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[4109.224] APS/SPR Student Research Program – Seema Anandalwar: Changes in Epidemiology and Outcomes in Infants With Pulmonary Hypertension and Bronchopulmonary Dysplasia
Seema P. Anandalwar, Lawrence M. Rhein, Mary P. Mullen. Newborn Medicine and Pediatric Pulmonary, Boston Children's Hospital, Boston, MA; Cardiology, Boston Children's Hospital, Boston, MA.
BACKGROUND: Recent studies have increased awareness of pulmonary hypertension (PH) as a common complication of bronchopulmonary dysplasia (BPD), with potential significant morbidity and mortality. Various outcomes have been described for infants with PH, from early resolution to significant mortality. Despite rising awareness of PH in BPD, information describing recent epidemiology and outcomes is lacking.
OBJECTIVE: To describe epidemiology and outcomes of infants with BPD-associated PH.
DESIGN/METHODS: We identified infants at a large tertiary care hospital, with birth gestational age ≤ 32 weeks, birth between 1998-2012, BPD diagnosis, and initial PH diagnosis (by echocardiogram) at ≥ 2 months of age. Echocardiograms were followed until documented PH resolution or death. Demographics and details of respiratory and PH management were extracted from the medical records.
RESULTS: 102 patients were identified. The early cohort included 46 patients born from January 1, 1998 to February 1, 2006; the late cohort included 56 patients born from February 2, 2006 to December 31, 2012. There were no differences between cohorts in gender, birth weight, gestational age, days on ventilator, severity of BPD, or treatment with sildenafil or nitric oxide. The late cohort had more patients treated with post-pyloric feeds (p=0.05) and tracheostomy (p=0.007). The late cohort had a younger mean age at PH diagnosis (285 vs 176 days, p=0.11), shorter time to PH resolution (p<0.03), and lower mortality rate.
CONCLUSIONS: Compared to earlier cohorts, more recent cohorts of infants with BPD and PH are more likely to be treated with aggressive respiratory management, exhibit shorter times to PH resolution, and have lower mortality.
First Author is a Medical Student
[2940.555A] APS/SPR Student Research Program – Eilann Santo: Efficacy of Bronchodilator Use in the Newborn Intensive Care Unit
Eilann C. Santo, Bridget K. Hughes, Lawrence M. Rhein. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; University of Rochester School of Medicine and Dentistry, Rochester, NY; Newborn Medicine and Pediatric Pulmonology, Boston Children's Hospital, Boston, MA.
BACKGROUND: Bronchodilators (BD) have been used for over 30 years in preterm infants with bronchopulmonary dysplasia (BPD). While some data is available on its role in short-term pulmonary compliance, little data exists regarding efficacy of BD for clinical respiratory outcomes.
OBJECTIVE: To assess efficacy of BD in improving pulmonary status of preterm infants within 48 hours of use, and to determine correlation with Newborn Intensive Care Unit (NICU) length of stay.
DESIGN/METHODS: We identified infants born between 2002 and 2013, who received BD treatment at any point during the initial hospitalization at a Level 3 NICU. We selected controls matched for birth gestational age week, birth year, race, and gender. Exclusion criteria included lack of control patient with matching criteria (n=6) or lack of information to allow calculation of the pulmonary score for either index or control patient (n=16). Pulmonary scores were calculated from clinical data (Madan et al, Pediatrics 2005) on the day prior to first BD exposure, and at 24 and 48 hours post treatment. Higher scores reflect worse lung disease. Pulmonary scores for controls were calculated on the same day of life corresponding to the day of first BD exposure for the matched patient. Demographic and clinical variables were extracted from medical records.
RESULTS: Infants who received BD had lower pulmonary scores at baseline pre-1st BD dose (2.23 v 0.18, p<0.0001), 24 hrs (1.09 v 0.10, p<0.0001) and 48 hrs (1.16 v 0.10, p<0.0001) compared to matched controls. Infants treated with BD showed greater improvement from baseline at both 24 (p<0.0001) and 48 hours (p<0.0001) than those who did not receive BD. NICU length of stay was increased in infants who received BDs compared to controls (p<0.0001).
CONCLUSIONS: Infants treated with BD showed greater improvement in respiratory function both 24 and 48 hours post BD administration compared to infants who did not receive BD. Infants who received BD had more severe lung disease at similar ages compared to matched controls, and despite short-term improvement in pulmonary score, had longer NICU length of stay. Prospective studies are needed to evaluate the role of BD in improving clinical respiratory outcomes.
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