Current Practices for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension in Neonates: A Survey Study in Spain.

Objective: To describe national patterns in the screening, diagnosis, and clinical management of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) in Spanish neonatal intensive care units (NICUs) and assess the need for standardized screening and management protocols and unified follow-up strategies.

Methods: A 20-question electronic survey was distributed to all Level III NICUs in the Spanish public health system to evaluate practices in BPD-PH screening, diagnosis, and clinical management. Results were analyzed globally and by NICU level (IIIB vs. IIIC).

Results: A total of 47 NICUs (59% response rate) participated, with a complete (100%) response rate from Level IIIC units, which represent the highest complexity centers. Although 70% of units reported routine screening for BPD-PH, only 36% used formal screening protocols, revealing inconsistencies in timing and criteria. Diagnostic approaches relied heavily on echocardiographic indicators of pulmonary hypertension, particularly interventricular septal flattening, and right-to-left shunting, but adjunct tests (e.g., NT-proBNP, catheterization) varied between centers. Only 19% of NICUs-mostly Level IIIC-used standardized clinical management algorithms. Asymptomatic infants were typically managed with conservative strategies (oxygen targeting, fluid restriction), while sildenafil was the predominant therapy for symptomatic BPD-PH cases (80% of units). Follow-up protocols showed significant heterogeneity, especially in asymptomatic patients discharged without treatment.

Conclusions: There is a clear need for national guidelines to address variability in screening protocols, diagnostic strategies, clinical management and follow-up practice of BPD-PH. Establishing uniform care standards across Spanish NICUs could improve equity and outcomes in this high-risk preterm population.