Clinical significance of early Pulmonary Hypertension in Preterm Infants

OBJECTIVE: To characterize different phenotypes of early pulmonary hypertension (PH) in preterm infants and their respective associations with bronchopulmonary dysplasia (BPD) and survival.STUDY DESIGN: A prospective cohort study in a tertiary University Medical Centre from June 2016 until March 2019. Infants with a gestational age <30 weeks and/or a birth weight <1000 grams were included. Echocardiographic assessment for PH was performed 3-10 days after birth. Subsequent development of BPD at 36 weeks postmenstrual age and mortality were assessed.RESULTS: Early-PH was identified in 55% of 104 included infants: 21% with persistent PH of the newborn (PPHN), 61% with flow-associated PH and 18% PH without-shunt. Only PPHN was associated with placental fetal vascular malperfusion, lower gestational age and low Apgar-scores. Both PPHN and flow-PH were associated with the development of BPD. Early-PH was associated with poorer survival, driven by PPHN.CONCLUSIONS: Early-PH is highly prevalent (55%) in preterm infants and associated with the development of BPD, independent of the phenotype of PH. Infants with PPHN had the poorest survival. Early-PH presents in various phenotypes that are characterized by different etiology, pathophysiology, and associated long-term sequelae.