Extremely premature infants born at 23-25 weeks gestation are at substantial risk for pulmonary hypertension

J Perinatol. 2022 Jun;42(6):781-787. doi: 10.1038/s41372-022-01374-w. Epub 2022 Apr 1.


Objective: Extremely low gestational age newborns (ELGANs) represent an especially vulnerable population. Herein, we aimed to determine incidence and severity of pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH) in extremely immature ELGANs (gestational age: 230/6-256/7 weeks).

Methods: In this prospective observational cohort study, we assessed BPD-PH by means of several echocardiography markers and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 3 and 12 months of chronological age. In addition, we analyzed incidence and efficacy of pharmacologic treatment for BPD-PH.

Results: At 3 months 15/34 ELGANs had echocardiographic evidence of BPD-PH, while at 12 months of age 6/34 still had PH. PH-targeted therapy consisted of sildenafil monotherapy in 11 and dual oral combination therapy (sildenafil and macitentan) in four ELGANs at 3 and 12 months.

Conclusion: 44% (15/34) of ELGANs developed BPD-PH. All received PH-targeted pharmacotherapy at 3 months, leading to hemodynamic improvements at 12 months in most infants.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers
  • Bronchopulmonary Dysplasia* / complications
  • Bronchopulmonary Dysplasia* / epidemiology
  • Child
  • Female
  • Gestational Age
  • Humans
  • Hypertension, Pulmonary* / drug therapy
  • Hypertension, Pulmonary* / epidemiology
  • Hypertension, Pulmonary* / etiology
  • Infant
  • Infant, Extremely Premature
  • Infant, Newborn
  • Pregnancy
  • Prospective Studies
  • Sildenafil Citrate / therapeutic use
  • Young Adult


  • Biomarkers
  • Sildenafil Citrate