A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension.
A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension.
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DOI：
10.3389/fped.2023.1077422
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发表时间：
2023
影响因子：
2.6
通讯作者：
中科院分区：
文献类型：
--
作者：
为了描述我们的多学科支气管肺发育不良(BPD)，咨询研究小组对BPD相关性肺动脉高压(PH)的系统方法，报告我们中心的结果，并评估临床与结果的相关性。从2018年到2020年，西雅图儿童医院BPD团队转诊的60名BPD-PH患者的回顾队列。排除危重先天性心脏病患者。回顾人口统计学、合并症、治疗、血流动力学相关的心内分流的关闭，以及临床结果，包括BPD-PH消退的时间。60例患者的中位胎龄为25周(IQR：24-26)。20%的人小于胎龄(SGA)，65%的人是男性，25%的人接受了气管切开。在积极的心肺管理包括优化呼吸支持，动脉导管未闭(PDA)和房间隔缺损(ASD)关闭(40%动脉导管未闭，5%ASD，3%)，以及肺血管扩张剂的有限使用(8%)，所有婴儿在随访期显示PH消退，其中3例(5%)后来死于非BPD-PH并发症。在我们的队列中，SGA状态和PH诊断的时间(<；36对≥36周PMA)都不影响BPD-PH缓解的时间[中位数72天(IQR30.5-166.5)]。我们的多学科、系统的BPD-PH管理方法与PH的完全缓解和较低的死亡率有关，尽管西地那非的使用量比可比队列报告的要少。我们方法的独特特点包括积极关闭PDA和ASD装置，罕见地仅在BPD-PH改善后才开始使用西地那非，并通过心导管检查确认呼吸支持的优化和诊断。
To describe our multidisciplinary bronchopulmonary dysplasia (BPD) consult team's systematic approach to BPD associated pulmonary hypertension (PH), to report our center outcomes, and to evaluate clinical associations with outcomes. Retrospective cohort of 60 patients with BPD-PH who were referred to the Seattle Children's Hospital BPD team from 2018 to 2020. Patients with critical congenital heart disease were excluded. Demographics, comorbidities, treatments, closure of hemodynamically relevant intracardiac shunts, and clinical outcomes including time to BPD-PH resolution were reviewed. Median gestational age of the 60 patients was 25 weeks (IQR: 24–26). 20% were small for gestational age (SGA), 65% were male, and 25% received a tracheostomy. With aggressive cardiopulmonary management including respiratory support optimization, patent ductus arteriosus (PDA) and atrial septal defect (ASD) closure (40% PDA, 5% ASD, 3% both), and limited use of pulmonary vasodilators (8%), all infants demonstrated resolution of PH during the follow-up period, including three (5%) who later died from non-BPD-PH morbidities. Neither SGA status nor the timing of PH diagnosis (<36 vs. ≥36 weeks PMA) impacted the time to BPD-PH resolution in our cohort [median 72 days (IQR 30.5–166.5)]. Our multidisciplinary, systematic approach to BPD-PH management was associated with complete resolution of PH with lower mortality despite less sildenafil use than reported in comparable cohorts. Unique features of our approach included aggressive PDA and ASD device closure and rare initiation of sildenafil only after lack of BPD-PH improvement with respiratory support optimization and diagnostic confirmation by cardiac catheterization.
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影响因子：
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作者：
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