Journal Article

Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension

Everett, Allen D., Leshko, Jenny, Nies, Melanie K., McGrath-Morrow, Sharon A., Dadlani, Gul H., Collaco, Joseph M.

2016

Overview

Pulmonary hypertension (PH) is a significant cause of morbidity in preterm infants, but no screening guidelines exist. We sought to identify risk factors and clinical outcomes associated with PH in preterm infants to develop a PH risk score. Retrospective analysis of two separate populations of preterm infants (NICU cohort n = 230; Clinic registry n = 580). 8.3% of the NICU cohort had PH after 4 weeks of age, while 14.8% of the clinic registry had PH after 2 months of age. Lower birth weights and longer initial hospitalizations were associated with PH in both populations (p<0.001 for all tests). Using adjusted logistic regression, patent ductus arteriosus (PDA) requiring ligation was associated with PH in both the NICU cohort (OR: 3.19; p = 0.024) and the clinic registry (OR: 2.67; p<0.001). Risk factors (birth weight ≤780 grams, home supplemental oxygen use, and PDA ligation) identified in the clinic registry (training dataset) were validated in the NICU cohort with 0-1 factors present were associated with ≤1.5% probability of having PH, any 2 factors with a 25% probability, and all 3 factors with a 40% probability. Lower birth weight, PDA ligation, and respiratory support were associated with PH in both populations. A PH risk score based on clinical indicators from the training dataset predicted PH in the validation set. This risk score could help focus resources to preterm infants at higher risk for PH. Further work is needed to determine whether earlier or more aggressive management of ductal lesions could alter PH outcomes.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Biology and Life Sciences / Birth weight / Cardiology / Cardiovascular disease / Clinical outcomes / Congenital diseases / Congenital heart defects / Consent / Coronary vessels / Ductus Arteriosus, Patent - etiology / Health screening / Heart / Hospitals / Humans / Hypertension / Hypertension, Pulmonary - etiology / Infant / Infant, Low Birth Weight - physiology / Infant, Newborn / Infant, Premature - physiology / Infants / Lesions / Ligation / Logistic Models / Lung diseases / Medicine and Health Sciences / Morbidity / Newborn babies / Oxygen / Patient outcomes / Pediatrics / People and Places / Physical Sciences / Population / Populations / Premature babies / Premature birth / Premature infants / Pulmonary arteries / Pulmonary hypertension / Registries / Regression analysis / Research and Analysis Methods / Respiratory therapy / Retrospective Studies / Review boards / Risk analysis / Risk Factors / Statistical analysis / Studies / Training / Ultrasonic imaging