Evaluation and management of pulmonary hypertension in infants with bronchopulmonary dysplasia

BPD: bronchopulmonary dysplasia; CT: computed tomography; O₂: oxygen; PaCO₂: partial pressure of carbon dioxide; PH: pulmonary hypertension; PMA: postmenstrual age; sBP: systolic blood pressure; sPAP: systolic pulmonary artery pressure.

* Practice varies regarding whether to perform echocardiographic screening for infants with mild BPD (eg, breathing room air by 36 weeks PMA).

¶ sPAP can be estimated using tricuspid regurgitant jet velocity in combination with other echocardiographic findings. The systemic sBP is measured at the same time to allow for comparison.

Δ Comorbidities that may contribute to PH disease include hypoxemia, aspiration, or structural heart disease.

◊ The goal of CT angiography is to assess the severity of parenchymal lung disease and identify any abnormalities in the pulmonary vasculature. In our practice, we perform CT angiography for any infant with BPD and moderate or severe PH, provided that they can tolerate the imaging protocol.

§ Cardiac catheterization prior to the initiation of long-term therapy is encouraged, but the risks and benefits of this procedure depend on local expertise with the procedure and severity of disease^[1].

¥ Comorbidites that may be diagnosed at catheterization include pulmonary vein stenosis, left ventricular diastolic dysfunction, shunts, or collateral vessels.