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Early cardiac function and death, severe bronchopulmonary dysplasia and pulmonary hypertension in extremely preterm infants

Pediatric Research (2023)Cite this article

Abstract

Background

Association between early cardiac function and neonatal outcomes are scarcely reported. The aim of the current study was to describe this association with death, severe bronchopulmonary dysplasia (BPD) and BPD-related pulmonary hypertension (PH).

Methods

Retrospective cohort study of infants <29 weeks born between 2015 and 2019. Infants with clinically acquired echocardiography at ≤21 days after birth were included and data were extracted by an expert masked to outcomes.

Results

A total of 176 infants were included. Echocardiogram was performed at a median of 9 days (IQR 5-13.5). Of these, 31 (18%) had death/severe BPD and 59 (33.5%) had death/BPD-related PH. Infants with death/severe BPD were of lower birth weight (745 [227] vs 852 [211] grams, p = 0.01) and more exposed to invasive ventilation, late-onset sepsis, inotropes and/or postnatal steroids. Early echocardiograms demonstrated decreased right ventricular [Tricuspid Annular Plane Systolic Excursion: 5.2 (1.4) vs 6.2 (1.5) cm, p = 0.03] and left ventricular function [Ejection fraction 53 (14) vs 58 (10) %, p = 0.03]. Infants with death/BPD-related PH had an increased Eccentricity index (1.35 [0.20] vs 1.26 [0.19], p = 0.02), and flat/bowing septum (19/54 [35%] vs 20/109 [18%], p = 0.021).

Conclusions

In extremely premature infants, altered ventricular function and increased pulmonary pressure indices within the first 21 days after birth, were associated with the combined outcome of death/severe BPD and death/BPD-related PH.

Impact

  • Decreased cardiac function on echocardiography performed during first three weeks of life is associated with severe bronchopulmonary dysplasia in extremely premature infants.

  • In extreme preterm infants, echocardiographic signs of pulmonary hypertension in early life are associated with later BPD-related pulmonary hypertension close to 36 weeks post-menstrual age.

  • Early cardiac markers should be further studied as potential intervention targets in this population.

  • Our study is adding comprehensive analysis of echocardiographic data in infants born below 29 weeks gestational age.

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Fig. 1: Patient inclusion flow diagram.

Data availability

Derived data generated will be shared on reasonable request to the corresponding author.

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Prior presentation

Results from this study were presented in abstract, poster and oral formats at the 15th International Conference Neonatal and Childhood Pulmonary Vascular Disease (2022), the Pediatric Academic Societies meeting (2022) and at Neoheart scientific meeting (2022).

Funding

Funding

This project was supported by grants from the Just for Kids Foundation, the Montreal Children’s Hospital foundation and the Department of Pediatrics of McGill University.

Author information

Authors and Affiliations

  1. Neonatology—McGill University Health Centre—Montreal Children’s Hospital; Department of Pediatrics—McGill University, Montreal, QC, Canada

    Shiran S. Moore, Gabriela De Carvalho Nunes, Marc Beltempo, Guilherme Sant’Anna & Gabriel Altit

  2. Neonatology—Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Shiran S. Moore

  3. Pediatric Cardiology—McGill University Health Centre—Montreal Children’s Hospital; Department of Pediatrics—McGill University, Montreal, QC, Canada

    Adrian Dancea & Jessica Simoneau

  4. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Punnanee Wutthigate

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  1. Shiran S. Moore
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Contributions

S.S.M. contributed to conceptualizing and designing the study, collected the data, analyzed the data, and drafted the initial and revised manuscript. G.D.C.N. collected the data and critically reviewed the manuscript. A.D. contributed to the interpretation of the findings, and critically reviewed the manuscript. P.W. collected the data and critically reviewed the manuscript. J.S. collected the data and critically reviewed the manuscript. M.B. contributed to the interpretation of the findings, and critically reviewed the manuscript. G.S.A. contributed to the interpretation of the findings, and critically reviewed the manuscript. G.A. conceptualized and designed the study, supervised data analysis, contributed to the interpretation of the findings and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Gabriel Altit.

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The authors declare no competing interests.

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Not required. The study was approved by the institutional ethics review committee.

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Moore, S.S., De Carvalho Nunes, G., Dancea, A. et al. Early cardiac function and death, severe bronchopulmonary dysplasia and pulmonary hypertension in extremely preterm infants. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02817-6

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