462 - Outcomes for Preterm Infants with Bronchopulmonary Dysplasia: The Role of Multidisciplinary Follow-Up in Managing Chronic Pulmonary Hypertension

Publication Number: 3447.462

Sally AM. Mashally, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Bernard Thébaud, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Sherri L. Katz, Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute; University of Ottawa, Ottawa, ON, Canada; Suzie Lee, Childrens Hospital of Eastern Ontario, Ottawa, ON, Canada; Nick Barrowman, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; Elham Almoli, University of Toronto Temerty Faculty of Medicine, Mississauga, ON, Canada; Nadya Ben Fadel, University of Ottawa Faculty of Medicine, ottawa, ON, Canada; Deepti Reddy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada

Background: BPD remains a leading cause of morbidity and mortality among extremely low gestational age (ELGA) infants. BPD-PH is a frequently reported complication that heralds increased mortality and morbidity. Despite its clinical significance, prospective studies exploring the prevalence, natural progression, and long-term outcomes are limited. Prognostic trajectories in affected ELGA are variable and difficult to predict.

Objective: To assess the prevalence, natural history, and predictors of late PH, as well as outcomes beyond the neonatal period, within a multidisciplinary framework.

Design/Methods: A prospective cohort study of 201 ELGA infants born < 29 weeks' gestation and infants with birth weight < 1000 gm admitted to a tertiary-level. Neonatal Intensive Care Unit (NICU). Infants with cardiac anomalies were excluded, except those with small atrial septal defect (ASD), patent foramen ovale (PFO) and patent ductus arteriosus (PDA). Serial echocardiograms to assess for PH were performed at 7 and 28 days of life (early and early persistent PH) and at 36 weeks postmenstrual age (late PH). For late PH, echocardiograms were repeated every 2 weeks until discharge and every 4 months thereafter, up to 2 years, or until PH resolution. Neurodevelopmental outcomes were assessed at 24 months of age using Ages and Stages Questionnaire. Neonatal morbidities, respiratory support needs, and neurodevelopmental outcomes were compared using Fisher's exact test and the Mann-Whitney test.

Results: Fifty-six infants (30 %) had moderate/severe BPD. Among these, 13 (23%) had early PH, 9 (16%) had early persistent PH, and 6 (11%) had late PH. Infants with BPD-PH had more small for gestational age (SGA) infants than those without PH (50% vs 20%), PDA (100% vs 72%), sepsis (100% vs 48%), and ROP (67% vs 38%). One third of infants with early PH died before discharge; 48% of infants with early PH who survived to 28 days had persistent early PH; 40% of those continued to have late PH. All infants with BPD-PH who survived to discharge required home oxygen and had higher rates of re-admission for respiratory infection (33.3% vs 6%), P (0.01). All surviving infants with BPD-PH no longer had PH by 15 months' age. There were no significant differences in neurodevelopment at 24 months between BPD infants with and without PH.

Conclusion(s): Early PH is associated with high rates of neonatal mortality, morbidities, late PH and need for respiratory support at discharge in our cohort of ELGA infants. Despite this severe early course, PH resolved by 15 months in survivors and was not associated with adverse neurodevelopmental outcomes at 24 months.

Table 1: Demographic and clinical characteristics of babies with moderate-severe BPD at 36 weeks


Figure 1: Progression of PH


Table 2: Respirology outcomes - Moderate/Severe BPD only (n=56)
PH defined as moderate or severe.