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The following is a summary of “Clinical phenotype of pulmonary vascular disease requiring treatment in extremely preterm infants,” published in the July 2024 issue of Pediatrics by Hong et al.
Pulmonary vascular disease (PVD) and pulmonary hypertension (PH) significantly impact the prognosis of extremely preterm infants. However, there is still no consensus on the definition and optimal treatments of PH, and there is also a lack of research comparing these conditions with persistent pulmonary hypertension of the newborn (PPHN), early PH, and late PH.
This study aims to address these gaps by investigating the characteristics and outcomes of PH in extremely preterm infants, with a focus on the timing of PH treatment initiation.
This retrospective study analyzed extremely preterm infants admitted to a single tertiary center between 2018 and 2022. Infants with a clinical or echocardiographic diagnosis of PH who required treatment were categorized into 3 groups based on the timing of treatment initiation that were within the first 3 days (extremely early-period), from day 4 to day 27 (early-period), and after day 28 (late-period). The study compared baseline characteristics, short-term outcomes, and treatment duration across the 3 groups. Key outcomes included mortality rates, bronchopulmonary dysplasia (BPD) severity, duration of PH treatment, and oxygen therapy duration.
Of 157 infants, 67 (42.7%) required PH treatment during their hospital stay. Among these, 39 (57.3%) received treatment in the extremely early period, 21 (31.3%) in the early period, and seven (11.4%) in the late period. The analysis revealed no significant differences in maternal factors, neonatal factors, or morbidity among the 3 groups. However, infants treated in the extremely early period exhibited higher mortality rates but shorter durations of noninvasive respiratory support, oxygen therapy, and PH medication use. Conversely, infants in the late-period treatment group required longer durations of respiratory support and treatment.
This study highlights significant differences in mortality rates, respiratory outcomes, and treatment durations among extremely preterm infants with PH based on the timing of treatment initiation. The findings suggest that varying pathophysiological mechanisms may be at play over time in these infants, necessitating tailored treatment strategies. Understanding these temporal differences can inform better clinical decision-making and potentially improve outcomes for this vulnerable population.
Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04943-4