Pulmonary Hypertension and Vascular Abnormalities in Bronchopulmonary Dysplasia

Abstract

Despite advances in the care of preterm infants, these infants remain at risk bronchopulmonary dysplasia (BPD), which results in prolonged need for supplemental oxygen, recurrent respiratory exacerbations, and exercise intolerance. Recent investigations have highlighted the important contribution of the developing pulmonary circulation to lung development, showing that these infants are also at risk for pulmonary vascular disease (PVD), including pulmonary hypertension (PH) and pulmonary vascular abnormalities. Several epidemiologic studies have delineated the incidence of PH in preterm infants and the impact on outcomes. These studies have also highlighted gaps in the understanding of PVD in BPD.

Keywords: Bronchopulmonary dysplasia; Echocardiogram; Inhaled nitric oxide; Pulmonary hypertension; Pulmonary vascular disease.

Figure 1

Schematic illustrating the components contributing to pulmonary vascular disease in bronchopulmonary dysplasia and the clinical manifestations that result. PDA: patent ductus arteriosis, SMC: smooth muscle cells.

Figure 2

The incidence of PH according to the degree of BPD severity. Incidence of PH among preterm infants from three studies, Seoul, Alabama, and Colorado/Indiana. The percentage of patients listed on the Y-axis represents the proportion of patients in each study in whom BPD status was ascertained. Please see text for inclusion criteria of each of the studies. BPD severity was based on NIH criteria. Physiologic assessment of oxygenation to determine BPD status was applied in the Alabama and CU/IU cohorts. The Seoul cohort did not include preterm infants without BPD. Numbers above the bars indicate the percentage of patients with PH.

Figure 3

Proposed clinical approach to screening, evaluation, and monitoring of pulmonary hypertension in bronchopulmonary dysplasia. Adapted from Mourani PM, Abman SH. Pulmonary vascular disease in bronchopulmonary dysplasia: physiology, diagnosis, and treatment. In: Abman SH, ed. Bronchopulmonary Dysplasia. New York: Informa; 2010:347–363; with permission. BNP: brain natriuretic protein; BPD: bronchopulmonary dysplasia; PMA: postmenstrual age; PH: pulmonary hypertension; RVSP: right ventricular systolic pressure; TRJV: tricuspid regurgitant jet velocity; ssBP: systemic systolic blood pressure; RV: right ventricle.