Early Pulmonary Vascular Disease in Preterm Infants Is Associated with Late Respiratory Outcomes in Childhood

Mourani, P. M., Mandell, E. W., Meier, M., Younoszai, A., Brinton, J. T., Wagner, B. D., Arjaans, S., Poindexter, B. B. & Abman, S. H., 15-Apr-2019, In : American Journal of Respiratory and Critical Care Medicine. 199, 8, p. 1020-1027 8 p.

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  • Early Pulmonary Vascular Disease in Preterm Infants Is Associated with Late Respiratory Outcomes in Childhood

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  • Peter M. Mourani
  • Erica W. Mandell
  • Maxene Meier
  • Adel Younoszai
  • John T. Brinton
  • Brandie D. Wagner
  • Sanne Arjaans
  • Brenda B. Poindexter
  • Steven H. Abman

Rationale: Early pulmonary vascular disease (PVD) after preterm birth is associated with a high risk for developing bronchopulmonary dysplasia (BPD), but its relationship with late respiratory outcomes during early childhood remains uncertain.

Objectives: To determine whether PVD at 7 days after preterm birth is associated with late respiratory disease (LRD) during early childhood.

Methods: This was a prospective study of preterm infants born before 34 weeks postmenstrual age (PMA). Echocardiograms were performed at 7 days and 36 weeks PMA. Prenatal and early postnatal factors and postdischarge follow-up survey data obtained at 6, 12, 18, and 24 months of age were analyzed in logistic regression models to identify early risk factors for LRD, defined as a physician diagnosis of asthma, reactive airways disease, BPD exacerbation, bronchiolitis, or pneumonia, or a respiratory-related hospitalization during follow-up.

Measurements and Main Results: Of the 221 subjects (median, 27 wk PMA; interquartile range, 25-28 and 920 g; interquartile range, 770-1090 g) completing follow-up, 61% met LRD criteria. Gestational diabetes and both mechanical ventilator support and PVD at 7 days were associated with LRD. The combination of PVD and mechanical ventilator support at 7 days was among the strongest prognosticators of LRD (odds ratio, 8.1; confidence interval, 3.1-21.9; P <0.001). Modeled prenatal and early postnatal factors accurately informed LRD (area under the curve, 0.764). Adding BPD status at 36 weeks PMA to the model did not change the accuracy (area under the curve, 0.771).

Conclusions: Early echocardiographic evidence of PVD after preterm birth in combination with other perinatal factors is a strong risk factor for LRD, suggesting that early PVD may contribute to the pathobiology of BPD.

Original languageEnglish
Pages (from-to)1020-1027
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number8
Publication statusPublished - 15-Apr-2019


  • late respiratory outcomes, echocardiography, prematurity, pulmonary vascular disease, mechanical ventilation, RIGHT-VENTRICULAR FUNCTION, BRONCHOPULMONARY DYSPLASIA, HYPERTENSION, PREMATURITY, BIRTH, AGE, GROWTH, DEATH, RISK, BORN

ID: 93016451