Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia

Peter M. Mourani, Marci K. Sontag, Adel Younoszai, Joshua I. Miller, John P. Kinsella, Christopher D. Baker, Brenda B. Poindexter, David Ingram, Steven H. Abman

Research output: Contribution to journalArticle

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Abstract

Rationale: Pulmonary hypertension (PH) is associated with poor outcomes among preterm infants with bronchopulmonary dysplasia (BPD), but whether early signs of pulmonary vascular disease are associated with the subsequent development of BPD or PH at 36 weeks post-menstrual age (PMA) is unknown. Objectives: To prospectively evaluate the relationship of early echocardiogram signs of pulmonary vascular disease in preterm infants to the subsequent development of BPD and late PH (at 36 wk PMA). Methods: Prospectively enrolled preterm infants with birthweights 500-1,250 g underwent echocardiogram evaluations at 7 days of age (early) and 36 weeks PMA (late). Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH. Measurements and Main Results: A total of 277 preterm infants completed echocardiogram and BPD assessments at 36 weeks PMA. The median gestational age at birth and birthweight of the infants were 27 weeks and 909 g, respectively. Early PH was identified in 42% of infants, and 14% were diagnosed with late PH. Early PH was a risk factor for increased BPD severity (relative risk, 1.12; 95% confidence interval, 1.03-1.23) and late PH (relative risk, 2.85; 95% confidence interval, 1.28-6.33). Infants with late PH had greater duration of oxygen therapy and increased mortality in the first year of life (P<0.05). Conclusions: Early pulmonary vascular disease is associated with the development of BPD and with late PH in preterm infants. Echocardiograms at 7 days of age may be a useful tool to identify infants at high risk for BPD and PH.

Original languageEnglish
Pages (from-to)87-95
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume191
Issue number1
DOIs
StatePublished - Jan 1 2015

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Bronchopulmonary Dysplasia
Vascular Diseases
Pulmonary Hypertension
Premature Infants
Lung Diseases
Confidence Intervals
Gestational Age
Parturition

Keywords

  • Bronchopulmonary dysplasia
  • Echocardiography
  • Prematurity
  • Pulmonary hypertension
  • Pulmonary vascular disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Mourani, P. M., Sontag, M. K., Younoszai, A., Miller, J. I., Kinsella, J. P., Baker, C. D., ... Abman, S. H. (2015). Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. American Journal of Respiratory and Critical Care Medicine, 191(1), 87-95. https://doi.org/10.1164/rccm.201409-1594OC

Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. / Mourani, Peter M.; Sontag, Marci K.; Younoszai, Adel; Miller, Joshua I.; Kinsella, John P.; Baker, Christopher D.; Poindexter, Brenda B.; Ingram, David; Abman, Steven H.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 191, No. 1, 01.01.2015, p. 87-95.

Research output: Contribution to journalArticle

Mourani, PM, Sontag, MK, Younoszai, A, Miller, JI, Kinsella, JP, Baker, CD, Poindexter, BB, Ingram, D & Abman, SH 2015, 'Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia', American Journal of Respiratory and Critical Care Medicine, vol. 191, no. 1, pp. 87-95. https://doi.org/10.1164/rccm.201409-1594OC
Mourani, Peter M. ; Sontag, Marci K. ; Younoszai, Adel ; Miller, Joshua I. ; Kinsella, John P. ; Baker, Christopher D. ; Poindexter, Brenda B. ; Ingram, David ; Abman, Steven H. / Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. In: American Journal of Respiratory and Critical Care Medicine. 2015 ; Vol. 191, No. 1. pp. 87-95.
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abstract = "Rationale: Pulmonary hypertension (PH) is associated with poor outcomes among preterm infants with bronchopulmonary dysplasia (BPD), but whether early signs of pulmonary vascular disease are associated with the subsequent development of BPD or PH at 36 weeks post-menstrual age (PMA) is unknown. Objectives: To prospectively evaluate the relationship of early echocardiogram signs of pulmonary vascular disease in preterm infants to the subsequent development of BPD and late PH (at 36 wk PMA). Methods: Prospectively enrolled preterm infants with birthweights 500-1,250 g underwent echocardiogram evaluations at 7 days of age (early) and 36 weeks PMA (late). Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH. Measurements and Main Results: A total of 277 preterm infants completed echocardiogram and BPD assessments at 36 weeks PMA. The median gestational age at birth and birthweight of the infants were 27 weeks and 909 g, respectively. Early PH was identified in 42{\%} of infants, and 14{\%} were diagnosed with late PH. Early PH was a risk factor for increased BPD severity (relative risk, 1.12; 95{\%} confidence interval, 1.03-1.23) and late PH (relative risk, 2.85; 95{\%} confidence interval, 1.28-6.33). Infants with late PH had greater duration of oxygen therapy and increased mortality in the first year of life (P<0.05). Conclusions: Early pulmonary vascular disease is associated with the development of BPD and with late PH in preterm infants. Echocardiograms at 7 days of age may be a useful tool to identify infants at high risk for BPD and PH.",
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AU - Mourani, Peter M.

