Pulmonary Vein Stenosis in Neonates with Severe Bronchopulmonary Dysplasia
Pulmonary Vein Stenosis in Neonates with Severe Bronchopulmonary Dysplasia
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DOI：
10.1055/s-0035-1571201
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发表时间：
2016-06-01
影响因子：
2
通讯作者：
Backes, Carl H.
中科院分区：
文献类型：
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作者：
Swier, Natasha L.;Richards, Bernadette;Backes, Carl H.
目的肺静脉狭窄(PVS)是一种罕见的致命性畸形，预后不良。鉴于支气管肺发育不良(BPD)与心血管并发症之间的关系，我们测试了假设：(1)重度BPD新生儿亚组发生PVS(BPD-PVS)且预后比仅有BPD的新生儿(BPD)更差；(2)在一组重度BPD相关性肺动脉高压(BPD-PH)的新生儿中，PVS是不良结局和死亡率的额外危险因素。研究设计：我们在2009年6月1日至2013年6月30日期间，根据Eunice Kennedy Shliver国立儿童健康与发展研究所(NICHD)标准，对患有严重BPD的新生儿进行了回顾性回顾。PVS是根据他们在住院期间进行的超声心动图系列回顾而确定的。结果213例重度BPD患儿中，10例(4.7%)合并PVS(BPD-PVS)。患有BPD-PVS的新生儿出生体重较低(634+/-178比767+/-165 g；p<；0.01)，并且更有可能发生宫内生长受限(80比11%；p<；0.01)。BPD-PVS组机械通气时间和住院时间均长于BPD组。BPD-PVS组的存活率低于BPD组(5/10[50%]vs.196/203[97%]；LOG检验p<；0.01)。在一组患有BPD-PH的新生儿中，PVS患儿的存活率低于无PVS患儿(5/9[56%]vs.26/30[86%]；LOG检验p=0.01)。结论与仅有重度BPD的新生儿相比，获得性PVS患儿预后不良的风险增加，包括死亡率更高。在BPD这一高危新生儿亚群中，需要关于筛查方案和监测的循证建议。
Objectives Pulmonary vein stenosis (PVS) is a rare, often lethal anomaly associated with poor outcomes. Given the association between bronchopulmonary dysplasia (BPD) and cardiovascular complications, we tested the hypotheses that (1) a subgroup of neonates with severe BPD develop PVS (BPD-PVS) and have worse outcomes than do neonates with severe BPD alone (BPD); (2) among a cohort of neonates with severe BPD-associated pulmonary hypertension (BPD-PH), PVS is an additional risk factor for adverse outcomes and mortality.Study Design We performed a retrospective review of neonates with severe BPD, based on the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) criteria, at our institution between June 1, 2009, and June 30, 2013. PVS was determined based on serial review of echocardiograms performed during their hospitalization. Neonates with congenital heart disease or chromosomal anomalies were excluded.Results Of 213 patients with severe BPD, 10 (4.7%) were found to have PVS (BPD-PVS). Neonates with BPD-PVS had lower birth weight (634 +/- 178 vs. 767 +/- 165 g; p < 0.01) and were more likely to be intrauterine growth restricted (80 vs. 11%; p < 0.01) than neonates with BPD alone. Time on mechanical ventilation and length of hospitalization were longer in the BPD-PVS group than BPD group. Survival was lower in the BPD-PVS group than BPD group (5/10 [50%] vs. 196/203 [97%]; log-rank test p < 0.01). Among a subgroup of neonates with BPD-PH, survival was lower among infants with PVS than those without PVS (5/9 [56%] vs. 26/30 [86%]; log-rank test p = 0.01).Conclusions Compared with neonates with severe BPD alone, those with acquired PVS are at increased risk for worse outcomes, including higher mortality. Evidence-based recommendations regarding screening protocols and surveillance are needed in this high-risk subgroup of BPD neonates.