Bronchopulmonary dysplasia associated pulmonary hypertension: implications across the lifespan.

Abstract

Bronchopulmonary dysplasia is a frequent complication of preterm birth and is often associated with the development of pulmonary hypertension (BPD-PH). BPD-PH is a multifactorial disease with variable hemodynamic phenotypes typically characterized by underdeveloped pulmonary vascular networks with altered microvascular function, carrying significant morbidity and mortality in infancy. Advances in neonatal care have improved the survival of preterm infants. Amongst survivors, there is a trend toward resolution of BPD-PH with adequate respiratory support and somatic growth, highlighting the importance of early recognition and intervention to optimize vascular growth potential. However, as this population ages the idea of "resolution" has been brought into question. There is increasing awareness of subclinical or recurrent pulmonary hypertension as survivors of prematurity from childhood through early adulthood suggesting that the vasculature remains at risk throughout life. The natural history of pulmonary vasculature is one of development, growth and aging. Each window presents unique opportunities and potential insults that impact overall BPD-PHseverity and progression. Here we review care of the BPD-PH patient across the lifespan highlighting windows of opportunity to reduce lifetime exposure to pulmonary hypertension.