
Anna Sądel-Wieczorek ◽  
Edyta Ryciak ◽  
Alicja Mirecka-Rola ◽  
Grażyna Brzezińska-Rajszys ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Prognostic Factors ◽  
Bronchopulmonary Dysplasia ◽  
Pressure Ratio ◽  
Point Of View ◽  
Term Outcome ◽  
Pulmonary Vasodilators ◽  
Long Term Effect ◽  
Postmenstrual Age ◽  
Pulmonary Arterial

Pulmonary hypertension in children with bronchopulmonary dysplasia (BPD-PH) significantly worsens the prognosis. Pulmonary vasodilators are often used in BPD-PH but the short-term outcome of treatment is not well described. The aim of this study was to evaluate BPD-PH children diagnosed beyond 36 weeks postmenstrual age treated with pulmonary vasodilators (sildenafil, bosentan, or both) and to assess the short and long-term effect of oral pulmonary vasodilators treatment. Twenty patients were included in the study. Cardiology evaluation (WHO-FC, NTproBNP, oxygen saturation, pulmonary to systemic pressure ratio PAP/SAP) was performed at diagnosis and after treatment initiation. In the majority of patients improvement in all evaluated factors was observed. No side effects of vasodilators were observed. PH resolved in 10 patients after a mean of 21.4 months of treatment. Six patients died. The number of poor prognostic factors commonly used to assess patients with pulmonary arterial hypertension (PAH) decreased significantly during BPD-PH treatment. The influence of BPD-PH perinatal risk factors on prognosis was considered but was not confirmed. In conclusion, the treatment of BPD-PH with pulmonary vasodilators was well tolerated and led to a clinical improvement with the possibility of discontinuation without recurrence of PH. Prognostic factors used in pediatric PAH risk stratification also seem to be useful in assessing treatment efficacy and prognosis in patients with BPD-PH.

Chronic Inflammatory Placental Lesions Correlate With Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants

2021 ◽  
pp. 109352662110136
Author(s):  
Amit Sharma ◽  
Beena G Sood ◽  
Faisal Qureshi ◽  
Yuemin Xin ◽  
Suzanne M Jacques
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Group Development ◽  
Respiratory Support ◽  
Placental Pathology ◽  
Inflammatory Lesions ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Objective Correlation of BPD with placental pathology is important for clarification of the multifactorial pathogenesis of BPD; however, previous reports have yielded varying results. We report placental findings in no/mild BPD compared to moderate/severe BPD, and with and without pulmonary hypertension (PH). Methods Eligible infants were 230/7-276/7 weeks gestational age. BPD was defined by the need for oxygen at ≥28 days with severity based on need for respiratory support at ≥36 weeks. Acute and chronic inflammatory placental lesions and lesions of maternal and fetal vascular malperfusion were examined. Results Of 246 eligible infants, 146 (59%) developed moderate/severe BPD. Thirty-four (23%) infants developed PH, all but 1 being in the moderate/severe BPD group. Chronic deciduitis (32% vs 16%, P = .003), chronic chorioamnionitis (23% vs 12%, P = .014), and ≥ 2 chronic inflammatory lesions (13% vs 3%, P = .007) were more frequent in the moderate/severe BPD group. Development of PH was associated with placental villous lesions of maternal vascular malperfusion (30% vs 15%, P = .047). Conclusions The association of chronic inflammatory placental lesions with BPD severity has not been previously reported. This supports the injury responsible for BPD as beginning before birth in some neonates, possibly related to cytokines associated with these chronic inflammatory lesions.

scholarly journals 1220. Impact of Mandatory Infectious Diseases Consultation on the Use of Core Measures and Mortality in Staphylococcus aureus Bacteremia (SAB) at an Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S370-S370 ◽  
Author(s):  
Elizabeth Gancher ◽  
Gregory Maslak ◽  
Jonathan Lustgarten ◽  
Sara Schultz ◽  
Marinela Ingilizova
Keyword(s):  
Infectious Diseases ◽  
Hospital Mortality ◽  
Medical Center ◽  
Academic Medical Center ◽  
Final Analysis ◽  
Patient Characteristics ◽  
University Hospital ◽  
Mortality Data ◽  
Core Measures ◽  
Related Mortality

