Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation

The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Journal of perinatology: official journal of the California Perinatal Association (Impact Factor: 2.35). 02/2011; 31(10):635-40. DOI: 10.1038/jp.2010.213
Source: PubMed

ABSTRACT The goal of this study was to delineate the epidemiology of echocardiographically diagnosed pulmonary hypertension (PH) in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) requiring prolonged positive pressure ventilation (PPV), and to determine the independent relationship between PH and mortality in these patients.
Our retrospective cohort included ELBW infants, with BPD requiring prolonged PPV, hospitalized in Cincinnati, Ohio during 2003-2009, as recorded in the National Institute of Child Health and Human Development Neonatal Research Network Database. Following chart review, a logistic regression model was constructed to understand the contribution of PH to mortality in infants with BPD requiring prolonged PPV.
We identified 216 patients (19%) with BPD requiring prolonged PPV among 1156 ELBW infants. Of these patients, 41% received echocardiography after 4 weeks of life, with 37% showing evidence of PH. Logistic regression analysis demonstrated that infants with BPD requiring prolonged PPV, with PH detectable by echocardiogram, were four times more likely to die (adjusted odds ratio): 4.6, 95% confidence interval: 1.3-16.5) when compared with infants with BPD requiring prolonged PPV without echocardiographic evidence of PH.
Pulmonary hypertension appears to be an important, independent determinant of death in infants with BPD requiring prolonged PPV.

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    • "Another study from Denmark found that 23% of infants with BPD were diagnosed with pulmonary hypertension (Ali et al., 2013). Other retrospective studies have also identified pulmonary hypertension as an independent variable associated with mortality (Khemani et al., 2007; Slaughter et al., 2011). The higher rate (approximately 1 in 4) of pulmonary hypertension in BPD in these retrospective studies rather than the approximately 1 in 6 in the prospective study (Bhat et al., 2012) may be due to selection of infants with more severe BPD for evaluation, rather than a screening of all extremely preterm infants, and to differences in the methods for evaluation. "
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