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Pulmonary hypertension in extremely low birth weight infants: characteristics and outcomes
Wambui Waruingi, Maroun Jean Mhanna
Cleveland, OH, USA
Author Affiliations: Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA (Waruingi W, Mhanna MJ)
Corresponding Author: Maroun Jean Mhanna, MD, MPH, Department of Pediatrics, Metro Health Medical Center, 2500 Metro Health Drive, Cleveland, OH 44109, USA (Tel: 216-778-1346; Fax: 216-778-4223; Email: mmhanna@metrohealth.org)
doi: 10.1007/s12519-014-0464-2
Background: To determine the characteristics and outcomes of pulmonary arterial hypertension (PAH) in extremely low birth weight (ELBW) infants.
Methods: A retrospective case-control study of all ELBW infants admitted to a level III neonatal intensive care unit (NICU) between January 1, 2003 and December 31, 2010.
Results: During the study period, 450 ELBW infants were admitted. 6.4% (29/450) were diagnosed with PAH and were matched to 26 controls. The mean gestational age of infants with PAH and their controls were similar [24.5¡À1.3 vs. 24.9¡À1.8 weeks (P=0.26)]; however the cases were smaller at birth than were controls [640.7¡À119.5 vs. 727.0¡À184.5 g (P=0.04)]. The diagnosis of PAH was made at a mean postnatal age of 131.8¡À 53.7 days. Infants with PAH had a higher rate of intrauterine exposure to illicit maternal drug use [12/29 (41%) vs. 1/25 (4%); P=0.001], a longer duration of initial mechanical ventilation [74.9¡À28.3 vs. 59.1¡À27.8 days; P=0.04)], a higher incidence of severe BPD [23/29 (79%) vs. 13/26 (50%); P=0.02], and a greater NICU mortality rate [12/29 (41%) vs. 4/26 (15%); P=0.04].
Conclusion: PAH in ELBW infants is associated with maternal illicit drug use in pregnancy, longer exposure to mechanical ventilation, severe bronchopulmonary dysplasia and a significant increase in early mortality.
Key words: bronchopulmonary dysplasia; echocardiography; illicit drug use; mechanical ventilation; prenatal exposure
World J Pediatr 2014;10(1):46-52
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