Joanne M Lagatta1, Erik B Hysinger2, Isabella Zaniletti3, Erica M Wymore4, Shilpa Vyas-Read5, Sushmita Yallapragada6, Leif D Nelin7, William E Truog8, Michael A Padula9, Nicolas F M Porta10, Rashmin C Savani6, Karin P Potoka11, Steven M Kawut12, Robert DiGeronimo13, Girija Natarajan14, Huayan Zhang9, Theresa R Grover4, William A Engle15, Karna Murthy10. 1. Children's Hospital of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. Electronic address: jlagatta@mcw.edu. 2. Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH. 3. Childrens Hospital Association, Lenexa, KS. 4. Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO. 5. Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA. 6. University of Texas Southwestern Medical Center, Dallas, TX. 7. Nationwide Children's Hospital, The Ohio State University, Columbus, OH. 8. Children's Mercy Hospital, University of Missouri, Kansas City, MO. 9. Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 10. Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. 11. Department of Pediatrics, Division of Newborn Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. 12. Department of Medicine, Perelman School of Medicine, Philadelphia, PA. 13. Seattle Children's Hospital, University of Washington, Seattle, WA. 14. Children's Hospital of Michigan, Wayne State University, Detroit, MI. 15. Riley Hospital for Children, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
Abstract
OBJECTIVES: To assess the effect of pulmonary hypertension on neonatal intensive care unit mortality and hospital readmission through 1 year of corrected age in a large multicenter cohort of infants with severe bronchopulmonary dysplasia. STUDY DESIGN: This was a multicenter, retrospective cohort study of 1677 infants born <32 weeks of gestation with severe bronchopulmonary dysplasia enrolled in the Children's Hospital Neonatal Consortium with records linked to the Pediatric Health Information System. RESULTS: Pulmonary hypertension occurred in 370 out of 1677 (22%) infants. During the neonatal admission, pulmonary hypertension was associated with mortality (OR 3.15, 95% CI 2.10-4.73, P < .001), ventilator support at 36 weeks of postmenstrual age (60% vs 40%, P < .001), duration of ventilation (72 IQR 30-124 vs 41 IQR 17-74 days, P < .001), and higher respiratory severity score (3.6 IQR 0.4-7.0 vs 0.8 IQR 0.3-3.3, P < .001). At discharge, pulmonary hypertension was associated with tracheostomy (27% vs 9%, P < .001), supplemental oxygen use (84% vs 61%, P < .001), and tube feeds (80% vs 46%, P < .001). Through 1 year of corrected age, pulmonary hypertension was associated with increased frequency of readmission (incidence rate ratio [IRR] = 1.38, 95% CI 1.18-1.63, P < .001). CONCLUSIONS: Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.
OBJECTIVES: To assess the effect of pulmonary hypertension on neonatal intensive care unit mortality and hospital readmission through 1 year of corrected age in a large multicenter cohort of infants with severe bronchopulmonary dysplasia. STUDY DESIGN: This was a multicenter, retrospective cohort study of 1677 infants born <32 weeks of gestation with severe bronchopulmonary dysplasia enrolled in the Children's Hospital Neonatal Consortium with records linked to the Pediatric Health Information System. RESULTS:Pulmonary hypertension occurred in 370 out of 1677 (22%) infants. During the neonatal admission, pulmonary hypertension was associated with mortality (OR 3.15, 95% CI 2.10-4.73, P < .001), ventilator support at 36 weeks of postmenstrual age (60% vs 40%, P < .001), duration of ventilation (72 IQR 30-124 vs 41 IQR 17-74 days, P < .001), and higher respiratory severity score (3.6 IQR 0.4-7.0 vs 0.8 IQR 0.3-3.3, P < .001). At discharge, pulmonary hypertension was associated with tracheostomy (27% vs 9%, P < .001), supplemental oxygen use (84% vs 61%, P < .001), and tube feeds (80% vs 46%, P < .001). Through 1 year of corrected age, pulmonary hypertension was associated with increased frequency of readmission (incidence rate ratio [IRR] = 1.38, 95% CI 1.18-1.63, P < .001). CONCLUSIONS:Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.
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