Short and long‐term outcomes of chronic pulmonary hypertension in preterm infants managed using a standardized algorithm

• Published in: Pediatric pulmonology 2021-05, Vol.56 (5), p.1155-1164
• Main Authors: Baczynski, Michelle, Kelly, Edmond, McNamara, Patrick J., Shah, Prakesh S., Jain, Amish
• Format: Article
• Language: English
• Subjects: chronic pulmonary hypertension; Diuretics; premature; Premature babies; Pulmonary hypertension
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.25200

Background There is limited data on management strategies for chronic pulmonary hypertension (cPH) in chronic lung disease (CLD) of prematurity. Our objective was to evaluate clinical outcomes following a standardized policy, wherein only cPH with right‐ventricular (RV) dilatation was treated and diuretics were employed as first‐line therapy; cPH without RV‐dilatation was managed expectantly. Method In this retrospective cohort study, all infants with CLD were categorized as “CLD‐only” or “CLD–cPH,” using echocardiography at ≥36 weeks postmenstrual age. Intergroup comparison was performed. Regression analysis examined the association between cPH and primary outcome of death or disability at 18–24 months. Results Of 128 CLD infants, 48 (38%) had cPH, of which 29 (60%) received diuretics. Symptomatic improvement within 1‐week was recorded in 90%. Although CLD–cPH had worse in‐hospital respiratory course than CLD‐only, all post‐discharge respiratory and neurodevelopmental outcomes were similar. cPH was not associated with death or disability (adjusted odds ratio, 1.02; 95% confidence interval, 0.32–3.27). Disease progression treated with sildenafil occurred in 2 (4%) cases. There was no death from respiratory or RV failure. Conclusion Primary treatment of CLD–cPH with diuretics using RV‐dilatation as therapeutic threshold, may result in symptomatic improvement, disease stabilization and post‐discharge outcomes comparable to infants without cPH.