Abstract Background Multiple studies have shown that Infectious Diseases (ID) consultation significantly improves adherence to guidelines for patients with SAB and decreases mortality. Data from a prior retrospective study done at Hahnemann University Hospital showed that ID consultation improved the use of guideline-based core measures for SAB management. Based on these data, a mandatory ID consultation was established at our institution in November 2016. Methods A retrospective, observational study was conducted to evaluate patient characteristics, adherence to core measures for SAB, and in-hospital mortality. All patients with at least one documented blood culture positive for S. aureus were stratified into two groups: pre-mandatory consult (January 1, 2014–November 1, 2016) and post mandatory consult (November 2, 2016–February 1, 2018). Results Three hundred seventy-three discrete episodes of SAB were included in the final analysis, 238 episodes before mandatory consult, and 135 episodes after the mandatory consult policy was enacted. Mandatory consultation significantly improved the use of the following core measures for SAB: surveillance blood cultures (87.7% pre vs. 99.2% post, P &lt; 0.001), echocardiography (81.9% vs. 96.9%, P &lt; 0.001), early targeted antimicrobial therapy with nafcillin or cefazolin in MSSA (71.7% vs. 88.6%, P &lt; 0.001), and appropriateness of final antibiotic choice (80.2% vs. 95.2%, P &lt; 0.001). In addition, in-hospital mortality (15.4% vs. 6.2%, P = 0.011), and infection-related mortality (14.3% vs. 5.6%, P = 0.011) were found to be statistically significantly lower in the post mandatory consultation patients. Conclusion Implementation of a mandatory ID consultation for patients with SAB at our institution was associated with increased adherence to guideline-based core measures for management of SAB, and decreased in-hospital and infection-related mortality. Our results suggest that mandatory ID consultation for SAB should be considered at all institutions. Disclosures All authors: No reported disclosures.

scholarly journals Early pulmonary hypertension is a risk factor for bronchopulmonary dysplasia-associated late pulmonary hypertension in extremely preterm infants

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyun Ho Kim ◽  
Se In Sung ◽  
Mi Sun Yang ◽  
Yea Seul Han ◽  
Hye Seon Kim ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Risk Factor ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Odds Ratio ◽  
Intraventricular Hemorrhage ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Grade 3 ◽  
Ventilator Care

AbstractThis study evaluated whether early pulmonary hypertension (PH) in extremely preterm infants (EPIs) at 22–27 weeks of gestation detected clinically with echocardiography at 4–7 postnatal days (PND) is a risk factor for death before 36 weeks post-menstrual age (PMA) or late PH in moderate or severe (m/s) bronchopulmonary dysplasia (BPD) (BPD-PH). We analyzed risk factors for death before 36 weeks PMA or BPD-PH. Among 247 EPIs enrolled, 74 (30.0%) had early PH. Twenty-one (28.4%) infants with early PH and 18 (10.4%) without early PH died before 36 weeks PMA; 14 (18.9%) infants with early PH and 9 (5.2%) without early PH had BPD-PH at 36–38 weeks PMA. Multivariate analysis revealed that early PH (adjusted odds ratio, 6.55; 95% confidence interval, 3.10–13.82, P < 0.05), clinical chorioamnionitis (2.50; 1.18–5.31), intraventricular hemorrhage (grade 3–4) (3.43; 1.26–9.37), and late sepsis (6.76; 3.20–14.28) independently increased the risk of development of death before 36 weeks PMA or BPD-PH. Subgroup analysis among m/s BPD patients revealed that early PH (4.50; 1.61–12.58) and prolonged invasive ventilator care (> 28 days) (4.91; 1.02–23.68) increased the risk for late PH independently. In conclusion, EPIs with early PH at 4–7 PND should be monitored for BPD-associated late PH development.

scholarly journals Early angiogenic proteins associated with high risk for bronchopulmonary dysplasia and pulmonary hypertension in preterm infants

