Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
Division of Pediatric Pulmonology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Am J Perinatol. 2024 Dec;41(16):2206-2213. doi: 10.1055/s-0044-1786544. Epub 2024 May 2.
Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth. Infants with BPD are at increased risk for pulmonary hypertension (PH). Cardiac catheterization is the gold standard for diagnosing PH, but cardiac catheterization is challenging to perform in small, sick, premature infants. The utility of echocardiography for diagnosing PH and predicting outcomes in extremely premature infants has not been clearly defined. Therefore, we sought to use predefined criteria to diagnose PH by echocardiogram and relate PH severity to mortality in extremely premature infants with BPD.
Echocardiograms from 46 infants born ≤28 weeks' postmenstrual age with a diagnosis of BPD were assessed for PH by three pediatric cardiologists using predefined criteria, and survival times among categories of PH patients were compared. A total of 458 echocardiograms were reviewed, and 15 (33%) patients were found to have at least moderate PH. Patients with at least moderate PH had similar demographic characteristics to those with no/mild PH.
Ninety percent of infants without moderate to severe PH survived to hospital discharge, compared with 67% of infants with at least moderate PH ( = 0.048). Patients with severe PH had decreased survival to hospital discharge (38%) compared with moderate (100%) and no/mild PH (90%) groups. Kaplan-Meier survival curves also differed among PH severity groups (Wilcoxon < 0.001).
Using predefined criteria for PH, premature infants with BPD can be stratified into PH severity categories. Patients diagnosed with severe PH by echocardiogram have significantly reduced survival.
· A composite score definition of PH by echocardiogram showed high inter- and intrarater reliability.. · Infants with severe PH by echocardiogram had decreased survival rates.. · Early diagnosis of PH by echocardiogram dictates treatment which may improve outcomes..
支气管肺发育不良（BPD）是早产儿最常见的并发症。患有 BPD 的婴儿患肺动脉高压（PH）的风险增加。心导管检查是诊断 PH 的金标准，但在小而病重的早产儿中进行心导管检查具有挑战性。超声心动图在诊断 PH 和预测极早产儿结局中的作用尚未明确界定。因此，我们试图使用预设标准通过超声心动图诊断 PH，并将 PH 严重程度与患有 BPD 的极早产儿的死亡率相关联。
对 46 名胎龄 ≤28 周的 BPD 诊断婴儿的超声心动图进行评估，由三位儿科心脏病专家使用预设标准进行 PH 诊断，并比较 PH 患者各分类的生存时间。共回顾了 458 次超声心动图，发现 15 名（33%）患者至少存在中度 PH。至少存在中度 PH 的患者与无/轻度 PH 的患者具有相似的人口统计学特征。
90%无中度至重度 PH 的婴儿存活至出院，而至少存在中度 PH 的婴儿存活率为 67%（= 0.048）。严重 PH 患者的存活率下降至出院（38%），而中度（100%）和无/轻度 PH（90%）组的存活率分别为 100%和 90%。PH 严重程度组的 Kaplan-Meier 生存曲线也不同（Wilcoxon <0.001）。
使用超声心动图诊断 PH 的预设标准，可以将患有 BPD 的早产儿分为 PH 严重程度类别。通过超声心动图诊断为严重 PH 的患者生存率显著降低。
