Pulmonary hypertension improves in most premature infants with BPD
PH resolved in the first year for many babies, but hospital use remained high
Pulmonary hypertension (PH) in extremely premature infants — those born before 28 weeks of pregnancy — who also have bronchopulmonary dysplasia (BPD) usually resolves within the first year and does not appear to increase the risk of death compared with BPD alone, according to a recent study.
BPD is the most common chronic lung disease in premature infants. It causes injury to the airways (bronchi) and interferes with normal development of the tiny air sacs in the lungs.
However, the study also showed that despite PH resolution happening in most cases, “extremely premature infants with BPD and PH experience greater healthcare utilization up to 5 years … [highlighting] the need for targeted outpatient strategies to reduce long-term morbidity in this high-risk population.”
The study, “Hospitalizations and outcomes in extremely premature infants with bronchopulmonary dysplasia and pulmonary hypertension at 5 years,” was published in the European Journal of Pediatrics.
PH is a common complication of BPD in extremely premature infants
PH happens when blood pressure rises in the pulmonary arteries, the blood vessels that carry blood from the heart to the lungs. In premature infants, PH is a frequent complication of BPD and is linked to more serious illness and greater use of healthcare services.
However, the long-term outlook beyond the first year of life for extremely premature infants with both BPD and PH remains “poorly characterized,” the researchers noted.
To learn more, researchers in the U.S. reviewed records from extremely premature infants treated in the neonatal intensive care unit (NICU) at Children’s Wisconsin. A total of 175 infants with BPD who were discharged from the NICU on home oxygen, born at a mean gestational age of 25.3 weeks, were included. Gestational age is calculated by starting from the first day of the mother’s last menstrual period.
PH was diagnosed in almost half of the infants (48%) based on at least one echocardiogram, a test that uses sound waves to look at the heart and nearby blood vessels. The median time from PH diagnosis to resolution was 59 days, and in most infants, PH resolved within the first year.
By five years of age, death rates were similar between infants with and without PH (4.8% vs. 4.4%). Emergency-department-only visits were also comparable (79.8% vs. 75.8%).
However, infants with PH tended to be more medically fragile. They had a lower average birth weight (677.1 vs. 771.6 grams, or 1.49 vs. 1.7 lbs), longer NICU stays (109.5 vs. 88 days), and needed breathing tubes for longer (57 vs. 32 days). They were also more likely to need a tracheostomy (an opening in the windpipe to help with breathing) before discharge (20.2% vs. 8.8%).
Children with PH needed more hospital care after leaving the NICU
During the five-year follow-up period, children with PH were significantly more likely to be hospitalized at least once after leaving the NICU (71.4% vs. 48.4%).
Among children who were hospitalized at least once, those with PH had a higher median number of hospital stays (four vs. two) and were readmitted sooner after discharge (53.5 vs. 155.5 days).
“Infants with PH may have more hospital readmissions due to medical fragility since this group is more likely to have hospital admissions for other causes,” the researchers wrote.
Almost half of the children with PH (47.6%) received pulmonary vasodilators — medications that widen the blood vessels in the lungs — during their NICU stay. The most commonly used were inhaled nitric oxide and sildenafil (sold as Revatio, with generic medications available).
Children with PH also needed home oxygen for longer than those without PH (189 vs. 134 days), which the researchers said may reflect “delayed lung maturation.”
“Moving forward, it will be important to evaluate the types of outpatient resources utilized by this patient population and whether certain resources or interventions lead to fewer hospitalizations or [emergency department] visits long term,” the scientists wrote. “Determining whether treatment of infants with PH medications affects long-term outcomes can also help to shape treatment strategies in the future.”
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