Clinical and functional features of the small circle of blood circulation in children with a new form of bronchopulmonary dysplasia

The aim of the work is to analyze the data of Echo-CG examination of premature infants who have formed and have not formed bronchopulmonary dysplasia (BPD) to determine the frequency of the formation of pulmonary hypertension (PH).

Materials and methods. A total of 199 preterm infants treated in the Department of Pathology of Newborns were examined. The first group included moderate and severe BPD children (n = 117; 59%). The second group consisted of children without BPD within clearly decreed terms (n = 82; 41%). In each group, patients were divided into four subgroups by the gestational age at birth and the timing of the Echo-CG.

Results. Only two (1.1%) patients out of 117 BPD children of the first group were diagnosed with pulmonary hypertension (PH). In 3 (2.5%) of 117 infants of the same group, enlargement of the right heart without PH was revealed. Out of 82 children without BPD, two patients had signs of right heart enlargement. PH was not diagnosed in any of the patients in this group.

Discussion. To aggravate the efficiency of PH diagnosis, a number of indices of screening echocardiography seem to be increased by additional analysis of changes in the systolic eccentricity index (EI), as a reliable marker of PH in BPD children. Systolic IE should be integrated into screening in preterm infants for the diagnosis of PH. The use of Echo-CG data along with analysis of blood BNP or NT-proBNP blood content be also expanded. Optimizing the diagnosis of PH at the early stages of BPD is necessary to increase the efficacy of targeted therapy and reduce the risk of severe complications of BPD.

Contribution:
Basargina М.А., Davydova I.V., Yaltikov V.Yu. — concept and design of the study;
Basargina М.А., Yaltikov V.Yu., Zharova O.P. — collection and processing of material;
Basargina М.А., Petrova A.S. — statistical processing;
Basargina М.А., Davydova I.V., Kharitonova N.A., Bondar В.А. — writing the text;
Basargina М.А., Fisenko A.P., Kharitonova N.A. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: October 26, 2021
Accepted: October 28, 2021
Published: November 15, 2021

1. Ovsyannikov D.Yu., Geppe N.A., Malakhov A.B., Degtyarev D.N. Bronchopulmonary Dysplasia [Bronkholegochnaya displaziya]. Moscow; 2020. (in Russian)

2. Solomakha A.Yu., Petrova N.A., Obraztsova G.I., Ivanov D.O., Sviryaev Yu.V. Dynamics of cardiorespiratory and echocardiographic parametres in infants with bronchopulmonary diplasia. Neonatologiya: Novosti. Mneniya. Obuchenie. 2019; 7(1): 31–7. https://doi.org/10.24411/2308-2402-2019-11004 (in Russian)

3. Butrous G. Pulmonary hypertension: From an orphan disease to a global epidemic. Glob. Cardiol. Sci. Pract. 2020; 2020(1): e202005. https://doi.org/10.21542/gcsp.2020.5

4. Jobe A.J. The new BPD: an arrest of lung development. Pediatric Res. 1999; 46(6): 641–3. https://doi.org/10.1203/00006450-199912000-00007

5. Thébaud B., Goss K.N., Laughon M., Whitsett J.A., Abman S.H., Steinhorn R.H., et al. Bronchopulmonary dysplasia. Nat. Rev. Dis. Primers. 2019; 5(1): 78. https://doi.org/10.1038/s41572-019-0127-7

6. Stoll B.J., Hansen N.I., Bell E.F., Walsh M.C., Carlo W.A., Shankaran S., et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015; 314(10): 1039–51. https://doi.org/10.1001/jama.2015.10244

7. Bose C., Van Marter L.J., Laughon M., O’Shea T.M., Allred E.N., Karna P., et al. Fetal growth restriction and chronic lung disease among infants born before the 28th week of gestation. Pediatrics. 2009; 124(3): 450–8. https://doi.org/10.1542/peds.2008-3249

8. Hartling L., Liang Y., Lacaze-Masmonteil T. Chorioamnionitis as a risk factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Arch. Dis. Child. Fetal Neonatal Ed. 2012; 97(1): F8–F17. https://doi.org/10.1136/adc.2010.210187

9. Antonucci R., Contu P., Porcella A., Atzeni C., Chiappe S. Intrauterine smoke exposure: a new risk factor for bronchopulmonary dysplasia? J. Perinat. Med. 2004; 32(3): 272–7. https://doi.org/10.1515/jpm.2004.051

10. Thekkeveedu R.K., Guaman M.C., Shivanna B. Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology. Respir. Med. 2017; 132: 170–7. https://doi.org/10.1016/j.rmed.2017.10.014

11. Jobe A.H., Bancalari E. Bronchopulmonary dysplasia. Am. J. Respir. Crit. Care. Med. 2001; 163(7): 1723–9. https://doi.org/10.1164/ajrccm.163.7.2011060

12. Lopez L., Colan S.D., Frommelt P.C., Ensing G.J., Kendall K., Younoszai A.K., et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J. Am. Soc. Echocardiogr. 2010; 23(5): 465–95. https://doi.org/10.1016/j.echo.2010.03.019

13. Mourani P.M., Sontag M.K., Younoszai A., Miller J.I., Kinsella J.P., Baker C.D., et al. Early pulmonary vascular disease in preterm infants at risk for bronchopulmonary dysplasia. Am. J. Respir. Crit. Care Med. 2015; 191(1): 87–95. https://doi.org/10.1164/rccm.201409-1594OC

14. Bhat R., Salas A.A., Foster C., Carlo W.A., Ambalavanan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics. 2012; 129(3): 682–9. https://doi.org/10.1542/peds.2011-1827

15. Mourani P.M., Sontag M.K., Younoszai A., Ivy D.D., Abman S.H. Clinical utility of echocardiography for the diagnosis and management of pulmonary vascular disease in young children with chronic lung disease. Pediatrics. 2008; 121(2): 317–25. https://doi.org/10.1542/peds.2007-1583

16. Khemani E., McElhinney D.B., Rhein L., Andrade O., Lacro R.V., Thomas K.C., et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics. 2007; 120(6): 1260–9. https://doi.org/10.1542/peds.2007-0971

17. McCrary A.W., Malowitz J.R., Hornik C.P., Hill K.D., Cotten C.M., Tatum G.H., et al. Differences in eccentricity index and systolic-diastolic ratio in extremely low birth weight infants with Bronchopulmonary Dysplasia at risk of pulmonary hypertension. Am. J. Perinat. 2016; 33(1): 57. https://doi.org/10.1055/s-0035-1556757

18. Seo Y.H., Choi H.J. Clinical utility of echocardiography for early and late pulmonary hypertension in preterm infants: relation with bronchopulmonary dysplasia. J. Cardiovasc. Ultrasound. 2017; 25(4): 124–30. https://doi.org/10.4250/jcu.2017.25.4.124

19. López-Candales A. Determinants of an abnormal septal curvature in chronic pulmonary hypertension. Echocardiography. 2015; 32(1): 49–55. https://doi.org/10.1111/echo.12609

20. Haddad F., Guihaire J., Skhiri M., Denault A.Y., Mercier O., Al-Halabi S., et al. Septal curvature is marker of hemodynamic, anatomical, and electromechanical ventricular interdependence in patients with pulmonary arterial hypertension. Echocardiography. 2014; 31(6): 699–707. https://doi.org/10.1111/echo.12468