Long-Term Outcomes of Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia

AbstractNew definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.

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Impact of the definition of bronchopulmonary dysplasia on neurodevelopmental outcomes

Scientific Reports ◽

10.1038/s41598-021-01219-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yea-Seul Han ◽

Sung-Ha Kim ◽

Tae-Jung Sung

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Univariate Analysis ◽

Admission Rate ◽

Respiratory Disorder ◽

Long Term Outcomes ◽

Neurodevelopmental Outcomes ◽

Predictive Values ◽

Grade 3

AbstractUnderstanding the short and long-term pulmonary and neurologic outcomes of neonates with bronchopulmonary dysplasia (BPD) is important in neonatal care for low-birth-weight infants. Different criteria for BPD may have different associations with long-term outcomes. Currently, two criteria for diagnosing BPD have been proposed by the NIH (2001) and NRN (2019) for preterm infants at a postmenstrual age (PMA) of 36 weeks. We investigated which BPD definition best predicts long-term outcomes. Korean nationwide data for preterm infants born between 24+0 and < 32+0 weeks gestation from January 2013 to December 2015 were collected. For long-term outcomes, severity based on the NRN criteria was significantly related to neurodevelopmental impairment (NDI) in a univariate analysis after other risk factors were controlled. For the admission rate for respiratory disorder, grade 3 BPD of the NRN criteria had the highest specificity (96%), negative predictive value (86%), and accuracy (83%). For predicting NDI at the 18–24 month follow-up, grade 3 BPD of the NRN criteria had the best specificity (98%), positive (64%) and negative (79%) predictive values, and accuracy (78%) while NIH severe BPD had the highest sensitivity (60%). The NRN definition was more strongly associated with poor 2-year developmental outcomes. BPD diagnosed by NRN definitions might better identify infants at high risk for NDI.

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Approach to the Child With Pulmonary Hypertension and Bronchopulmonary Dysplasia

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-10.2.98 ◽

2011 ◽

Vol 10 (2) ◽

pp. 98-103 ◽

Cited By ~ 1

Author(s):

Steven H. Abman

Keyword(s):

Pulmonary Hypertension ◽

Bronchopulmonary Dysplasia ◽

Progressive Disease ◽

Clinical Care ◽

Therapeutic Strategies ◽

Pulmonary Vascular Disease ◽

Long Term Outcomes ◽

Risks And Benefits ◽

Relative Risks

Pulmonary vascular disease and pulmonary hypertension contribute to the pathophysiology and outcomes of infants with bronchopulmonary dysplasia. Data are extremely limited regarding many aspects of pulmonary hypertension in bronchopulmonary dysplasia, including the need to learn more about its natural history and prevalence, mechanisms that cause pulmonary hypertension or contribute to progressive disease, and the relative risks and benefits of current therapeutic strategies. Although new therapies are now available for the treatment of pulmonary hypertension, their role in the clinical care of severe bronchopulmonary dysplasia, and improving long-term outcomes requires more thorough investigation.

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Association of Newer Definitions of Bronchopulmonary Dysplasia with Pulmonary Hypertension and Long-Term Outcomes

10.21203/rs.3.rs-1078279/v1 ◽

2021 ◽

Author(s):

Jae Kyoon Hwang ◽

Seung Han Shin ◽

Ee-Kyung Kim ◽

Seh Hyun Kim ◽

Han-Suk Kim

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Multiple Logistic Regression Analysis ◽

Respiratory Illness ◽

Long Term Outcomes ◽

Postmenstrual Age ◽

Study Population ◽

Grade 3 ◽

Definition Of

Abstract The diagnostic criteria of bronchopulmonary dysplasia (BPD) have been reassessed based on current practices and highest accuracy in predicting long-term outcomes. We investigated the association between BPD severity based on different definitions in terms of long-term outcomes and pulmonary arterial hypertension (PAH). This retrospective study enrolled preterm infants born at <32 weeks of gestation. The definition of BPD recommended by the National Institutes of Health in 2001, National Institute of Child Health and Human Development (NICHD) in 2018, and Jensen et al. in 2019 were used. The association between re-hospitalization due to respiratory illness, neurodevelopmental impairment (NDI) at a corrected age of 18–24 months, and PAH at a postmenstrual age (PMA) of 36 weeks with the severity of BPD based on these three definitions were evaluated. Among 354 infants, gestational age (26.9 weeks) and birth weight (730 g) were lowest in severe BPD based on NIH 2001 definition. In total, 14.1% of study population experienced NDI and 19.0% were re-hospitalized due to respiratory illness. Multiple logistic regression analysis showed that the adjusted odds ratio (OR) for re-hospitalization was highest in grade-3 BPD of the Jensen (2019) criteria (7.45). The adjusted OR for NDI (13.23) and PAH (40.37) were also highest in grade-3 of the Jensen (2019) criteria.Conclusion: Based on recently suggested criteria, severity of BPD is associated with long-term outcomes and PAH at PMA of 36 weeks in preterm infants.

