Abstract
Background
To investigate association of prenatal risk factors and neonatal outcomes of preterm infants with pulmonary hypertension (PH).
Methods
A prospective cohort study of very-low-birth-weight infants born at 22–29 weeks’ gestation who received PH-specific treatment during hospitalization. Infants were classified using a two-step cluster analysis based on gestational age (GA), small-for-gestational-age (SGA), exposure to antenatal corticosteroids (ACS), histologic chorioamnionitis (HCA), and oligohydramnios.
Results
Among 910 infants, six clusters were identified: cluster A (HCA, n = 240), cluster B (oligohydramnios, n = 79), cluster C (SGA, n = 74), cluster D (no-ACS, n = 109), cluster E (no dominant parameter, n = 287), and cluster F (HCA and oligohydroamnios, n = 121). Cluster A was used as a reference group for comparisons among clusters. Compared to cluster A, cluster C (aHR: 1.63 [95% CI: 1.17–2.26]) had higher risk of overall in-hospital mortality. Clusters B (aHR: 1.52 [95% CI: 1.09–2.11]), D (aHR: 1.71 [95% CI: 1.28–2.30]), and F (aHR: 1.51 [95% CI: 1.12–2.03]) had higher risks of receiving PH-specific treatment within the first week of birth compared to cluster A.
Conclusion
These findings may provide a better understanding of prenatal risk factors contributing to the development of PH.
Impact
-
Pulmonary hypertension (PH), presenting as hypoxic respiratory failure, has complex etiologies in preterm infants.
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Although multifactorial risks for the development of PH in preterm infants are known, few studies have classified infants with similar etiologies for PH.
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Each cluster has distinct patterns of prenatal condition and neonatal outcome.
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Data availability
The Korean Neonatal Network (KNN) Publication Ethics Policy adheres to the following research data management and access guidelines. All information about patients and participating NICUs are confidential. They might be used by individuals for approved research purposes. If an individual or institution that is not affiliated with KNN wants to use the data, it must make an official request to the KNN publication-Ethics Committee and obtain approval from the network.
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Acknowledgements
This research was supported by a research grant (2022-ER0603-00#) funded by Korea National Institute of Health.
Funding
This research was supported by Soonchunhyang University Research Fund (grant number 2022-1214) to cover publication costs. The funder had no role in (1) the design, (2) the collection, analysis, and interpretation of data, (3) the writing of the report, or (4) the decision to submit the paper for publication.
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S.P.B. and S.S.K. conceptualized and designed the research. S.P.B. and S.P. collected and analyzed the data. S.P.B. and J.Y. wrote the manuscript. H.L. assisted with study design and reviewed the manuscript. S.S.K. and W.H.H. reviewed and revised the manuscript. All authors read and approved the final manuscript.
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Participation of infants in the registration of data in the KNN was approved by the Institutional Review Board (IRB) of each participating center. Written informed consent was obtained from parents of each participant in the study.
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Bae, S.P., Kim, S.S., Yun, J. et al. Neonatal outcomes of preterm infants with pulmonary hypertension: clustering based on prenatal risk factors. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03232-1
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DOI: https://doi.org/10.1038/s41390-024-03232-1