Download PDF
Am J Perinatol 2016; 33(09): 903-909
DOI: 10.1055/s-0036-1581079
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Temporal Profile of Early Pulmonary Hypertension in Preterm Infants

Hussnain Mirza
1   Center for Neonatal Care, Florida Hospital for Children, UCF College of Medicine, Orlando, Florida
,
James Ziegler
2   Division of Pediatric Cardiology, Hasbro Children's Hospital, The Alpert Medical School of Brown University, Providence, Rhode Island
,
Sara Ford
2   Division of Pediatric Cardiology, Hasbro Children's Hospital, The Alpert Medical School of Brown University, Providence, Rhode Island
,
James Padbury
3   Department of Pediatrics, Women & Infants Hospital, The Alpert Medical School of Brown University, Providence, Rhode Island
,
Richard Tucker
3   Department of Pediatrics, Women & Infants Hospital, The Alpert Medical School of Brown University, Providence, Rhode Island
,
Abbot Laptook
3   Department of Pediatrics, Women & Infants Hospital, The Alpert Medical School of Brown University, Providence, Rhode Island
› Author Affiliations
Further Information

Publication History

30 July 2015

12 February 2016

Publication Date:
08 April 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Objective The objective of this study was to study the temporal profile of pulmonary hypertension (PH) in preterm infants.

Study Design Infants < 28 weeks were screened for early PH at 10 to 14 days of life. Infants with early PH (n = 10) and gestationally matched controls (n = 18) underwent serial echocardiography every 7 to 10 days until 36 weeks postmenstrual age.

Results Groups with and without early PH were comparable except for higher Fio 2 by day 10 among infants with early PH. Early PH was moderate in extent and resolved in all infants with recurrence in one infant. Among infants without early PH, five infants developed late PH. In both groups, development of late PH occurred in association with important neonatal morbidities, such as patent ductus arteriosus, bronchopulmonary dysplasia, and infection.

Conclusion Early moderate PH among preterm infants resolves over a variable time period but recurrence is possible. Late PH can appear during the course of hospitalization in association with other clinical morbidities.