2020 ◽  
Vol 318 (4) ◽  
pp. L644-L654 ◽  
Author(s):  
Sanne Arjaans ◽  
Brandie D. Wagner ◽  
Peter M. Mourani ◽  
Erica W. Mandell ◽  
Brenda B. Poindexter ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Subsequent Development ◽  
Pulmonary Vascular Disease ◽  
Morphogenetic Protein ◽  
Angiogenic Proteins ◽  
Postmenstrual Age ◽  
Hepatocyte Growth ◽  
Increased Susceptibility

Early pulmonary vascular disease in preterm infants is associated with the subsequent development of bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH); however, mechanisms that contribute to or identify infants with increased susceptibility for BPD and/or PH are incompletely understood. Therefore, we tested if changes in circulating angiogenic peptides during the first week of life are associated with the later development of BPD and/or PH. We further sought to determine alternate peptides and related signaling pathways with the risk for BPD or PH. We prospectively enrolled infants with gestational age <34 wk and collected blood samples during their first week of life. BPD and PH were assessed at 36 wk postmenstrual age. Samples were assayed for each of the 1,121 peptides included in the SOMAscan scan technology, with subsequent pathway analysis. Of 102 infants in the study, 82 had BPD, and 13 had PH. Multiple angiogenic proteins (PF-4, VEGF121, ANG-1, bone morphogenetic protein 10 [BMP10], hepatocyte growth factor (HGF), ANG-2) were associated with the subsequent diagnosis of BPD; and FGF-19, PF-4, connective tissue activating peptide (CTAP)-III, and PDGF-AA levels were associated with BPD severity. Early increases in BMP10 was strongly associated with the late risk for BPD and PH. We found that early alterations of circulating angiogenic peptides and others were associated with the subsequent development of BPD. We further identified peptides that were associated with BPD severity and BPD-associated PH, including BMP10. We speculate that proteomic biomarkers during the first week of life may identify infants at risk for BPD and/or PH to enhance care and research.

scholarly journals BNP, troponin I, and YKL-40 as screening markers in extremely preterm infants at risk for pulmonary hypertension associated with bronchopulmonary dysplasia

2016 ◽  
Vol 311 (6) ◽  
pp. L1076-L1081 ◽  
Author(s):  
Kai König ◽  
Katelyn J. Guy ◽  
Claudia A. Nold-Petry ◽  
Charles P. Barfield ◽  
Geraldine Walsh ◽  
...  
Keyword(s):  
At Risk ◽  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Troponin I ◽  
Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Bronchopulmonary dysplasia (BPD) is often complicated by pulmonary hypertension (PH). We investigated three biomarkers potentially suitable as screening markers for extremely preterm infants at risk of BPD-associated PH. In this prospective observational cohort study conducted in a tertiary neonatal intensive care unit, 83 preterm infants with BPD born <28-wk gestation and still inpatients at 36-wk corrected age received an echocardiogram and blood tests of B-type natriuretic peptide (BNP), troponin I, and YKL-40. Infants were analyzed according to echocardiographic evidence of tricuspid regurgitation (TR). Thirty infants had evidence of TR on echocardiogram at 36-wk corrected age. Infants with or without TR had similar baseline demographics: mean ± SD gestational age 261 ± 12 vs. 261 ± 11 wk and birth weight 830 ± 206 vs. 815 ± 187 g, respectively. There was no difference in duration of respiratory support. The right ventricular systolic pressure of infants with evidence of TR was 40 ± 16 mmHg. BNP was the only biomarker that proved to be significantly higher in infants with evidence of TR: median (interquartile range) serum level 54.5 (35–105) vs. 41.5 (30–59) pg/ml, P = 0.043. Subgroup analysis of infants with severe BPD requiring discharge on home oxygen or BPD-related mortality revealed similar results. There was no difference between groups for troponin I and YKL-40. In conclusion, increased serum levels of BNP were associated with evidence of TR at 36-wk corrected gestational age in extremely preterm infants, suggesting a potential role as a screening biomarker for BPD-associated PH.

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