Together we stand, divided we fall – the impact of prematurity on cardiovascular and pulmonary health

Sunday, April 27, 2025

2:00pm – 3:30pm HST

Location: Convention Center: 311

CE: 1.5

Selected By: MOD

Chair(s)

KL

Krithika Lingappan, MD MS PhD (she/her/hers)

Associate Professor
Childrens Hospital of Philadelphia
Baylor College of Medicine
Philadelphia, Pennsylvania, United States
Shazia Bhombal, MD

Associate Professor
Children’s Healthcare of Atlanta/Emory University
Atlanta, Georgia, United States
Roopa Siddaiah, MD

Associate professor of Pediatrics
Penn State Children's Hospital
Hershey, Pennsylvania, United States
Steve Abman, MD (he/him/his)

Professor
University of Colorado School of Medicine
Denver, Colorado, United States

Disclosure(s):

Krithika Lingappan, MD MS PhD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Shazia Bhombal, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Roopa Siddaiah, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Steve Abman, MD: Chiesi (Ongoing) (Products/Services: Consultant)

Preterm infants are born with underdeveloped lungs that are not fully equipped for efficient gas exchange. The lifesaving ventilatory support further stress their immature pulmonary microvasculature and hinder alveolar development, leading to inflammation, vascular remodeling and onset of bronchopulmonary dysplasia (BPD and associated pulmonary hypertension (BPD-PH). This issue is more severe in infants with intrauterine growth restriction (IUGR) where disrupted angiogenesis results in a sparse pulmonary microvasculature and maladaptive fetal pulmonary vessels that become thick and stiff. This can further exacerbate right ventricular dysfunction, worsening pulmonary blood flow and gas exchange.
Cardiorespiratory mechanics are further complicated by other co-morbidities associated with prematurity such as elevated systemic afterload due to abnormal renin-angiotensin regulation. Additionally, left ventricular diastolic dysfunction characterized by impaired relaxation and increased stiffness, can cause pulmonary congestion due to back pressure leading to post-capillary or pulmonary venous hypertension.
Positive pressure ventilation also impacts cardiac function. Insufficient ventilation can increase pulmonary vascular resistance (PVR) and compromises pulmonary blood flow, while excessive positive pressure could negatively affect both pulmonary and systemic venous return, altering cardiac output and function. Achieving an optimal Positive End-Expiratory Pressure (PEEP) is essential for recruiting lung function and improving oxygenation while lowering PVR without adversely affecting cardiac hemodynamics. Understanding early cardiopulmonary interaction is crucial for grasping the cardiovascular challenges and potential long-term health impacts these infants may face as they grow into adults.

Learning Objectives:

Understand the pulmonary vascular, right heart, and left heart dysfunction associated with premature birth
Evaluate the impact of ventilation on hemodynamics in the setting of BPD-PH
Appreciate long-term sequelae of cardiopulmonary dysfunction in preterm-born adults

Presentations:

2:00pm – 2:05pm HST

Introduction
Speaker: Krithika Lingappan, MD MS PhD (she/her/hers) – Childrens Hospital of Philadelphia
2:05pm – 2:18pm HST

Effect of Prematurity on Pulmonary Vascular Growth and Impact on the Right Ventricle
Speaker: Kara N. Goss, MD – University of Texas Southwestern Medical School
2:18pm – 2:31pm HST

Consequences of Preterm Birth on Left Ventricle and Systemic Circulation
Speaker: Arvind Sehgal, PhD (he/him/his) – MONASH UNIVERSITY
2:31pm – 2:44pm HST

Tools to Assess Cardiopulmonary Interactions in Preterm Infants
Speaker: Shazia Bhombal, MD – Children’s Healthcare of Atlanta/Emory University
2:44pm – 2:57pm HST

Review Ventilatory Strategies to Optimize Hemodynamics in BPD
Speaker: Roopa Siddaiah, MD – Penn State Children's Hospital
2:57pm – 3:10pm HST

Long-term Implications of Prematurity on the Cardiovascular System
Speaker: Krithika Lingappan, MD MS PhD (she/her/hers) – Childrens Hospital of Philadelphia
3:10pm – 3:20pm HST

Panel Discussion
Speaker: Shazia Bhombal, MD – Children’s Healthcare of Atlanta/Emory University
Speaker: Kara N. Goss, MD – University of Texas Southwestern Medical School
Speaker: Krithika Lingappan, MD MS PhD (she/her/hers) – Childrens Hospital of Philadelphia
Speaker: Anne Monique Nuyt, MD (she/her/hers) – Universite de Montreal Faculty of Medicine
Speaker: Arvind Sehgal, PhD (he/him/his) – MONASH UNIVERSITY
Speaker: Roopa Siddaiah, MD – Penn State Children's Hospital
3:20pm – 3:30pm HST

Q & A
Speaker: Krithika Lingappan, MD MS PhD (she/her/hers) – Childrens Hospital of Philadelphia