WIP 53 - Evaluation of Echocardiography Parameters in Preterm Infants Born to Mothers with Preeclampsia at Risk for Developing Pulmonary Hypertension - A Pilot Study

Poster Number: WIP 53
Publication Number: WIP 53.690

Background: Bronchopulmonary dysplasia (BPD) remains a significant morbidity associated with prematurity, with late pulmonary hypertension (PH) secondary to pulmonary vascular dysgenesis being one major contributor. Placental insufficiency (PI) is a risk factor for BPD, suggesting the role of fetal reprogramming in its pathogenesis. PI leads to decreased capillary density, altered endothelial function, and vascular remodeling, thus increasing pulmonary vascular resistance. As a result, infants exposed to PI undergo right heart remodeling, with increased wall thickness and a more spherical shape. Specifically, retrospective cohort studies have correlated septal flattening and right ventricle dilatation on echocardiography (echo) on day of life 7 with the late PH. This supports the concept of delayed postnatal transition in the pathogenesis of late PH. However, the causal role of delayed transition in the development of late PH has not been validated prospectively.

Objective: In this study, we hypothesize that cardiac remodeling following exposure to preeclampsia in utero leads to delayed postnatal transition and predisposes preterm infants to late PH. The aim is to assess longitudinal echo parameters prospectively in infants born at less than 33 weeks gestation with and without exposure to hypertensive disorders of pregnancy.

Design/Methods: This single-center, prospective, pilot study began enrollment in 2022 after obtaining institutional IRB approval for infants born at less than 33 weeks gestation. Mothers with multiple gestations, COVID-19 infection in labor, illicit drug use, or infants with congenital anomalies or metabolic disorders were excluded. To evaluate the cardiac parameters over time, echo images were acquired at the following time intervals after birth: 24 hrs, 3 days, 7 days, and every month until discharge. These will be correlated with the late PH diagnosis based on clinical echo at 36 weeks postmenstrual age. Enrollment, data collection, and analysis will be complete by February.