Mascarenhas Dwayne, Al-Balushi Marwa, Al-Sabahi Aida, Weisz Dany E, Jain Amish, Jasani Bonny
The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Arch Dis Child Fetal Neonatal Ed. 2025 Jun 19;110(4):344-352. doi: 10.1136/archdischild-2024-327547.
Knowledge gaps exist on the incidence and risk factors for developing pulmonary hypertension (PH) in preterm infants with bronchopulmonary dysplasia (BPD) and its impact on outcomes.
To systematically review and meta-analyse the incidence, risk factors and short- and long-term outcomes of BPD-PH in preterm infants.
PubMed, Embase, Cochrane CENTRAL and CINAHL were searched for studies including infants<37 weeks gestational age (GA) or birth weight<2500 g with BPD-PH versus BPD-no PH from inception until 5 April 2023.
Incidence, risk factors and short- and long-term outcomes.
44 observational studies evaluating 7677 preterm infants were included. The incidence of PH in mild, moderate and severe BPD was 5%, 18% and 41%, respectively. Small for GA (25 studies; N=5814; OR 1.8; 95% CI 1.3, 2.5), necrotising enterocolitis (22 studies; N=3387; OR 1.6; 95% CI 1.3, 2.2), early PH (four studies; N=820 OR 2.2; 95% CI 1.5, 3.3) and severe BPD (20 studies; N=2587; OR 5.4; 95% CI 3.2, 9.1) were significant risk factors for BPD-PH. Compared with BPD-no PH, the BPD-PH group had significantly higher mortality (22 studies; N=4882; OR 6.4; 95% CI 4.7, 8.6), longer duration of mechanical ventilation, oxygen supplementation, length of hospital stay, need for home oxygen and tracheostomy requirement. The BPD-PH infants also had a significantly higher risk of neurodevelopmental impairment in the motor domain.
PH increases across the severity of BPD and is associated with higher odds of mortality and adverse short-term and neurodevelopmental outcomes.
CRD42023413119.
支气管肺发育不良（BPD）的早产儿发生肺动脉高压（PH）的发病率、危险因素及其对预后的影响方面存在知识空白。
系统评价和荟萃分析早产儿BPD合并PH的发病率、危险因素及短期和长期预后。
检索了PubMed、Embase、Cochrane CENTRAL和CINAHL数据库，纳入自开始至2023年4月5日的研究，研究对象为胎龄<37周或出生体重<2500g的BPD合并PH与不合并PH的婴儿。
发病率、危险因素及短期和长期预后。
纳入44项观察性研究，共7677例早产儿。轻度、中度和重度BPD中PH的发病率分别为5%、18%和41%。小于胎龄儿（25项研究；N=5814；比值比1.8；95%置信区间1.3，2.5）、坏死性小肠结肠炎（22项研究；N=3387；比值比1.6；95%置信区间1.3，2.2）、早期PH（4项研究；N=820；比值比2.2；95%置信区间1.5，3.3）和重度BPD（20项研究；N=2587；比值比5.4；95%置信区间3.2，9.1）是BPD合并PH的显著危险因素。与不合并PH的BPD组相比，合并PH的BPD组死亡率显著更高（22项研究；N=4882；比值比6.4；95%置信区间4.7，8.6），机械通气时间、吸氧时间、住院时间更长，需要家庭吸氧及气管切开的比例更高。合并PH的BPD婴儿在运动领域神经发育障碍的风险也显著更高。
PH的发生率随BPD严重程度增加而升高，且与更高的死亡几率及不良短期和神经发育结局相关。
PROSPERO注册号：CRD42023413119。
