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Short and long‐term outcomes of chronic pulmonary hypertension in preterm infants managed using a standardized algorithm
Author(s) -
Baczynski Michelle,
Kelly Edmond,
McNamara Patrick J.,
Shah Prakesh S.,
Jain Amish
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25200
Subject(s) - medicine , odds ratio , pulmonary hypertension , confidence interval , retrospective cohort study , pediatrics , cohort
Abstract 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.