Acute Vasoreactivity Testing during Cardiac Catheterization of Neonates with Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension

To assess whether better baseline pulmonary hemodynamics or positive acute vasoreactivity testing (AVT) during cardiac catheterization are associated with improved outcomes in infants with bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). This retrospective, single-center study inclu...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of pediatrics 2019-05, Vol.208, p.127-133
Main Authors: Frank, Benjamin S., Schäfer, Michal, Grenolds, Alicia, Ivy, D. Dunbar, Abman, Steven H., Darst, Jeffrey R.
Format: Article
Language:English
Subjects:
acute vasoreactivity testing
Administration, Inhalation
bronchopulmonary dysplasia
Bronchopulmonary Dysplasia - complications
Bronchopulmonary Dysplasia - therapy
Cardiac Catheterization
Echocardiography
Hemodynamics
Humans
Hypertension, Pulmonary - complications
Hypertension, Pulmonary - therapy
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - therapy
Lung - physiopathology
neonatal
Nitric Oxide - metabolism
prematurity
Proportional Hazards Models
Pulmonary Artery
pulmonary hypertension
Retrospective Studies
Risk
Treatment Outcome
Vasodilator Agents - pharmacology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To assess whether better baseline pulmonary hemodynamics or positive acute vasoreactivity testing (AVT) during cardiac catheterization are associated with improved outcomes in infants with bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). This retrospective, single-center study included 26 premature neonates with BPD who underwent catheterization to evaluate PH. AVT was assessed with exposure to 100% fractional inspired oxygen with or without inhaled nitric oxide. AVT was positive if the patient met the Barst criteria or increased shunt volume and decreased pulmonary vascular resistance index by >50%. At baseline, the median pulmonary artery mean pressure was 29 mm Hg (IQR, 24-35) and the pulmonary vascular resistance index was 5.3 units*m2 (IQR, 3.5-6.9). Nine patients (35%) had a positive AVT response, which was associated with a decreased risk of death or tracheostomy by 2-year follow-up (hazard ratio, 0.15; P = .02). Baseline pulmonary hemodynamics and the presence of left ventricular diastolic dysfunction were not associated with late outcomes in this cohort. We found that 35% of infants with BPD who underwent catheterization had positive AVT and that a positive response was associated with better long-term outcomes than nonresponders. AVT better distinguishes higher from lower risk PH in infants with BPD than baseline pulmonary hemodynamics. AVT may aid in the assessment of disease severity and management of BPD-associated PH.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2018.12.004