Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany.
Neonatology. 2018;113(1):81-88. doi: 10.1159/000480694. Epub 2017 Nov 8.
Pulmonary hypertension (PH) affects 1 in 6 infants with a birthweight <1,000 g (extremely low birthweight; ELBW) and is frequently associated with bronchopulmonary dysplasia (BPD). If untreated, the mortality rates of the disease are high.
The aim of this study was to characterize risk factors for PH in ELBW infants and to describe the timing of onset of the disease by setting up a screening program.
ELBW infants treated at the Department of Neonatology (level III neonatal intensive care unit at the University of Cologne Medical Centre, Germany) between January 2010 and March 2015 were included. Echocardiography screening for PH was performed either before discharge or if BPD was diagnosed. Additionally, infants had at least 1 echocardiographic scan after discharge. Survival with PH, age at diagnosis of PH, and risk factors associated with PH were assessed.
In total, 34/188 (18%) infants had PH. Of these, 14 (41%) were identified after discharge. Another 11 (32%) were diagnosed with PH without suffering from moderate or severe BPD. The risk factors for diagnosis of PH were moderate (odds ratio, OR 4 [2-8]) or severe BPD (OR 13 [2-71]), prolonged rupture of membranes >7 days (OR 5 [1-19]), and birthweight below the 3rd percentile (OR 3 [1-9]). All infants with PH before discharge and 50% diagnosed after discharge were treated with sildenafil (2.0 mg/kg/day). PH resolved and sildenafil was discontinued in all patients after a median duration of 13 months (IQR 8-20).
An echocardiographic screening program may help to identify infants with PH. Examinations should include all ELBW infants irrespective of the presence of BPD and be continued after discharge.
肺动脉高压（PH）影响体重<1000g（极低出生体重；ELBW）的婴儿中的 1/6，并且常与支气管肺发育不良（BPD）相关。如果不治疗，疾病的死亡率很高。
本研究旨在描述 ELBW 婴儿 PH 的危险因素，并通过建立筛查计划描述疾病的发病时间。
纳入 2010 年 1 月至 2015 年 3 月在德国科隆大学医学中心新生儿科（三级新生儿重症监护病房）接受治疗的 ELBW 婴儿。PH 的超声心动图筛查在出院前或诊断出 BPD 时进行。此外，婴儿出院后至少进行 1 次超声心动图检查。评估 PH 存活、PH 诊断年龄和与 PH 相关的危险因素。
共有 34/188（18%）婴儿患有 PH。其中，14 例（41%）在出院后被发现。另有 11 例（32%）在没有中重度 BPD 的情况下被诊断为 PH。诊断 PH 的危险因素是中度（比值比，OR 4 [2-8]）或重度 BPD（OR 13 [2-71]）、胎膜早破>7 天（OR 5 [1-19]）和出生体重低于第 3 百分位（OR 3 [1-9]）。所有在出院前患有 PH 的婴儿和 50%在出院后被诊断为 PH 的婴儿均接受了西地那非（2.0mg/kg/天）治疗。中位治疗时间为 13 个月（IQR 8-20）后，所有患者的 PH 均得到缓解，且停用了西地那非。
超声心动图筛查方案可能有助于识别 PH 婴儿。检查应包括所有 ELBW 婴儿，无论是否存在 BPD，并在出院后继续进行。
