Varghese Nidhy P, Altit Gabriel, Gubichuk Megan M, Siddaiah Roopa
Department of Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin St., Ste 1040, Houston, TX 77030, USA.
Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, QC H4A 3J1, Canada.
J Clin Med. 2024 Jun 11;13(12):3417. doi: 10.3390/jcm13123417.
Advances in perinatal intensive care have significantly enhanced the survival rates of extremely low gestation-al-age neonates but with continued high rates of bronchopulmonary dysplasia (BPD). Nevertheless, as the survival of these infants improves, there is a growing awareness of associated abnormalities in pulmonary vascular development and hemodynamics within the pulmonary circulation. Premature infants, now born as early as 22 weeks, face heightened risks of adverse development in both pulmonary arterial and venous systems. This risk is compounded by parenchymal and airway abnormalities, as well as factors such as inflammation, fibrosis, and adverse growth trajectory. The presence of pulmonary hypertension in bronchopulmonary dysplasia (BPD-PH) has been linked to an increased mortality and substantial morbidities, including a greater susceptibility to later neurodevelopmental challenges. BPD-PH is now recognized to be a spectrum of disease, with a multifactorial pathophysiology. This review discusses the challenges associated with the identification and management of BPD-PH, both of which are important in minimizing further disease progression and improving cardiopulmonary morbidity in the BPD infant.
围产期重症监护的进展显著提高了极低孕周新生儿的存活率，但支气管肺发育不良（BPD）的发生率仍然很高。然而，随着这些婴儿存活率的提高，人们越来越意识到肺血管发育和肺循环血流动力学存在相关异常。现在，最早在22周出生的早产儿面临着肺动脉和静脉系统不良发育的更高风险。这种风险因实质和气道异常以及炎症、纤维化和不良生长轨迹等因素而加剧。支气管肺发育不良相关性肺动脉高压（BPD-PH）与死亡率增加和严重疾病相关，包括对后期神经发育挑战更易感性。现在认为BPD-PH是一种具有多因素病理生理学的疾病谱。本综述讨论了与BPD-PH的识别和管理相关的挑战，这两者对于最大限度地减少疾病进一步进展和改善BPD婴儿的心肺疾病都很重要。
