Extremely Low Gestational Age Newborns Born at 23 to 25 Weeks of Gestation Have a Substantial Risk for Chronic Pulmonary Hypertension at 12 Months of Chronological Age

Objectives: Extremely low gestational age newborns (ELGANs) represent a vulnerable population. We hypothesized that right ventricular (RV) pressure, size, and function indicate pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD-PH) that can be efficiently treated between 3 and 12 months of chronological age.

Methods: In this prospective observational cohort study, we determined echocardiographic variables of PH (tricuspid annular plane systolic excursion [TAPSE], estimated RV systolic pressure [RVSP], left ventricular end-systolic eccentricity index [LVesEI], RV/left ventricular [LV] end-systolic dimension ratio, pulmonary arterial acceleration time [PAAT]), and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in 34 surviving ELGANs (gestational age: 23^0/7–25^6/7 weeks; birth weight: mean, 670 g [580–726 g]) at 3 and 12 months of chronological age.

Result: Thirty-one of 34 ELGANs developed mild (n = 16), moderate (n = 10), or severe BPD (n = 5). Fifteen of 34 ELGANs (44%) had echocardiographic signs of both PH and moderate-to-severe BPD at 3 months, and 6 (17.6%) had BPD-PH at 12 months of age. PH-targeted therapy consisted of sildenafil monotherapy in 11 and dual oral combination therapy in 4 ELGANs at 3 and 12 months. BPD-PH infants had lower TAPSE, higher RVSP, higher LVesEI, higher end-systolic RV/LV ratio, lower PAAT, and higher NT-proBNP (p < 0.001) at both time points compared with ELGANs without PH (19/34).

Conclusion: Near half (44%) of ELGANs developed BPD-PH, all of which received PH-targeted pharmacotherapy at 3 months of chronological age, leading to marked hemodynamic improvement at 12 months. However, 40% (6/15) of ELGANs with BPD-PH still required continued combination pharmacotherapy at 12 months of chronological age.

Publication History

Article published online:
21 February 2021