Early characteristics of infants with pulmonary hypertension in a referral neonatal intensive care unit

BMC Pediatrics

Research Article

Curtis Travers¹  Jane Stremming²  Prabhu Shankar³  David P. Carlton³  Anne Fitzpatrick³  Shilpa Vyas-Read⁴  Usama Kanaan⁵ 

[1] Biostatistics, Pediatric Research Alliance, Atlanta, GA, USA;Department of Pediatrics, University of Colorado, Denver, CO, USA;Pediatrics, Emory University School of Medicine, Atlanta, GA, USA;Pediatrics, Emory University School of Medicine, Atlanta, GA, USA;Division of Neonatology, Emory University School of Medicine, 2015 Uppergate Dr. NE, 3rd floor, 30322, Atlanta, GA, USA;Pediatrics, Emory University School of Medicine, Atlanta, GA, USA;Sibley Heart Center, Pulmonary Hypertension Program, Atlanta, GA, USA;

关键词: Very low birth weight;    Growth restriction;    Caffeine;    Pulmonary hypertension;    Atrial septal defect;   

DOI  :  10.1186/s12887-017-0910-0

 received in 2017-03-31, accepted in 2017-06-29,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundApproximately 8–23% of premature infants develop pulmonary hypertension (PH), and this diagnosis confers a higher possibility of mortality. As a result, professional societies recommend PH screening in premature infants. However, the risk factors for and the outcomes of PH may differ depending on the timing of its diagnosis, and little evidence is available to determine at-risk infants in the referral neonatal population. The objective of this study was to define clinical and echocardiographic characteristics of infants with pulmonary hypertension during the neonatal hospital course and at or near-term.MethodsInfants who had the following billing codes: < 32 weeks, birth weight < 1500 g, neonatal unit, and echocardiograph had records abstracted from a data warehouse at Children’s Healthcare of Atlanta. The outcome was defined as late PH on the final echocardiogram for all patients, and, separately, for patients with multiple studies. Descriptive statistics, univariable, and multivariable models were evaluated, and odds ratios and 95% confidence intervals are expressed below as (OR, CI).Results556 infants were included in the overall study, 59 had PH on their final echocardiogram (11%). In multivariable analyses, atrial septal defect (2.9, 1.4–6.1), and intrauterine growth restriction (2.7, 1.2–6.3) increased the odds of late PH, whereas caffeine therapy decreased PH (0.4, 0.2–0.8). When the analyses were restricted to 32 infants who had multiple echocardiograms during their hospitalization, the association between atrial septal defect (5.9, 2.0–16.5) and growth restriction (3.7, 1.3–10.7) and late PH was strengthened, but the effect of caffeine therapy was no longer significant. In this smaller subgroup, infants with late PH had their final echocardiogram at a median of 116 days of life, and 42–74% of them had right ventricular pathology.ConclusionsEarly clinical variables are associated with PH persistence in a referral neonatal population. Identification of early clinical factors may help guide the ascertainment of infant risk for late PH, and may aid in targeting sub-groups that are most likely to benefit from PH screening.

【 授权许可】

CC BY   
© The Author(s). 2017