Prospective Analysis of Pulmonary Hypertension in Extremely Low Birth Weight Infants
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TLDR
Routine screening of ELBW infants with echocardiography at 4 weeks of age identifies only one-third of the infants diagnosed with pulmonary hypertension, a relatively common condition affecting at least 1 in 6 EL BW infants, and persists to discharge in most survivors.Abstract:
OBJECTIVES: Pulmonary hypertension is associated with bronchopulmonary dysplasia in extremely low birth weight (ELBW) infants and contributes to morbidity and mortality. The objective was to determine the prevalence of pulmonary hypertension among ELBW infants by screening echocardiography and evaluate subsequent outcomes. METHODS: All ELBW infants admitted to a regional perinatal center were evaluated for pulmonary hypertension with echocardiography at 4 weeks of age and subsequently if clinical signs suggestive of right-sided heart failure or severe lung disease were evident. Management was at discretion of the clinician, and infants were evaluated until discharge from the hospital or pre-discharge death occurred. RESULTS: One hundred forty-five ELBW infants (birth weight: 755 ± 144 g; median gestational age: 26 weeks [interquartile range: 24–27]) were screened from December 2008 to February 2011. Overall, 26 (17.9%) were diagnosed with pulmonary hypertension at any time during hospitalization (birth weight: 665 ± 140 g; median gestational age: 26 weeks [interquartile range: 24–27]): 9 (6.2%) by initial screening (early pulmonary hypertension) and 17 (11.7%) who were identified later (late pulmonary hypertension). Infants with pulmonary hypertension were more likely to receive oxygen treatment on day 28 compared with those without pulmonary hypertension (96% vs 75%, P CONCLUSIONS: Pulmonary hypertension is relatively common, affecting at least 1 in 6 ELBW infants, and persists to discharge in most survivors. Routine screening of ELBW infants with echocardiography at 4 weeks of age identifies only one-third of the infants diagnosed with pulmonary hypertension. Further research is required to determine optimal detection and intervention strategies.read more
Citations
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Journal ArticleDOI
Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society
Steven H. Abman,Georg Hansmann,Stephen L. Archer,D. Dunbar Ivy,Ian Adatia,Wendy K. Chung,Brian D. Hanna,Erika B. Rosenzweig,J. Usha Raj,David N. Cornfield,Kurt R. Stenmark,Robin H. Steinhorn,Bernard Thébaud,Jeffrey R. Fineman,Titus Kuehne,Jeffrey A. Feinstein,Mark K. Friedberg,Michael G. Earing,Robyn J. Barst,Roberta L. Keller,John Kinsella,Mary P. Mullen,Robin R. Deterding,Thomas J. Kulik,George B. Mallory,Tilman Humpl,David L. Wessel +26 more
TL;DR: A panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension.
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Hannah C. Glass,Andrew T. Costarino,Stephen A. Stayer,Claire M. Brett,Franklyn Cladis,Peter J. Davis +5 more
TL;DR: Treating and preventing long-term deficits must be developed in the context of a “moving target” because the outcomes of extremely low birth weight infants are ever evolving and efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated.
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D. Dunbar Ivy,Steven H. Abman,Robyn J. Barst,Rolf M. F. Berger,Damien Bonnet,Thomas R. Fleming,Sheila G. Haworth,J. Usha Raj,Erika B. Rosenzweig,Ingram Schulze Neick,Robin H. Steinhorn,Maurice Beghetti +11 more
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Physiology of Transition from Intrauterine to Extrauterine Life
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