Keywords

pulmonary hypertension - neonatal transition - BPD - preterm infants
 

  • References

  • 1 Abman SH, Chatfield BA, Hall SL, McMurtry IF. Role of endothelium-derived relaxing factor during transition of pulmonary circulation at birth. Am J Physiol 1990; 259 (6, Pt 2): H1921-H1927
    PubMedGoogle Scholar
  • 2 Emmanouilides GC, Moss AJ, Duffie Jr ER, Adams FH. Pulmonary arterial pressure changes in human newborn infants from birth to 3 days of age. J Pediatr 1964; 65: 327-333
    CrossrefPubMedGoogle Scholar
  • 3 Skinner JR, Boys RJ, Hunter S, Hey EN. Pulmonary and systemic arterial pressure in hyaline membrane disease. Arch Dis Child 1992; 67 (4 Spec No): 366-373
    CrossrefPubMedGoogle Scholar
  • 4 Randala M, Eronen M, Andersson S, Pohjavuori M, Pesonen E. Pulmonary artery pressure in term and preterm neonates. Acta Paediatr 1996; 85 (11) 1344-1347
    CrossrefPubMedGoogle Scholar
  • 5 Walther FJ, Benders MJ, Leighton JO. Persistent pulmonary hypertension in premature neonates with severe respiratory distress syndrome. Pediatrics 1992; 90 (6) 899-904
    PubMedGoogle Scholar
  • 6 Evans NJ, Archer LN. Doppler assessment of pulmonary artery pressure during recovery from hyaline membrane disease. Arch Dis Child 1991; 66 (7 Spec No): 802-804
    CrossrefPubMedGoogle Scholar
  • 7 Gill AB, Weindling AM. Pulmonary artery pressure changes in the very low birthweight infant developing chronic lung disease. Arch Dis Child 1993; 68 (3 Spec No): 303-307
    CrossrefPubMedGoogle Scholar
  • 8 Gill AB, Weindling AM. Raised pulmonary artery pressure in very low birthweight infants requiring supplemental oxygen at 36 weeks after conception. Arch Dis Child Fetal Neonatal Ed 1995; 72 (1) F20-F22
    CrossrefPubMedGoogle Scholar
  • 9 Bhat R, Salas AA, Foster C, Carlo WA, Ambalavanan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics 2012; 129 (3) e682-e689
    CrossrefPubMedGoogle Scholar
  • 10 Mourani PM, Sontag MK, Younoszai A , et al. Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. Am J Respir Crit Care Med 2015; 191 (1) 87-95
    CrossrefPubMedGoogle Scholar
  • 11 Mirza H, Ziegler J, Ford S, Padbury J, Tucker R, Laptook A. Pulmonary hypertension in preterm infants: prevalence and association with bronchopulmonary dysplasia. J Pediatr 2014; 165 (5) 909-14.e1
    CrossrefPubMedGoogle Scholar
  • 12 Skinner JR, Boys RJ, Heads A, Hey EN, Hunter S. Estimation of pulmonary arterial pressure in the newborn: study of the repeatability of four Doppler echocardiographic techniques. Pediatr Cardiol 1996; 17 (6) 360-369
    CrossrefPubMedGoogle Scholar
  • 13 King ME, Braun H, Goldblatt A, Liberthson R, Weyman AE. Interventricular septal configuration as a predictor of right ventricular systolic hypertension in children: a cross-sectional echocardiographic study. Circulation 1983; 68 (1) 68-75
    CrossrefPubMedGoogle Scholar
  • 14 Khemani E, McElhinney DB, Rhein L , et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics 2007; 120 (6) 1260-1269
    CrossrefPubMedGoogle Scholar
  • 15 Bancalari E, Claure N. Definitions and diagnostic criteria for bronchopulmonary dysplasia. Semin Perinatol 2006; 30 (4) 164-170
    CrossrefPubMedGoogle Scholar
  • 16 Kair LR, Leonard DT, Anderson JM. Bronchopulmonary dysplasia. Pediatr Rev 2012; 33 (6) 255-263 , quiz 263–264
    CrossrefPubMedGoogle Scholar
  • 17 Walsh M, Engle W, Laptook A , et al; National Institute of Child Health and Human Development Neonatal Research Network. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved?. Pediatrics 2005; 116 (4) 857-861
    CrossrefPubMedGoogle Scholar
  • 18 Evans NJ, Archer LN. Doppler assessment of pulmonary artery pressure and extrapulmonary shunting in the acute phase of hyaline membrane disease. Arch Dis Child 1991; 66 (1 Spec No): 6-11
    CrossrefPubMedGoogle Scholar
  • 19 Subhedar NV, Shaw NJ. Changes in pulmonary arterial pressure in preterm infants with chronic lung disease. Arch Dis Child Fetal Neonatal Ed 2000; 82 (3) F243-F247
    CrossrefPubMedGoogle Scholar
  • 20 Ambalavanan N, Mourani P. Pulmonary hypertension in bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol 2014; 100 (3) 240-246
    CrossrefPubMedGoogle Scholar
  • 21 Skinner JR, Stuart AG, O'Sullivan J, Heads A, Boys RJ, Hunter S. Right heart pressure determination by Doppler in infants with tricuspid regurgitation. Arch Dis Child 1993; 69 (2) 216-220
    CrossrefPubMedGoogle Scholar
  • 22 Currie PJ, Seward JB, Chan KL , et al. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol 1985; 6 (4) 750-756
    CrossrefPubMedGoogle Scholar
  • 23 Hoeper MM. The new definition of pulmonary hypertension. Eur Respir J 2009; 34 (4) 790-791
    CrossrefPubMedGoogle Scholar
  • 24 Ivy DD, Abman SH, Barst RJ , et al. Pediatric pulmonary hypertension. J Am Coll Cardiol 2013; 62 (25, Suppl): D117-D126
    CrossrefPubMedGoogle Scholar
  • 25 Pandya KA, Puligandla PS. Pulmonary hypertension management in neonates. Semin Pediatr Surg 2015; 24 (1) 12-16
    CrossrefPubMedGoogle Scholar
  • 26 Gao Y, Raj JU. Regulation of the pulmonary circulation in the fetus and newborn. Physiol Rev 2010; 90 (4) 1291-1335
    CrossrefPubMedGoogle Scholar
  • 27 Kovacs G, Avian A, Pienn M, Naeije R, Olschewski H. Reading pulmonary vascular pressure tracings. How to handle the problems of zero leveling and respiratory swings. Am J Respir Crit Care Med 2014; 190 (3) 252-257
    PubMedGoogle Scholar
  • 28 Eyal FG, Hachey WE, Curtet-Eyal NL, Kellum FE, Alpan G. Effect of modulators of hypoxic pulmonary vasoconstriction on the response to inhaled nitric oxide in a neonatal model of severe pulmonary atelectasis. Semin Perinatol 1996; 20 (3) 186-193
    CrossrefPubMedGoogle Scholar