470 - Evaluation of factors related to pulmonary hypertension and pulmonary vasodilator use in a severe bronchopulmonary dysplasia population at a level IV referral NICU

Publication Number: 470.4979

Valeria G. Varela, Phoenix Children's Hospital, Phoenix, AZ, United States; Jennifer Hann, Phoenix Children's Hospital, Phoenix, AZ, United States; Rajeev Bhatia, Phoenix Children's Hospital, Phoenix, AZ, United States; Mohammed Elkhwad, Phoenix Children's Hospital, phoenix, AZ, United States; Donna Garey, Creighton University School of Medicine, Scottsdale, AZ, United States; Gregg Martin, Phoenix Children's Hospital, Cave Creek, AZ, United States; Sophia Williams, Phoenix Children's Hospital, Phoenix, AZ, United States; Pamela Griffiths, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) is a major contributor to morbidity and mortality in severe BPD (sBPD) and is present in up to 25% of patients. In 2019, Phoenix Children’s developed a structured interdisciplinary BPD program, including regular screening and interdisciplinary management of BPD-PH. Recently, some centers with ID BPD programs have shown lower usage and fewer patients discharged on pulmonary vasodilators with an increased effort to optimize respiratory support. We have not formally evaluated our use of pulmonary vasodilators in our cohort.

Objective: To identify and describe patterns of pulmonary vasodilator use in infants with BPD-PH in a cohort with grades 2 and 3 BPD.

Design/Methods: Retrospective review of infants born < 32 wks gestation and admitted to Phoenix Children’s NICU between Jan 2020-Mar 2024, who were classified as Grade 2 or 3 BPD based on requirement for positive pressure support at 36 wk PMA. A PH diagnosis was given if on or after 36 wk PMA, the infant had evidence of right ventricular systolic pressure > ½ of systemic based on conventional markers; including septal position, tricuspid regurgitation, and shunt velocities. Demographic, outcome, and PH practice variables were compared using Mann Whitney and Fisher’s exact tests. Patterns of pulmonary vasodilator usage were recorded.

Results: Forty-two infants with a diagnosis of PH and 94 without a diagnosis of PH were included. Cohort characteristics are shown in Table 1. Tracheostomy placement (60% vs 29%) and length of stay (LOS) (149 vs 114 days) were greater in BPD-PH. Among infants with PH, a pulmonary vasodilator (PV) was used in 40 (95%) of subjects, 35 (83%) of which received PDE5 inhibitors (sildenafil) while 17% and 21% received endothelin receptor antagonists (ERA) and prostacyclins, respectively (Table 2). Twenty-five (60%) were discharged on PVs, while in 11 subjects, PVs were discontinued prior to discharge at a median age of 188 (149, 226) days and a PMA of 56.7 (50.2, 58.2) weeks (Figure 1). The relative proportion of infants discharged on PVs has decreased over time (Figure 2).

Conclusion(s): Infants in our cohort were similar to those reported at other institutions in respect to clinical characteristics. However, PV use in our infants was higher than that reported by other centers with interdisciplinary BPD programs. While rate of discharge on PVs is down trending, there is still opportunity for improvement. Efforts to rigorously consider the need for PV in the context of respiratory support needs and earlier discontinuation when medically stable may be beneficial.

Varela PCH PGY3.pdf

Table 2. Characteristics of pulmonary vasodilator (PV) use ³36 wk PMA in Phoenix Children’s cohort with comparison to recent published cohorts from interdisciplinary BPD programs.
NICU Varela Table 2.jpeg1. Yung D, Jackson EO, Blumenfeld A, et al. A multidisciplinary approach to severe bronchopulmonary dysplasia is associated with resolution of pulmonary hypertension. Front Pediatr. 2023;11:1077422. doi:10.3389/fped.2023.1077422

2. Kielt MJ, Logan JW, Backes CH, Reber KM, Nelin LD, Shepherd EG. In-hospital outcomes of late referrals for established bronchopulmonary dysplasia. J Perinatol. Aug 2021;41(8):1972-1982. doi:10.1038/s41372-021-01041-6

Postmenstrual age (PMA) at pulmonary vasodilator discontinuation during NICU hospitalization and Percent of infants discharged on pulmonary vasodilators over time
NICU Varela Figure.jpeg