Neurological Problems Possible in Premature Babies with BPD-related PH, Study Finds

Alice Melão, MSc avatar

by Alice Melão, MSc |

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persistent pulmonary hypertension of the newborn

Pulmonary hypertension (PH) is associated with poorer neurodevelopmental outcome and impaired growth in the first two years of life for preterm infants with bronchopulmonary dysplasia, a study shows.

The study, “Developmental outcomes of preterm infants with bronchopulmonary dysplasia-associated pulmonary hypertension at 18-24 months of corrected age,” was published in the journal BMC Pediatrics.

The premature infant population is at risk of developing pulmonary complications, such as bronchopulmonary dysplasia (BPD), a form of chronic lung disease characterized by damage to the airway passages.

PH is a common consequence of BPD in premature newborns. Extreme prematurity, intrauterine growth restriction, prolonged mechanical ventilation, use of oxygen supplementation, and maternal preeclampsia/hypertension are risk factors for PH in BPD.

Although PH in preemies has been associated with a poor prognosis, the natural history of PH and outcomes in BPD patients remain unclear.

Korean researchers have now evaluated the impact of PH on the growth and neurodevelopment of preterm infants with BPD during their first years of life.

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The team reviewed the clinical records of 256 preterm infants born with less than 28 weeks of gestational age, and who were admitted to the neonatal intensive care unit of Seoul National University Children’s Hospital between 2005 and 2014.

Approximately 66% of the infants were diagnosed with severe or moderate BPD at a follow-up appointment at 18-24 months of age. Among these, 20 infants (25%) had also PH. More preemies with severe BPD had PH, compared to infants with moderate BPD.

BPD children with PH had a slightly lower weight and smaller head circumference than those without PH. In addition, children with both conditions showed significantly lower scores in cognitive, language, and motor domains, as determined by the Bayley III scale of infant and toddler development.

Nine (45%) of the 20 infants with PH showed signs of cognitive delay compared to only six (9.8%) of the 61 without PH.

Among those with PH, 55% had had sepsis (a life-threatening generalized immune response to infection), a significantly higher incidence than in infants without PH. Also, infants with PH had a longer median duration of hospitalization.

The team also found that growth restriction is more likely to persist after discharge in severe BPD infants with PH than in infants with severe BPD without PH.

The team concluded that PH is “a worsening factor of non-optimal growth and poor neurodevelopmental outcome in preterm infants with BPD at 18-24 months.”

According to the team, the development of PH may exacerbate BPD symptoms, as it may promote blood flow instability and an abnormally low concentration of oxygen in the blood.

“A more tailored approach on post-discharge neurodevelopment and growth should be implemented for long-term follow-up of preterm infants with BPD-associated PH,” the team suggested.

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