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      Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia

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          Abstract

          Objective

          To determine the relationship between interventricular septal position (SP) and right ventricular systolic pressure (RVSP) and mortality in infants with severe BPD (sBPD).

          Study design

          Infants with sBPD in the Children’s Hospitals Neonatal Database who had echocardiograms 34–44 weeks’ postmenstrual age (PMA) were included. SP and RVSP were categorized normal, abnormal (flattened/bowed SP or RVSP > 40 mmHg) or missing.

          Results

          Of 1157 infants, 115 infants (10%) died. Abnormal SP or RVSP increased mortality (SP 19% vs. 8% normal/missing, RVSP 20% vs. 9% normal/missing, both p < 0.01) in unadjusted and multivariable models, adjusted for significant covariates (SP OR 1.9, 95% CI 1.2–3.0; RVSP OR 2.2, 95% CI 1.1–4.7). Abnormal parameters had high specificity (SP 82%; RVSP 94%), and negative predictive value (SP 94%, NPV 91%) for mortality.

          Conclusions

          Abnormal SP or RVSP is independently associated with mortality in sBPD infants. Negative predictive values distinguish infants most likely to survive.

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          Most cited references29

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          New intrauterine growth curves based on United States data.

          Irene Olsen, Sue A Groveman, M Louise Lawson … (2010)
          The objective of this study was to create and validate new intrauterine weight, length, and head circumference growth curves using a contemporary, large, racially diverse US sample and compare with the Lubchenco curves. Data on 391 681 infants (Pediatrix Medical Group) aged 22 to 42 weeks at birth from 248 hospitals within 33 US states (1998-2006) for birth weight, length, head circumference, estimated gestational age, gender, and race were used. Separate subsamples were used to create and validate curves. Smoothed percentile curves (3rd to 97th) were created by the Lambda Mu Sigma (LMS) method. The validation sample was used to confirm representativeness of the curves. The new curves were compared with the Lubchenco curves. Final sample included 257 855 singleton infants (57.2% male) who survived to discharge. Gender-specific weight-, length-, and head circumference-for-age curves were created (n = 130 111) and successfully validated (n = 127 744). Small-for-gestational age and large-for-gestational age classifications using the Lubchenco curves differed significantly from the new curves for each gestational age (all P 36 weeks) who were large-for-gestational-age. The Lubchenco curves may not represent the current US population. The new intrauterine growth curves created and validated in this study, based on a contemporary, large, racially diverse US sample, provide clinicians with an updated tool for growth assessment in US NICUs. Research into the ability of the new definitions of small-for-gestational-age and large-for-gestational-age to identify high-risk infants in terms of short-term and long-term health outcomes is needed.
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            Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era.

            Ekta Khemani, Doff B McElhinney, Lawrence Rhein … (2007)
            Although abnormal pulmonary vascular structure and function in preterm infants with bronchopulmonary dysplasia may predispose infants to pulmonary artery hypertension, little is known about the characteristics and outcomes of bronchopulmonary dysplasia-associated pulmonary artery hypertension in the surfactant era. We studied 42 premature infants ( or = 2 months after birth, between 1998 and 2006, at a median age of 4.8 months. Pulmonary artery hypertension was graded through echocardiography for all patients; 13 patients also underwent cardiac catheterization. Eighteen (43%) of 42 patients had severe pulmonary artery hypertension (systemic or suprasystemic right ventricular pressure). Among 13 patients who underwent catheterization, the mean pulmonary artery pressure was 43 +/- 8 mmHg and the pulmonary vascular resistance index was 9.9 +/- 2.8 Wood units. In 12 patients, pulmonary artery pressure and pulmonary vascular resistance improved with 100% oxygen and 80 ppm inhaled nitric oxide but remained elevated. The pulmonary vascular resistance index decreased to 7.9 +/- 3.8 Wood units in 100% oxygen and to 6.4 +/- 3.1 Wood units with the addition of nitric oxide. Sixteen patients (38%) died during the follow-up period. Estimated survival rates were 64% +/- 8% at 6 months and 53% +/- 11% at 2 years after diagnosis of pulmonary artery hypertension. In multivariate analyses, severe pulmonary artery hypertension and small birth weight for gestational age were associated with worse survival rates. Among 26 survivors (median follow-up period: 9.8 months), pulmonary artery hypertension was improved, relative to its most severe level, in 24 patients (89%). Premature infants with bronchopulmonary dysplasia and severe pulmonary artery hypertension are at high risk of death, particularly during the first 6 months after diagnosis of pulmonary artery hypertension.
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              Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia.

