Bronchopulmonary dysplasia associated pulmonary hypertension: Making the best use of bedside echocardiography

Pulmonary hypertension (PH) complicating bronchopulmonary dysplasia (BPD) is known though echocardiographic (ECHO) criteria and clinical relevance are unclear. An audit of infants ≤ 28 weeks’ gestational age (GA) and with ‘severe’ BPD was carried out for the period January 2014 to May 2015. Six objective ECHO markers were decided a priori. During the period, 56 infants with GA and birthweight of 26 ± 1.4 weeks and 796 ± 190 g had ‘severe’ BPD. Twenty (35%) infants had no echocardiogram performed after 34 weeks’ corrected GA; the remaining 36 infants had an echocardiogram at 36.7 ± 2 weeks’ GA. ECHO parameters indicative of PH were noted in 22 (39.3%) infants in the overall cohort. The most common parameter was tricuspid regurgitation in 13/36 (36%) infants. The GA of infants with and without PH was comparable (25.8 ± 1.6 vs 25.8 ± 1.3 weeks, p = 0.9). The total duration of respiratory support in the BPD with PH group was significantly longer compared to those without (224 ± 130 vs 132 ± 82 days, p = 0.001). Overall, 29 (52%) infants were discharged on oxygen/respiratory support; the odds when PH was present were 2.2 (95% CI 0.8–5.7). This was not statistically significant. BPD associated PH contributes to respiratory sequelae. Objective ECHO criteria may aid ascertaining true incidence.