120 - Pulmonary Hypertension Screening in Preterm Infants is Associated with Reduced Re-Admission After NICU Discharge

Poster Number: 120
Publication Number: 120.2272

Background: Preterm infants with bronchopulmonary dysplasia (BPD) are at risk for pulmonary hypertension (PH) which can lead to increased morbidity and mortality. In 2018 the University of Rochester PH team implemented a BPD-PH screening guideline yet data regarding screening benefits is lacking.

Objective: To determine if screening for PH in at-risk preterm infants reduces morbidity reflected by decreased NICU length of stay.

Design/Methods: This single-center retrospective cohort chart review compared infants born < 32 weeks gestational age (GA) between 1/2017 and 10/2022, before and after the implementation of a PH screening guideline. PH risk factors such as perinatal characteristics, demographics, and NICU complications, respiratory interventions, outcomes, mortality, and hospital re-admissions were extracted from the medical record. To determine eligibility for screening and diagnosis of PH, the screening protocol and echocardiogram report parameters for PH diagnosis were applied to both epochs. The epochs were compared using appropriate parametric and nonparametric tests.

Results: A total of 990 infants were included with similar mean GA (28.6 weeks) and birthweight (1.16kg) in the pre- (N=513) and post-screen (N=477) epochs (Table 1). Perinatal characteristics were similar with exception of increased prenatal steroids (100% vs 96%, p= < 0.001 ) and chorioamnionitis (27.1% vs 16.7%, p= < 0.001) in the pre-screen epoch. Rates of BPD by Jensen criteria were not different. Pre-screen epoch infants qualifying for PH screening trended higher (47.8 vs 40.7%, p=0.052) but more post-screen epoch infants actually received an echo at ≥ 28 days of life (34.9% vs 44.3%, p=0.003) after updating our guideline. There was no difference in rates of PH diagnosis, length of stay, corrected GA at discharge, respiratory support at discharge, or use of pulmonary vasodilators. Survival analysis found no difference in the setting of a low mortality event rate. The post-screen group showed reduced diuretic treatment (p < 0.001), increased systemic steroid treatment with dexamethasone (p=0.046) and prednisolone (p= < 0.001), increased tube feeding at discharge (p=0.004), and decreased re-admission within 6 months of NICU discharge (18.2 vs 12.3%, p=0.01).

Conclusion(s): Our PH screening guideline did not change NICU length of stay. However, the screening guideline and involvement of a multidisciplinary PH team may assist in reducing risk of hospital readmission through increased echo surveillance and interventions such as lung protective tube feedings and treatment of chronic lung disease with steroids.