Pulmonary hypertension in preterm infants: results of a prospective screening program

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Abstract

OBJECTIVE:

Determine prevalence and associations with pulmonary hypertension (PH) in preterm infants.

STUDY DESIGN:

Prospective institutional echocardiographic PH screening at 36 to 38 weeks’ corrected gestational age (GA) for infants born <32 weeks’ GA who had bronchopulmonary dysplasia (BPD; group BPD), and infants without BPD who had a birth weight (BW) <750 g, or clinical suspicion for PH (group NoBPD).

RESULTS:

Two hundred and four infants were screened (GA 25.9 ± 2 weeks, BW 831 ± 286 g). The PH prevalence in group BPD was higher than in group NoBPD (44/159 (28%) vs 5/45 (11%); P = 0.028). In group BPD, BW and GA were lower in infants with PH compared with NoPH. Following correction for BW and GA, necrotizing enterocolitis (NEC), severe intraventricular hemorrhage (IVH), atrial septal defect (ASD), and mortality were independently associated with PH in infants with BPD. In group NoBPD, NEC was the only identified factor associated with PH. Altogether, screening only those infants with NEC and infants with BPD who also had a BW <840 g would have yielded a 84% sensitivity for detecting PH, and reduced the number of screening echocardiograms by 43%.

CONCLUSIONS:

PH in prematurity is associated with NEC in infants with and without BPD. In infants with BPD, smaller GA and BW, severe IVH, ASD and mortality are also associated with PH. Infants without identified PH-associated factors may not require routine echocardiographic PH screening.

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