Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia

Am J Respir Crit Care Med. 2015 Jan 1;191(1):87-95. doi: 10.1164/rccm.201409-1594OC.


Rationale: Pulmonary hypertension (PH) is associated with poor outcomes among preterm infants with bronchopulmonary dysplasia (BPD), but whether early signs of pulmonary vascular disease are associated with the subsequent development of BPD or PH at 36 weeks post-menstrual age (PMA) is unknown.

Objectives: To prospectively evaluate the relationship of early echocardiogram signs of pulmonary vascular disease in preterm infants to the subsequent development of BPD and late PH (at 36 wk PMA).

Methods: Prospectively enrolled preterm infants with birthweights 500-1,250 g underwent echocardiogram evaluations at 7 days of age (early) and 36 weeks PMA (late). Clinical and echocardiographic data were analyzed to identify early risk factors for BPD and late PH.

Measurements and main results: A total of 277 preterm infants completed echocardiogram and BPD assessments at 36 weeks PMA. The median gestational age at birth and birthweight of the infants were 27 weeks and 909 g, respectively. Early PH was identified in 42% of infants, and 14% were diagnosed with late PH. Early PH was a risk factor for increased BPD severity (relative risk, 1.12; 95% confidence interval, 1.03-1.23) and late PH (relative risk, 2.85; 95% confidence interval, 1.28-6.33). Infants with late PH had greater duration of oxygen therapy and increased mortality in the first year of life (P < 0.05).

Conclusions: Early pulmonary vascular disease is associated with the development of BPD and with late PH in preterm infants. Echocardiograms at 7 days of age may be a useful tool to identify infants at high risk for BPD and PH.

Keywords: bronchopulmonary dysplasia; echocardiography; prematurity; pulmonary hypertension; pulmonary vascular disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Bronchopulmonary Dysplasia / epidemiology
  • Bronchopulmonary Dysplasia / etiology
  • Bronchopulmonary Dysplasia / prevention & control*
  • Colorado
  • Female
  • Humans
  • Hypertension, Pulmonary / complications*
  • Hypertension, Pulmonary / diagnostic imaging
  • Hypertension, Pulmonary / epidemiology
  • Hypertension, Pulmonary / etiology
  • Incidence
  • Indiana
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature*
  • Logistic Models
  • Lung / diagnostic imaging
  • Lung / pathology
  • Lung / physiopathology*
  • Male
  • Oxygen Inhalation Therapy / adverse effects*
  • Oxygen Inhalation Therapy / methods
  • Prospective Studies
  • Respiration, Artificial / adverse effects*
  • Respiration, Artificial / methods
  • Risk Factors
  • Schools, Medical
  • Time Factors
  • Ultrasonography
  • Vascular Diseases / complications*
  • Vascular Diseases / diagnostic imaging
  • Vascular Diseases / epidemiology