752 - The Association of Pulmonary Hypertension with Bronchopulmonary Dysplasia in Extremely Preterm Infants: A National Data Analysis

Publication Number: 752.6828

Somaya Abuelazm, Cleveland Clinic Children's, Cleveland, OH, United States; Rakesh Lavu, Cleveland clinic children’s, Beachwood, OH, United States; Hatem Eltaly, Cleveland Clinic Children's, Cleveland, OH, United States; Aysuna Galandarova, Cleveland Clinic, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States; Hany Aly, Cleveland Children’s Hospital, Cleveland, OH, United States

Background: Bronchopulmonary dysplasia (BPD) remains a prevalent morbidity among extremely premature infant. Severe forms of BPD are often associated with prolonged mechanical ventilation and high oxygen exposure, induce vascular remodeling and impair pulmonary vascular development, predisposing these infants to pulmonary hypertension (PH).

Objective: To explore the association of PH with the prevalence of bronchopulmonary dysplasia (BPD) in preterm infants < 28 weeks gestational age (GA) and to examine potential associated predisposing factors and other adverse outcomes.

Design/Methods: We used the National Inpatient Sample (NIS) dataset produced by the Healthcare Cost and Utilization Project (HCUP) for the years 2016-2020 to complete this analysis. We used the International Classification of Diseases-Version 10 (ICD10) codes to identify diagnoses of interest. Infants < 28 weeks GA were included. We excluded infants with severe congenital anomalies of the brain, heart, lung, abdomen, infants with multiple congenital anomalies and those with chromosomal disorders. We excluded infants who expired in the first 48 hours of life as this may reflect extreme immaturity. We used chi square and Fisher exact test to examine odds ratios (OR) of relevant associations and logistic regression models to control for confounding factors

Results: The analysis was conducted on a total of 73.244 infants who met inclusion and exclusion criteria. Infants who developed BPD were 16,358 (22.3%) and those who were diagnosed with PH were 2810 (3.84%). Infants with PH had a significantly higher chance to develop BPD (43.6%) vs. infants who did not develop PH, where BPD rate was 21.5%, adjusted odds ratios 2.25 (2.07-2.45), p < 0.001, after controlling for confounding factors. Table (1) shows factors associated with BPD in infants with PH compared to infants without PH. Of note, female sex, Caucasian race, BW < 750, chorioamnionitis, pulmonary hemorrhage and sepsis are associated with PH in infants with BPD. Adverse outcomes such as severe intraventricular hemorrhage (IVH), Necrotizing enterocolitis (NEC), periventricular Leukomalacia (PVL), increased length of hospital stay, and mortality are significantly increased in infants with BPD and PH compared to BPD without PH

Conclusion(s): Pulmonary hypertension is significantly associated with an increased incidence of bronchopulmonary dysplasia among extremely preterm infants. the co-morbidity of PH and BPD is influenced by distinct predisposing factors and correlates with worse clinical outcomes. Future qualitative research is indicated to explore the potential causal relationships.

Table (1)
Demographic and clinical characteristics and adverse outcomes of infants who developed bronchopulmonary dysplasia in association with pulmonary hypertension compared to those with bronchopulmonary dysplasia but without pulmonary hypertension