Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Pediatr Neonatol. 2015 Oct;56(5):317-23. doi: 10.1016/j.pedneo.2014.12.006. Epub 2015 Feb 12.
Bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) is a well-known complication of prematurity; however, the additional impact of a left-to-right interatrial shunt on this condition remains poorly understood. The aim of the present study was to identify the significance of atrial left-to-right shunt lesions in PH infants with moderate or severe BPD.
The medical records of 383 preterm infants (gestational age of < 32 weeks) who were diagnosed with BPD between 2005 and 2013 were retrospectively reviewed. Baseline characteristics such as interatrial shunts and outcomes were compared between the infants who developed PH (n = 50) and infants who did not (n = 144). Infants with hemodynamically significant residual patent ductus arteriosus were excluded. Among the infants diagnosed with PH (n = 50), the outcomes were compared between the patients with (n = 21) and without atrial shunts (n = 29) at 36 weeks corrected postmenstrual age.
Fifty (15%) preterm infants with BPD were diagnosed with PH. The number of infants with a history of atrial shunt lesions was significantly higher in the PH group than in the non-PH group (42% vs. 15.3%, respectively). The adjusted odds ratio for PH in the atrial shunt group was 3.8 (95% confidence interval, 1.8-8.0), compared to PH-BPD infants without an atrial shunt.
The presence of an atrial left-to-right shunt was associated with PH in preterm infants with moderate or severe BPD. Close follow up is needed for infants with interatrial shunts, and a more tailored prognostic evaluation and treatment are recommended.
支气管肺发育不良（BPD）相关肺动脉高压（PH）是早产儿的一种众所周知的并发症；然而，左向右房间分流对这种情况的额外影响仍知之甚少。本研究的目的是确定中重度 BPD 早产儿中房间左向右分流病变对 PH 的意义。
回顾性分析了 2005 年至 2013 年间诊断为 BPD 的 383 例早产儿（<32 周胎龄）的病历。比较了发生 PH（n=50）和未发生 PH（n=144）的婴儿的房间分流和结局等基线特征。排除了有血流动力学意义的持续性动脉导管未闭的婴儿。在诊断为 PH（n=50）的婴儿中，比较了 36 周校正后月经龄时伴有（n=21）和不伴有房间分流（n=29）的患者的结局。
50 例（15%）BPD 早产儿被诊断为 PH。PH 组有房间分流病变史的婴儿数量明显高于非 PH 组（分别为 42%和 15.3%）。房间分流组发生 PH 的调整比值比为 3.8（95%置信区间，1.8-8.0），而无房间分流的 PH-BPD 婴儿为 1.8。
中重度 BPD 早产儿存在房间左向右分流与 PH 相关。需要对有房间分流的婴儿进行密切随访，并建议进行更具针对性的预后评估和治疗。
