397 - Early Pulmonary Hypertension as a Predictor of Moderate-Severe BPD

Publication Number: 1380.397

Gabrielle Battaglia, Cohen Children's Medical Center, East Meadow, NY, United States; Joanna Fishbein, Northwell Health, Manhasset, NY, United States; Barry Weinberger, Cohen Children's Medical Center, New Hyde Park, NY, United States; Irina Gershkovich, Cohen Children's Medical Center, Hewlett, NY, United States

Background: Bronchopulmonary dysplasia (BPD) is frequently associated with pulmonary hypertension (PH), but the direction of causation is unclear. Established moderate-severe BPD is characterized by disruption of alveolar architecture, which can increase the resistance to pulmonary blood flow and contribute to PH. Conversely, it is likely that congenital pulmonary vascular disease causes PH in the first week of life for some preterm infants, increasing their ventilatory requirements and subsequent risk for developing BPD. Prior studies on the association of PH and BPD were done before the widespread use of non-invasive respiratory support and using older definitions of BPD.

Objective: To determine whether moderate-severe PH by echocardiography or serum B-type natriuretic peptide (BNP) at 7 days are associated with Grade 2-3 BPD at 36 weeks postmenstrual age (PMA).

Design/Methods: Premature infants with birth weight < 1500 g (n=204) were enrolled in this prospective cohort study. Clinical data was collected from the EMR. Echocardiography was performed and serum concentration of BNP was measured at 7 days of life. Pulmonary artery pressure (PAP) was calculated based on peak systolic velocity of tricuspid regurgitation jet, peak systolic velocity of the patent ductus arteriosus (PDA, if present), or estimated by interventricular septal configuration. Moderate-severe PH was defined as PAP greater than half of systemic pressure. Grade 2-3 BPD was defined at 36 weeks PMA as the requirement for positive pressure or nasal cannula flow > 2 L/min, based on the Jensen criteria.

Results: The mean gestational age at birth was 25.8 weeks +/- 1.8 weeks and the median (Q1 - Q3) birth weight was 800g (600-900). Moderate-severe PH on day 7 was associated with the finding of Grade 2-3 BPD (p = 0.0024), and the odds of grade 2-3 BPD at 36 weeks PMA were higher among infants with moderate-severe PH (compared to the no-mild PH) on day 7 (OR: 2.8, 95% CI: 1.4 to 5.7). The association between early PH and the development of BPD remained significant after adjustment for the presence and size of a PDA by logistic regression. However, BNP levels on day 7 were not predictive of moderate-severe BPD.

Conclusion(s): Moderate-severe PH on day 7 is associated with the later development of Grade 2-3 BPD in preterm infants. Echocardiographic screening for PH at 1 week would enable clinicians to identify this population of infants at increased risk for chronic lung disease. Early and targeted implementation of preventive therapies and novel ventilation strategies may improve outcomes for these vulnerable infants.