349 - Risk Factors Associated with Pulmonary Hypertension Treatment after 36 weeks Postmenstrual Age in Patients with Grade 2-3 Bronchopulmonary Dysplasia - A Pilot Study

Publication Number: 349.6302

Kaitlyn Miller, Nationwide Children's Hospital, Columbus, OH, United States; Leif D. Nelin, Nationwide Children's Hospital, Columbus, OH, United States; Matthew Kielt, Nationwide Children's Hospital, Columbus, OH, United States

Background: Infants with Grade 2-3 bronchopulmonary dysplasia (BPD) are at increased risk of developing BPD-associated pulmonary hypertension (BPD-PH). BPD-PH is commonly treated with pulmonary vasodilator therapy and carries up to a four-fold risk of increased mortality as compared to infants with BPD without PH. Identifying risk factors that are associated with pulmonary vasodilator treatment in infants with BPD-PH may distinguish infants at the highest risk for experiencing adverse outcomes and facilitate the development of precision BPD-PH echocardiographic screening guidelines.

Objective: To identify clinical characteristics associated with exposure to pulmonary vasodilator therapy after 36 weeks’ post-menstrual age (PMA) in infants with grade 2-3 BPD.

Design/Methods: Patients included were those born at gestational age < 32 weeks, diagnosed with Grade 2-3 BPD, and admitted to the BPD Unit at Nationwide Children’s Hospital from 2010-2018. Patients were evaluated for any exposure to sildenafil, bosentan, or iloprost occurring after 36 weeks’ PMA. Multivariable logistic regression was used to determine the association of clinical risk factors that could be measured at 36 weeks’ PMA with subsequent exposure to pulmonary vasodilator therapy.

Results: In our cohort of 643 patients with Grade 2-3 BPD, only 65 (10.1%) were exposed to pulmonary vasodilator therapy after 36 weeks’ PMA. Clinical characteristics that differed between groups were birth weight, early high frequency ventilation, and invasive mechanical ventilation at 36 weeks (Table 1). A larger proportion of subjects exposed to pulmonary vasodilator therapy received inhaled and systemic steroids (Table 2). Infants treated for PH had greater mortality and tracheostomy rates than did infants not treated for PH (Table 3). The median length of stay for patients treated for PH was twice that of infants not treated for PH (Table 3). On adjusted analyses, early high frequency ventilation, invasive ventilation at 36 weeks’ PMA, and weight at 36 weeks’ PMA were associated with subsequent exposure to pulmonary vasodilators. (Table 4)

Conclusion(s): In this pilot study, we identified that early high frequency ventilation, invasive ventilation at 36 weeks’ PMA, and weight at 36 weeks’ PMA are associated with need for PH treatment in infants with grade 2-3 BPD.

Table 1 and Table 2
Table 1: Clinical Characteristics
Table 2: Exposures and Complications

Table 3
Table 3: Outcomes

Table 4
Table 4: Multivariable logistic regression model results evaluating the association between clinical risk factors and exposure to pulmonary vasodilator therapy after 36 weeks’ post-menstrual age (PMA)