117 - Early Pulmonary Hypertension as a Risk Factor for Late Pulmonary Hypertension in Very-Low-Birth-Weight Infants

Poster Number: 117
Publication Number: 117.2234

Background: Bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) are critical diseases that affect the long-term prognosis of preterm infants, extending their effects into infancy, childhood, and even adulthood. Recent studies highlight that early PH (EPH) finding in echocardiography is related to the severity of BPD, incidence of late PH (LPH) and mortality. In previous study, we have demonstrated that EPH is a risk factor for moderate/severe BPD-associated LPH in extremely preterm infants (EPI).

Objective: In this study, we aimed to investigate the incidence of EPH and LPH in VLBW infants based on the severity of BPD. Additionally, we aimed to investigate that EPH is related to an increased risk of LPH, regardless of the presence and severity of BPD, for identifying the impact of abnormal pulmonary vascular development on the development of LPH.

Design/Methods: Clinical data of 179 VLBW infants born at and admitted to a single center between 2021 Feb to 2023 Mar were retrospectively analyzed. Echocardiography was performed between 4 to 14 days after birth to assess EPH. Infants who had been treated for persistent pulmonary hypertension of the newborn shortly after birth were also considered to have EPH. LPH was assessed through echocardiography conducted after 36 weeks of corrected age (CA). In cases where echocardiography was not performed after 36 weeks of CA, the most recent echocardiography before discharge was used for assessment.

Results: The prevalence of EPH was 42.5% in the entire study population, and 51.6% in EPI group. The proportion of infants with EPH increased as BPD severity worsened (no 18.5%, mild 44.4%, moderate 55.0%, severe 75.9%), and the occurrence of LPH also increased (no 3.1%, mild 2.2%, moderate 12.5%, severe 48.3%). However, almost all cases of LPH were noted in infants where EPH was confirmed (90.9%). Furthermore, LPH was occurred in infants with no BPD or mild BPD. In univariate analysis of infants with LPH, the prevalence and severity of BPD were found to be significant, however, in risk factor analysis using logistic regression, only EPH was a risk factor with an odds ratio of 11.39.

Conclusion(s): In this study, we demonstrated that EPH assessed early after birth is the most significant risk factor for LPH in VLBW infants, irrespective of the presence and severity of BPD. This provides clinical evidence that abnormal pulmonary vascular development observed during the perinatal period influence the occurrence of LPH. The results of this study emphasize the value of detection for EPH in predicting LPH, which significantly impacts the long-term outcome of VLBW infants.