404 - Incidence of Pulmonary Hypertension Vasodilator Treatment in Established Bronchopulmonary Dysplasia

Publication Number: 1387.404

Kaitlyn Hipp, Nationwide Children's Hospital, Columbus, OH, United States; Leif D. Nelin, Nationwide Children's Hospital, Columbus, OH, United States; Matthew Kielt, Nationwide Children's Hospital, Columbus, OH, United States

Background: Infants with bronchopulmonary dysplasia (BPD) are at risk of developing subsequent pulmonary hypertension (PH). The reported incidence of BPD-PH is 25-50% and typically those with more severe forms of BPD are at the highest risk. The proportion of patients with BPD-PH who require therapy with pulmonary vasodilators is not well documented in the literature and likely varies widely by center. It has been reported that infants with BPD-PH have up to 4-fold higher mortality rates compared to infants with the same severity of BPD but without PH. Reports also suggest that patients with BPD-PH have increased risk of tracheostomy placement, longer length of stay, and worse neurodevelopmental outcomes.

Objective: To evaluate the incidence of PH therapy in established BPD patients.

Design/Methods: Patients were included if they were admitted to the Inpatient Unit of the Comprehensive Center for BPD at Nationwide Children’s Hospital between 2015 and 2023, were born at < 32 weeks gestation, and were at least 36 weeks PMA with a formal diagnosis of BPD. Patients were evaluated for any exposure to inhaled nitric oxide, sildenafil, bosentan, or iloprost. Patients admitted on a pulmonary vasodilator were excluded.

Results: Of 599 patients meeting inclusion, 58 (10%) patients were treated for BPD-PH. The median duration of therapy was 83 days (IQR, 53 – 168) and 19/58 (33%) of patients treated for BPD-PH were discharged home on PH therapy. The clinical characteristics of this cohort of 599 patients is shown in Table 1. As shown in Table 2, the PH therapy group had lower birth weight, more were SGA, male, and had grade 3 BPD. Patients treated for PH had lower weight and length at 36 weeks PMA. Patients who were treated with vasodilators for PH had a significantly longer length of stay (PH therapy group median 249 days (IQR, 135 – 349), No PH Therapy group median 114 days (IQR, 72 – 172; P< 0.001).

Conclusion(s): The incidence of patients with BPD-PH who received vasodilator therapy after 36 weeks PMA was relatively low in this cohort of patients with established BPD. A better understanding of the role of PH in established BPD is necessary to optimize treatment and identify those BPD patients at highest risk for adverse outcomes due to BPD-PH.

Table 1. Clinical Characteristics of the Cohort
Table 1.pdf

Table 2. Characteristics Identifiable at 36 weeks PMA
Table 2.pdf