Pulmonary artery pressure: early predictor of chronic lung disease in preterm infants

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 78; no. 1; pp. F20 - F24
• Main Authors: Subhedar, N V, Hamdan, A H, Ryan, S W, Shaw, N J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.01.1998; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; AT:RVET(c) ratio; Biological and medical sciences; Blood Pressure - physiology; Chronic Disease; chronic lung disease; Cohort Studies; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Humans; Infant, Newborn; Infant, Premature - physiology; Infant, Premature, Diseases - physiopathology; Infants; inspired oxygen concentration; Intensive care medicine; Lung Diseases - physiopathology; Male; Medical sciences; Original; Prognosis; Pulmonary Artery - physiopathology; pulmonary artery pressure; Regression Analysis; Respiration, Artificial; ROC Curve; Ventilation; Human; Premature; Lung disease; Oxygen; Prognosis; Inspired gas; Respiratory disease; Early stage; Pulmonary artery; Newborn diseases; Newborn; Predictive value; Bronchus disease; Bronchopulmonary dysplasia; Arterial pressure; Hemodynamics
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/fn.78.1.F20

AIM To determine if pulmonary artery pressure (PAP) in ventilated preterm infants is independently associated with the development of chronic lung disease (CLD) and whether early assessment has any prognostic value. METHODS Two cohorts (development n = 55; and validation n = 28) of preterm infants were studied at 24 hours of age. PAP was assessed non-invasively using its inverse correlation with the corrected acceleration time to right ventricular ejection time ratio (AT:RVET(c)), calculated from the pulmonary artery Doppler waveform. Clinical and respiratory variables were also collected. Using logistic regression analysis to identify factors independently associated with CLD, a prognostic score was developed to predict CLD. The ability of the score to predict CLD was described using receiver operating characteristic (ROC) curves. RESULTS Birthweight, inspired oxygen concentration, and AT:RVET(c) were independently predictive of CLD. The area under the ROC curve was 0.96 for the development and 0.89 for the validation cohort. Exclusion of AT:RVET(c) resulted in a reduction to 0.88 and 0.73, respectively. CONCLUSION PAP is independently associated with CLD. An early assessment of PAP using AT:RVET(c) may permit the early prediction of CLD as part of a multifactorial scoring system.