Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. 1260-1269 (doi:10.1542/peds.2007-0971)
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ARTICLE

Pulmonary Artery Hypertension in Formerly Premature Infants With Bronchopulmonary Dysplasia: Clinical Features and Outcomes in the Surfactant Era

Ekta Khemani, MSca,b, Doff B. McElhinney, MDa,b, Lawrence Rhein, MDb,c,d, Olyn Andradeb,c, Ronald V. Lacro, MDa,b, Kristin C. Thomas, MS, RNa,b and Mary P. Mullen, MD, PhDa,b

a Department of Cardiology
Divisions of c Pulmonology
d Neonatology, Children's Hospital Boston, Boston, Massachusetts
b Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

BACKGROUND. Although abnormal pulmonary vascular structure and function in preterm infants with bronchopulmonary dysplasia may predispose infants to pulmonary artery hypertension, little is known about the characteristics and outcomes of bronchopulmonary dysplasia-associated pulmonary artery hypertension in the surfactant era.

METHODS. We studied 42 premature infants (<32 weeks of gestation) with bronchopulmonary dysplasia who were diagnosed as having pulmonary artery hypertension ≥2 months after birth, between 1998 and 2006, at a median age of 4.8 months. Pulmonary artery hypertension was graded through echocardiography for all patients; 13 patients also underwent cardiac catheterization.

RESULTS. Eighteen (43%) of 42 patients had severe pulmonary artery hypertension (systemic or suprasystemic right ventricular pressure). Among 13 patients who underwent catheterization, the mean pulmonary artery pressure was 43 ± 8 mmHg and the pulmonary vascular resistance index was 9.9 ± 2.8 Wood units. In 12 patients, pulmonary artery pressure and pulmonary vascular resistance improved with 100% oxygen and 80 ppm inhaled nitric oxide but remained elevated. The pulmonary vascular resistance index decreased to 7.9 ± 3.8 Wood units in 100% oxygen and to 6.4 ± 3.1 Wood units with the addition of nitric oxide. Sixteen patients (38%) died during the follow-up period. Estimated survival rates were 64% ± 8% at 6 months and 53% ± 11% at 2 years after diagnosis of pulmonary artery hypertension. In multivariate analyses, severe pulmonary artery hypertension and small birth weight for gestational age were associated with worse survival rates. Among 26 survivors (median follow-up period: 9.8 months), pulmonary artery hypertension was improved, relative to its most severe level, in 24 patients (89%).

CONCLUSION. Premature infants with bronchopulmonary dysplasia and severe pulmonary artery hypertension are at high risk of death, particularly during the first 6 months after diagnosis of pulmonary artery hypertension.

Key Words: pulmonary vascular disease • atrial septal defect • chronic lung disease • prematurity

Abbreviations: BPD—bronchopulmonary dysplasia • NO—nitric oxide • PA—pulmonary artery • PAH—pulmonary artery hypertension • PVR—pulmonary vascular resistance • RV—right ventricle • SGA—small for gestational age • WU—Wood unit

Accepted Jun 8, 2007.