Screening echocardiogram performed at the time of bronchopulmonary dysplasia (BPD) diagnosis can help identify infants at higher risk for developing clinically significant, long-term pulmonary hypertension (PH), particularly when coupled with serum brain natriuretic peptide (BNP) values, according to the results of a retrospective longitudinal study published in Pediatric Cardiology.1

As many as 68% of neonates born at less than 29 weeks’ gestation are diagnosed with BPD,2 and between 18% and 43% of those neonates develop secondary PH.3-5 Studies have demonstrated poor neurodevelopmental outcomes and 2-year mortality rates in up to 40% in these infants.6,7

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Several guidelines have recently been published that encourage echocardiographic screening of lower gestational age and birth weight infants to allow for early detection,4,8,9 but there remains no guidance on how to interpret these data or when to intervene. Thus, researchers assessed the utility of screening serum BNP and echocardiograms performed at the time of BPD diagnosis (“early PH”) to predict “late PH” at the last follow-up in 37 premature infants with BPD.

Screening evaluation demonstrated early PH in 9 patients; 4 had late PH at an average follow-up interval of 52.7 weeks. Of note, 1 patient without early PH had late PH.

At initial screening, infants with late PH were significantly more likely to have elevated BNP values and echocardiographic evidence of right atrial dilatation, right ventricular hypertrophy, lower right ventricular area change percentage, and larger main pulmonary artery Z-scores.

“In conclusion, our data suggest that screening echocardiograms performed at the time of BPD diagnosis can help identify those patients at highest risk for developing clinically significant, long-term PH, particularly when coupled with serum BNP values,” stated the investigators.

References

1. Behere S, Alapati D, McCulloch MA. Screening echocardiography and brain natriuretic peptide levels predict late pulmonary hypertension in infants with bronchopulmonary dysplasia [published online April 1, 2019]. Pediatr Cardiol. doi:10.1007/s00246-019-02100-8

2. Stoll BJ, Hansen NI, Bell EF, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126(3):443-456.

3. Kim D-H, Kim HS, Choi CW, Kim EK, Kim BI, Choi JH. Risk factors for pulmonary artery hypertension in preterm infants with moderate or severe bronchopulmonary dysplasia. Neonatology. 2012;101(1):40-46.

4. Weismann CG, Asnes JD, Bazzy-Asaad A, Tolomeo C, Ehrenkranz RA, Bizzarro MJ. Pulmonary hypertension in preterm infants: results of a prospective screening program. J Perinatol. 2017;37(5):572-577.

5. Bhat R, Salas AA, Foster C, Ambalavanan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics. 2012;129(3):e682-e689.

6. 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. Pediatrics. 2007;120(6):1260-1269.

7. del Cerro MJ, Sabaté Rotés A, Cartón A, et al. Pulmonary hypertension in bronchopulmonary dysplasia: clinical findings, cardiovascular anomalies and outcomes. Pediatr Pulmonol. 2014;49(1):49-59.

8. Krishnan U, Feinstein JA, Adatia I, et al; Pediatric Pulmonary Hypertension Network (PPHNet). Evaluation and management of pulmonary hypertension in children with bronchopulmonary dysplasia. J Pediatr. 2017;188:24-34.

9. Abman SH, Collaco JM, Shepherd EG, et al; Bronchopulmonary Dysplasia Collaborative. Interdisciplinary care of children with severe bronchopulmonary dysplasia. J Pediatr. 2017;181:12-28.e1.