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Screening for pulmonary hypertension in preterm infants—not ready for prime time

Journal of Perinatology volume 38, pages 206–210 (2018)Cite this article

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Bronchopulmonary dysplasia (BPD) occurs in >40% of preterm infants born at <28 weeks gestation and is a complex multicomponent disease with pathology related to the airways, lung interstitium, lung parenchyma, pulmonary vasculature and the chest wall [1, 2]. Fifty years ago, radiologist William Northway described the characteristic progressive pattern of lung injury due to combination of positive pressure ventilation and oxygen in preterm infants. [3] Originally, BPD was described in infants born at <38 weeks gestation. The most severe forms of BPD are now seen in infants born at very early gestations and involve diminished pulmonary vascular growth and a consequent incomplete alveolarization known as “new BPD”. [4, 5] Pulmonary hypertension (PH) occurs in infants with BPD but is seen in preterm infants without BPD as well. PH leads to right ventricular hypertrophy and if left unchecked, eventually cor pulmonale.

This recognition of the development of PH in a subset of preterm infants has led to studies where all preterm infants, or those with BPD, were screened for the presence of PH. [6, 7] Recently, the American Heart Association (AHA) and American Thoracic Society (ATS) published guidelines in which the authors, based on consensus expert opinion and while admitting a lack of supporting evidence, suggest that all infants with BPD be screened for the presence of PH [8]. Although such expert consensus statements are well-intentioned, they can mask significant differences in opinion and perspective among experts, lead to the overuse of diagnostic tests and therapeutic interventions, create ethical challenges to future randomized controlled trials, and potentially cause harm to patients.

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References

  1. Lal CV, Ambalavanan N. Genetic predisposition to bronchopulmonary dysplasia. Semin Perinatol 2015;39:584–91.

    Article  PubMed  Google Scholar 

  2. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. Jama 2015;314:1039–51.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Northway WH Jr., Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. New Engl J Med 1967;276:357–68.

    Article  PubMed  Google Scholar 

  4. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. Lancet 2006;367:1421–31.

    Article  PubMed  Google Scholar 

  5. Silva DM, Nardiello C, Pozarska A, Morty RE. Recent advances in the mechanisms of lung alveolarization and the pathogenesis of bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2015;309:L1239–1272.

    Article  PubMed  CAS  Google Scholar 

  6. Montgomery AM, Bazzy-Asaad A, Asnes JD, Bizzarro MJ, Ehrenkranz RA, Weismann CG. Biochemical screening for pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Neonatology 2016;109:190–4.

    Article  PubMed  CAS  Google Scholar 

  7. Mourani PM, Sontag MK, Younoszai A, Miller JI, Kinsella JP, Baker CD, et al. Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. Am J Respir Crit Care Med 2015;191:87–95.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, et al. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 2015;132:2037–99.

    Article  PubMed  Google Scholar 

  9. Krishnan U, Feinstein JA, Adatia I, Austin ED, Mullen MP, Hopper RK, et al. Evaluation and management of pulmonary hypertension in children with bronchopulmonary dysplasia. J Pediatr 2017;188:24–34. e21

    Article  PubMed  Google Scholar 

  10. Grimes DA, Schulz KF. Uses and abuses of screening tests. Lancet 2002;359:881–4.

    Article  PubMed  Google Scholar 

  11. Wilson JM, Jungner YG. [Principles and practice of mass screening for disease]. Bol Oficina Sanit Panam 1968;65:281–393.

    PubMed  CAS  Google Scholar 

  12. Kumar P. Universal pulse oximetry screening for early detection of critical congenital heart disease. Clin Med Insights Pediatr 2016;10:35–41.

    PubMed  PubMed Central  Google Scholar 

  13. Westin SN, Mills GB, Myers AP. Repurposing the Pap smear: one step closer to gynecologic cancer screening. Sci Transl Med 2013;5:167ps161.

    Article  CAS  Google Scholar 

  14. Graves RS. Users’ guides to the medical literature: A manual for evidence-based clinical practice. J Med Libr Assoc 2002;90:483–483.

    PubMed Central  Google Scholar 

  15. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155:529–36.

    Article  PubMed  Google Scholar 

  16. Hayes JH, Barry MJ. Screening for prostate cancer with the prostate-specific antigen test: a review of current evidence. Jama 2014;311:1143–9.

    Article  PubMed  CAS  Google Scholar 

  17. Ambalavanan N, Aschner JL. Management of hypoxemic respiratory failure and pulmonary hypertension in preterm infants. J Perinatol: Off J Calif Perinat Assoc 2016;36(Suppl 2):S20–27.

    Article  CAS  Google Scholar 

  18. Baczynski M, Ginty S, Weisz DE, McNamara PJ, Kelly E, Shah P, et al. Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide. Arch Dis Child Fetal Neonatal Ed 2017;102:F508–F5114.

    Article  PubMed  Google Scholar 

  19. Barrington KJ, Finer N, Pennaforte T. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev 2017;1:CD000509.

    PubMed  Google Scholar 

  20. Perez KM, Laughon M. Sildenafil in term and premature infants: a systematic review. Clin Ther 2015;37:2598–607. e2591

    Article  PubMed  CAS  Google Scholar 

  21. More K, Athalye-Jape GK, Rao SC, Patole SK. Endothelin receptor antagonists for persistent pulmonary hypertension in term and late preterm infants. Cochrane Database Syst Rev 2016, Issue 8. Art. No.: CD010531. doi:10.1002/14651858.CD010531.pub2.

  22. Ryan T, Petrovic O, Dillon JC, Feigenbaum H, Conley MJ, Armstrong WF. An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 1985;5:918–27.

    Article  PubMed  CAS  Google Scholar 

  23. Carlton EF, Sontag MK, Younoszai A, DiMaria MV, Miller JI, Poindexter BB, et al. Reliability of echocardiographic indicators of pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. J Pediatr 2017;186:29–33.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bhat R, Salas AA, Foster C, Carlo WA, Ambalavanan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics 2012;129:e682–689.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric, Baylor College of Medicine, Section Head and Service Chief of Neonatology, Texas Children‘s Hospital, 6621 Fannin, Suite W6104 Houston, TX, 77030, USA

    Gautham Suresh & Sunil K. Jain

  2. Instructor of Pediatrics, Baylor College of Medicine, Texas Children‘s Hospital, 6621 Fannin, Suite W6104, Houston, TX, 77030, USA

    Brian C. King

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  1. Gautham Suresh
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Correspondence to Sunil K. Jain.

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Suresh, G., King, B. & Jain, S.K. Screening for pulmonary hypertension in preterm infants—not ready for prime time. J Perinatol 38, 206–210 (2018). https://doi.org/10.1038/s41372-017-0014-6

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