              Milenka Cuevas-Guaman, Steven H. Abman, Joseph Collaco … (2017)
              Article 0 comments Cited 92 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Shilpa Vyas-Read: +(404) 727 , 3360 , svyasre@emory.edu
                Journal
                Journal ID (nlm-ta): J Perinatol
                Journal ID (iso-abbrev): J Perinatol
                Title: Journal of Perinatology
                Publisher: Nature Publishing Group US (New York )
                ISSN (Print): 0743-8346
                ISSN (Electronic): 1476-5543
                Publication date (Electronic): 30 September 2019
                Publication date (Print): 2020
                Volume: 40
                Issue: 1
                Pages: 149-156
                Affiliations
                [1 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Children’s Healthcare of Atlanta, , Emory University School of Medicine, ; Atlanta, GA USA
                [2 ]ISNI 0000 0001 0703 675X, GRID grid.430503.1, Children’s Hospital Colorado, , University of Colorado School of Medicine, ; Aurora, CO USA
                [3 ]GRID grid.429588.a, Children’s Hospital Association, ; Lenexa, KS USA
                [4 ]ISNI 0000 0001 2299 3507, GRID grid.16753.36, Ann and Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, , Northwestern University, ; Chicago, IL USA
                [5 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Children’s Hospital of Philadelphia, , University of Pennsylvania Perelman School of Medicine, ; Philadelphia, PA USA
                [6 ]ISNI 0000 0001 2162 3504, GRID grid.134936.a, Children’s Mercy Hospital, , University of Missouri, ; Kansas City, MO USA
                [7 ]ISNI 0000 0001 2287 3919, GRID grid.257413.6, Riley Hospital for Children, Department of Pediatrics, , Indiana University School of Medicine, ; Indianapolis, IN USA
                [8 ]ISNI 0000 0000 9482 7121, GRID grid.267313.2, University of Texas Southwestern Medical Center, ; Dallas, TX USA
                [9 ]ISNI 0000 0001 2285 7943, GRID grid.261331.4, Nationwide Children’s Hospital, , The Ohio State University, ; Columbus, OH USA
                [10 ]ISNI 0000 0000 9025 8099, GRID grid.239573.9, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, ; Cincinnati, OH USA
                [11 ]ISNI 0000 0001 1456 7807, GRID grid.254444.7, Children’s Hospital of Michigan, , Wayne State University, ; Detroit, MI USA
                [12 ]ISNI 0000 0000 9753 0008, GRID grid.239553.b, Department of Pediatrics, Division of Newborn Medicine, , Children’s Hospital of Pittsburgh of UPMC, ; Pittsburgh, PA USA
                [13 ]ISNI 0000000122986657, GRID grid.34477.33, Seattle Children’s Hospital, , University of Washington, ; Seattle, WA USA
                [14 ]ISNI 0000 0001 2111 8460, GRID grid.30760.32, Children’s Hospital of Wisconsin, Department of Pediatrics, , Medical College of Wisconsin, ; Milwaukee, WI USA
                Author information
                http://orcid.org/0000-0003-2050-5930
                http://orcid.org/0000-0002-9533-5422
                http://orcid.org/0000-0002-6135-8503
                Article
                Publisher ID: 508
                DOI: 10.1038/s41372-019-0508-5
                PMC ID: 7222140
                PubMed ID: 31570799
                SO-VID: 73ee192a-62af-47c8-972e-b4ab407e9b0f
                Copyright © © The Author(s), under exclusive licence to Springer Nature America, Inc. 2019
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 27 March 2019
                Date revision received : 9 September 2019
                Date accepted : 18 September 2019
                Categories
                Subject: Article
                Custom metadata
                issue-copyright-statement © Springer Nature America, Inc. 2020

                ScienceOpen disciplines: Pediatrics
                Keywords: respiratory tract diseases,outcomes research
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: respiratory tract diseases, outcomes research

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