Neonatal Intensive Care Unit, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy.
Institute Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Udine, Italy.
Eur J Pediatr. 2021 Jun;180(6):1711-1720. doi: 10.1007/s00431-021-03954-y. Epub 2021 Jan 21.
Neonatologist-performed echocardiography (NPE) is an established tool for bedside hemodynamic evaluation, including pulmonary hypertension (PH). PH may complicate bronchopulmonary dysplasia (BPD) course. Aims of this retrospective study were to assess the feasibility of NPE follow-up of infants with BPD and to describe the course of PH of infants with moderate/severe BPD. Preterm infants <32 gestational weeks or birthweight ≤1500 g with moderate/severe BPD underwent NPE follow-up, from 36 weeks postmenstrual age up to 8 months postnatal age. Twenty-three preemies were included (birth weight 840 (213) g, gestational age 26.8 (2.3) weeks); 12/23 developed mild PH, 2/12 after discharge. PH resolved at 8.9 (3.9) months. Clinical and echocardiographic variables did not differ between infants with and without PH, except pulmonary artery acceleration time (PAAT) and PAAT/right ventricle ejection time (RVET) ratio (PAAT: 36 weeks, 68.9 (11.9) vs 52.0 (19.1), p = 0.0443; 6 months: 83.9 (38.9) vs 74.8 (16.9), p = 0.0372). No deaths or admissions for PH were reported. Neonatologist's Image Quality Assessment score attributed by the cardiologist assumed as gold standard was adequate or optimal (9.5/14 total score); inter-rater agreement was excellent (ICC 0.974).Conclusions: NPE follow-up seems to be feasible and safe in both intensive care and outpatient clinic. Mild PH is frequently detected in moderate/severe BPD, with good prognosis. What is Known: • Preterm infants with bronchopulmonary dysplasia (BPD) may develop pulmonary hypertension (PH) and have a late diagnosis. • Neonatologist-performed echocardiography (NPE) is an established tool for bedside hemodynamic evaluation of the neonate. What is New: • To our knowledge this is the first study of NPE follow-up of moderate/severe BPD, describing the course of mild PH from diagnosis to its resolution. • NPE follow-up of BPD seems to be safe and practicable, in both intensive care and outpatient clinic, as long as neonatologists maintain a sound collaboration with pediatric cardiologists.
新生儿科医师施行的超声心动图（NPE）是一种用于床边血液动力学评估的既定工具，包括肺动脉高压（PH）。PH 可能使支气管肺发育不良（BPD）复杂化。本回顾性研究的目的是评估对患有 BPD 的婴儿进行 NPE 随访的可行性，并描述患有中重度 BPD 的婴儿 PH 的病程。对 32 孕周以下或出生体重≤1500g 的患有中重度 BPD 的早产儿进行 NPE 随访，从校正孕周 36 周开始，直至生后 8 个月。共纳入 23 例早产儿（出生体重 840（213）g，胎龄 26.8（2.3）周）；12/23 例发展为轻度 PH，其中 2 例在出院后发生。PH 在 8.9（3.9）个月时得到解决。除肺动脉加速时间（PAAT）和 PAAT/右心室射血时间（RVET）比值外（PAAT：校正孕周 36 周时为 68.9（11.9）比 52.0（19.1），p=0.0443；6 个月时为 83.9（38.9）比 74.8（16.9），p=0.0372），患有 PH 和无 PH 的婴儿的临床和超声心动图变量没有差异。报告没有因 PH 而死亡或住院的病例。由心脏病专家评估的新生儿科医师图像质量评分被认为是金标准，评分为中等或良好（总分 14 分中的 9.5 分）；观察者间一致性极好（ICC 0.974）。结论：NPE 随访在重症监护病房和门诊均可行且安全。中重度 BPD 中经常发现轻度 PH，且预后良好。已知：•患有支气管肺发育不良（BPD）的早产儿可能会发展为肺动脉高压（PH），且诊断较晚。•新生儿科医师施行的超声心动图（NPE）是一种用于新生儿床边血液动力学评估的既定工具。新内容：•据我们所知，这是首例对中重度 BPD 进行 NPE 随访的研究，描述了从诊断到解决轻度 PH 的过程。•只要新生儿科医生与儿科心脏病医生保持良好的合作，BPD 的 NPE 随访在重症监护病房和门诊均安全且可行。