AU - Sontag, Marci K.

AU - Younoszai, Adel

AU - Miller, Joshua I.

AU - Kinsella, John P.

AU - Baker, Christopher D.

AU - Poindexter, Brenda B.

AU - Ingram, David

AU - Abman, Steven H.

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N2 - Rationale: Pulmonary hypertension (PH) is associated with poor outcomes among preterm infants with bronchopulmonary dysplasia (BPD), but whether early signs of pulmonary vascular disease are associated with the subsequent development of BPD or PH at 36 weeks post-menstrual age (PMA) is unknown. Objectives: To prospectively evaluate the relationship of early echocardiogram signs of pulmonary vascular disease in preterm infants to the subsequent development of BPD and late PH (at 36 wk PMA). Methods: Prospectively enrolled preterm infants with birthweights 500-1,250 g underwent echocardiogram evaluations at 7 days of age (early) and 36 weeks PMA (late). Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH. Measurements and Main Results: A total of 277 preterm infants completed echocardiogram and BPD assessments at 36 weeks PMA. The median gestational age at birth and birthweight of the infants were 27 weeks and 909 g, respectively. Early PH was identified in 42% of infants, and 14% were diagnosed with late PH. Early PH was a risk factor for increased BPD severity (relative risk, 1.12; 95% confidence interval, 1.03-1.23) and late PH (relative risk, 2.85; 95% confidence interval, 1.28-6.33). Infants with late PH had greater duration of oxygen therapy and increased mortality in the first year of life (P<0.05). Conclusions: Early pulmonary vascular disease is associated with the development of BPD and with late PH in preterm infants. Echocardiograms at 7 days of age may be a useful tool to identify infants at high risk for BPD and PH.

AB - Rationale: Pulmonary hypertension (PH) is associated with poor outcomes among preterm infants with bronchopulmonary dysplasia (BPD), but whether early signs of pulmonary vascular disease are associated with the subsequent development of BPD or PH at 36 weeks post-menstrual age (PMA) is unknown. Objectives: To prospectively evaluate the relationship of early echocardiogram signs of pulmonary vascular disease in preterm infants to the subsequent development of BPD and late PH (at 36 wk PMA). Methods: Prospectively enrolled preterm infants with birthweights 500-1,250 g underwent echocardiogram evaluations at 7 days of age (early) and 36 weeks PMA (late). Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH. Measurements and Main Results: A total of 277 preterm infants completed echocardiogram and BPD assessments at 36 weeks PMA. The median gestational age at birth and birthweight of the infants were 27 weeks and 909 g, respectively. Early PH was identified in 42% of infants, and 14% were diagnosed with late PH. Early PH was a risk factor for increased BPD severity (relative risk, 1.12; 95% confidence interval, 1.03-1.23) and late PH (relative risk, 2.85; 95% confidence interval, 1.28-6.33). Infants with late PH had greater duration of oxygen therapy and increased mortality in the first year of life (P<0.05). Conclusions: Early pulmonary vascular disease is associated with the development of BPD and with late PH in preterm infants. Echocardiograms at 7 days of age may be a useful tool to identify infants at high risk for BPD and PH.

KW - Bronchopulmonary dysplasia

KW - Echocardiography

KW - Prematurity

KW - Pulmonary hypertension

KW - Pulmonary vascular disease

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