Developmental Outcome of Preterm Infants with Bronchopulmonary Dysplasia associated Pulmonary Hypertension

Abstract

Background: Despite bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) is becoming a growing concern in preterm infants, there is only a few studies have focused on neurodevelopmental outcome. Objectives: To identify the significance of PH on growth and neurodevelopmental outcome at 18 months of corrected age in preterm infants with BPD. Methods: This study was conducted as a retrospective study, including 394 infants (< 28 weeks of gestation) who were admitted to the neonatal intensive care unit at Seoul National University Childrens Hospital between 2005 and 2014. One hundred and forty-four infants (36.6%) had complete data regarding the growth assessment and the Bayley scales of infant and toddler development, third edition (Bayley-III) at 18 months of corrected age (CA). Of these, 81 infants (56.2%) were defined BPD. Baseline characteristics and outcomes were compared between the infants who developed BPD associated PH (n = 20) and infants who did not (n = 61). To control for BPD severity, the outcomes were compared between the infants with and without PH among the infants diagnosed with severe BPD (n = 40) only. Results: Infants with PH in BPD showed significantly lower in cognitive (85 vs. 95, p=0.004), language (81 vs. 89, p=0.040) and motor score (88 vs. 94, p=0.010) in Bayley-III at 18-month CA than infants without PH. The cognitive delay was more prevalent in the BPD with PH group and the adjusted odds ratio for cognitive delay in PH group was 4.2 (95% confidence interval, 1.1 – 15.5), compared to non- PH group. They had lower z-score of body weight (-1.4 ± 1.3 vs. -0.6 ± 1.1, p = 0.011) and head circumference (-1.2 ± 1.8 vs. -0.5 ± 1.0, p = 0.035) at 18 months of CA than only BPD infants. When controlling for BPD severity, the mean z-score of weight (-1.7 ± 1.2 vs. -0.7 ± 1.3, p = 0.016) and cognitive scores (85 vs. 95, p=0.048) were still significantly lesser in infants with PH. Conclusion: We found an association between PH and a non-optimal growth and neurodevelopmental outcome at 18 months of CA. These results suggest that PH infants have additional risks for developmental delay caused by postnatal and post discharge growth restriction . Therefore, particular attentions for PH infants is needed to promote catch-up growth and to prevent negative consequences of neurodevelopment