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Researchers examine long-term outcomes of very preterm infants born in The Netherlands nearly 20 years ago

PsycEXTRA Dataset ◽

10.1037/e556752006-009 ◽

2001 ◽

Keyword(s):

The Netherlands ◽

Preterm Infants ◽

Long Term Outcomes ◽

Very Preterm Infants ◽

Very Preterm

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Long-Term Outcome after Asphyxia and Therapeutic Hypothermia in Late Preterm Infants: A Pilot Study

Healthcare ◽

10.3390/healthcare9080994 ◽

2021 ◽

Vol 9 (8) ◽

pp. 994

Author(s):

Hanne Lademann ◽

Karl Abshagen ◽

Anna Janning ◽

Jan Däbritz ◽

Dirk Olbertz

Keyword(s):

Pilot Study ◽

Preterm Infants ◽

Perinatal Asphyxia ◽

Psychomotor Development ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Developmental Index ◽

Mental Developmental Index

Therapeutic hypothermia (THT) is the recommended treatment for neuroprotection in (near) term newborns that experience perinatal asphyxia with hypoxic-ischemic encephalopathy. The benefit of THT in preterm newborns is unknown. This pilot study aims to investigate long-term outcomes of late preterm asphyctic infants with and without THT compared to term infants. The single-center, retrospective analysis examined medical charts of infants with perinatal asphyxia born between 2008 and 2015. Long-term outcome was assessed using the Bayley Scales of Infant Development 2 at the age of (corrected) 24 months. Term (n = 31) and preterm (n = 8) infants with THT showed no differences regarding their long-term outcomes of psychomotor development (Psychomotor Developmental Index 101 ± 16 vs. 105 ± 11, p = 0.570), whereas preterm infants had a better mental outcome (Mental Developmental Index 105 ± 13 vs. 93 ± 18, p = 0.048). Preterm infants with and without (n = 69) THT showed a similar mental and psychomotor development (Mental Developmental Index 105 ± 13 vs. 96 ± 20, p = 0.527; Psychomotor Developmental Index 105 ± 11 vs. 105 ± 15, p = 0.927). The study highlights the importance of studying THT in asphyctic preterm infants. However, this study shows limitations and should not be used as a basis for decision-making in the clinical context. Results of a multicenter trial of THT for preterm infants (ID No.: CN-01540535) have to be awaited.

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Early High-dose Caffeine Improves Respiratory Outcomes in Preterm Infants

Children ◽

10.3390/children8060501 ◽

2021 ◽

Vol 8 (6) ◽

pp. 501

Author(s):

Vineet Lamba ◽

Oscar Winners ◽

Prem Fort

Keyword(s):

Mechanical Ventilation ◽

Preterm Infants ◽

Regression Models ◽

High Dose ◽

Long Term Outcomes ◽

Logistic Regression Models ◽

Caffeine Citrate ◽

Timing Of Initiation ◽

Respiratory Outcomes

The objective of the study is to determine if early high-dose caffeine (HD) therapy is associated with shorter duration of mechanical ventilation, bronchopulmonary dysplasia (BPD), or decreased need for mechanical ventilation. We conducted a single center, retrospective cohort study of 273 infants less than 32 weeks gestational age (GA). Infants receiving early HD (10 mg/kg/day maintenance) caffeine citrate started within 24 h of life were compared with those receiving LD (6 mg/kg/day) with variable timing of initiation using linear and logistic regression models. The infants in the early HD group had 91.4 (95% confidence interval (CI): −166.6, −16.1; p = 0.018) less hours of mechanical ventilation up to 36 weeks PMA or discharge as compared with the LD group. Moreover, infants in the HD group had 0.37 (95% CI: 0.14, 0.97; p = 0.042) times lower odds of developing moderate/severe BPD compared with the LD group. Infants receiving early HD caffeine had improved respiratory outcomes with no increase in measured comorbidities. Large prospective studies are needed to determine the long-term outcomes of using high-dose caffeine prophylaxis for preterm infants.

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Occult catheter rupture causing episodic symptoms in a patient treated with epoprostenol

Pulmonary Circulation ◽

10.1177/2045893217748054 ◽

2017 ◽

Vol 8 (1) ◽

pp. 204589321774805 ◽

Cited By ~ 1

Author(s):

Barbara L. LeVarge ◽

Anica C. Law ◽

Blanche Murphy

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Adverse Events ◽

Arterial Hypertension ◽

Long Term Outcomes ◽

Pulmonary Arterial

Infection, thrombosis, and catheter dislodgment are well-recognized potential complications of chronic intravenous prostanoid therapy for pulmonary arterial hypertension. As long-term outcomes of pulmonary hypertension patients improve, novel adverse events are likely to arise. We describe the sudden development of unexplained hypotension and lightheadedness in a patient receiving intravenous epoprostenol for several years, ultimately determined to be due to an unusual catheter complication, not previously described in this population.

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