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

- Pulmonary hypertension may complicate BPD; bedside echocardiography is commonly used to make the diagnosis
- This article assesses a priori echocardiographic criteria used for the diagnosis of pulmonary hypertension
- Correlates the co-presence of pulmonary hypertension with duration of respiratory support

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.