Screening for pulmonary hypertension in preterm infants with bronchopulmonary dysplasia: when, how often and does it matter?

IF 3.6 2区 医学 Q1 PEDIATRICS
Samuel J Gentle, Waldemar A Carlo, Namasivayam Ambalavanan
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引用次数: 0

Abstract

Objective: Bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (BPD-PH) is the most severe endotype of BPD; there is insufficient evidence to support the optimal screening strategy in at-risk infants. We hypothesised that serial echocardiography throughout hospitalisation would improve PH detection with increased negative predictive value (NPV) beyond 36 week's postmenstrual age (PMA).

Study design: This was a single centre cohort study conducted between 2017 and 2023. In infants with BPD-PH, all echocardiograms preceding a diagnostic echocardiogram were included and considered false negatives for prediction of later PH. In infants with BPD alone, all echocardiograms were included and were considered true negatives. These indices were then used to estimate the sensitivity and NPV of echocardiographic screening for PH. In addition, we compared the performance of four different potential echocardiographic screening approaches on the ability to identify infants with BPD-PH.

Results: Data from 394 infants were available for this analysis of whom 258 had BPD alone and 136 had BPD-PH. 2542 echocardiograms were used in estimates of diagnostic accuracy. The highest NPVs occurred with echocardiographic screening starting at 36 weeks' and continuing monthly until discharge. Detection of BPD-PH among infants with BPD differed by screening strategy: 34.5% for comprehensive screening, 20.0% for early screening, 15.0% for singular screening and 30.7% for late screening (p<0.05).

Conclusions: While the diagnostic accuracy of echocardiographic screening increases at and beyond 36 weeks' PMA, obtaining a singular echocardiogram may be an insufficient screening strategy for the detection of BPD-PH in at-risk infants.

支气管肺发育不良早产儿肺动脉高压筛查:何时、多久、重要吗?
目的:支气管肺发育不良(BPD)相关肺动脉高压(BPD- ph)是BPD最严重的内分型;没有足够的证据支持高危婴儿的最佳筛查策略。我们假设在整个住院期间进行连续超声心动图检查可以改善PH检测,并增加月经后36周(PMA)后的阴性预测值(NPV)。研究设计:这是一项在2017年至2023年间进行的单中心队列研究。对于患有BPD- ph的婴儿,在诊断性超声心动图之前的所有超声心动图都被包括在内,并被认为是假阴性,以预测后来的ph。对于单独患有BPD的婴儿,所有超声心动图都被包括在内,并被认为是真阴性。然后使用这些指标来估计超声心动图筛查ph的敏感性和NPV。此外,我们比较了四种不同的潜在超声心动图筛查方法在识别BPD-PH婴儿能力方面的表现。结果:394名婴儿的数据可用于该分析,其中258名单独患有BPD, 136名患有BPD- ph。2542张超声心动图用于估计诊断准确性。超声心动图筛查的npv最高,从36周开始,每月持续到出院。不同筛查策略对BPD患儿BPD- ph的检出率存在差异:综合筛查34.5%,早期筛查20.0%,单一筛查15.0%,晚期筛查30.7% (p结论:超声心动图筛查的诊断准确性在PMA 36周及以上有所提高,但单一超声心动图可能不足以检测高危婴儿BPD- ph。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.00
自引率
4.50%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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