Weismann C G, Asnes J D, Bazzy-Asaad A, Tolomeo C, Ehrenkranz R A, Bizzarro M J
Department of Pediatrics, Division of Pediatric Cardiology, Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA.
Pediatric Heart Center, Skåne Universitetssjukhus, Lasarettgatan 48, Lund, Sweden.
J Perinatol. 2017 May;37(5):572-577. doi: 10.1038/jp.2016.255. Epub 2017 Feb 16.
Determine prevalence and associations with pulmonary hypertension (PH) in preterm infants.
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).
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%.
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.
确定早产儿肺动脉高压（PH）的患病率及其相关因素。
对出生胎龄<32周且患有支气管肺发育不良（BPD；BPD组）的婴儿，以及出生体重（BW）<750g或临床怀疑患有PH的无BPD婴儿（无BPD组），在矫正胎龄36至38周时进行前瞻性机构超声心动图PH筛查。
共筛查204例婴儿（胎龄25.9±2周，体重831±286g）。BPD组的PH患病率高于无BPD组（44/159（28%）对5/45（11%）；P=0.028）。在BPD组中，患有PH的婴儿的BW和胎龄低于无PH的婴儿。在校正BW和胎龄后，坏死性小肠结肠炎（NEC）、重度脑室内出血（IVH）、房间隔缺损（ASD）和死亡率与BPD婴儿的PH独立相关。在无BPD组中，NEC是唯一确定的与PH相关的因素。总体而言，仅对患有NEC的婴儿以及BW<840g的BPD婴儿进行筛查，对检测PH的敏感性将达到84%，并可将筛查超声心动图的数量减少43%。
早产PH与有无BPD的婴儿的NEC相关。在患有BPD的婴儿中，较小的胎龄和BW、重度IVH、ASD和死亡率也与PH相关。未发现PH相关因素的婴儿可能不需要常规超声心动图PH筛查。
