Pulmonary Hypertension in Extremely Preterm Infants (PiEP)

AZ Sint-Jan AV, Universitaire Ziekenhuizen KU Leuven, GZA Ziekenhuizen Campus Sint-Augustinus, Ziekenhuis Netwerk Antwerpen (ZNA), Ziekenhuis Oost-Limburg, University Hospital, Ghent

Extremely preterm infants are at risk for developing bronchopulmonary dysplasia (BPD) and associated chronic pulmonary hypertension (PH), a consequence of altered pulmonary vasculature. This condition occurs in about 25% of babies with BPD, and the association grows with increasing BPD severity. Other risk factors have been described as well. Morbidity and mortality associated with prematurity and/or BPD increase significantly in the presence of PH. Thus, international guidelines encourage the use of standardized screening protocols for this condition. However, several questions regarding these recommendations are left unanswered, such as a clear definition for PH in this population. The research aim is to prospectively evaluate prevalence, risk factors and clinical course of PH in these children. The investigators aim to identify at-risk infants early on and ultimately improve survival making use of an early targeted intervention.

There will be screened for pulmonary hypertension by means of serial echocardiographies during the study period

At 36 weeks postmenstrual age there will be screened for pulmonary hypertension by means of an NT-proBNP measurement in a blood sample

Pulmonary hypertension will be defined as one or more of the following echocardiographic findings: Presence of a cardiac shunt with bidirectional or right-to-left flow Estimated right ventricular systolic pressure (RVSP) >40 mmHg RVSP/systemic systolic blood pressure (SBP) ratio >0.5 Presence of ventricular septal wall flattening

Pulmonary hypertension will be defined as one or more of the following echocardiographic findings: Presence of a cardiac shunt with bidirectional or right-to-left flow Estimated right ventricular systolic pressure (RVSP) >40 mmHg RVSP/systemic systolic blood pressure (SBP) ratio >0.5 Presence of ventricular septal wall flattening

Pulmonary hypertension will be defined as one or more of the following echocardiographic findings: Presence of a cardiac shunt with bidirectional or right-to-left flow Estimated right ventricular systolic pressure (RVSP) >40 mmHg RVSP/systemic systolic blood pressure (SBP) ratio >0.5 Presence of ventricular septal wall flattening

Pulmonary hypertension will be defined as one or more of the following echocardiographic findings: Presence of a cardiac shunt with bidirectional or right-to-left flow Estimated right ventricular systolic pressure (RVSP) >40 mmHg RVSP/systemic systolic blood pressure (SBP) ratio >0.5 Presence of ventricular septal wall flattening

Pulmonary hypertension will be defined as one or more of the following echocardiographic findings: Presence of a cardiac shunt with bidirectional or right-to-left flow Estimated right ventricular systolic pressure (RVSP) >40 mmHg RVSP/systemic systolic blood pressure (SBP) ratio >0.5 Presence of ventricular septal wall flattening

Inclusion Criteria: Preterm infants with Gestational age <28 0/7 weeks Birth weight <1000 grams Exclusion Criteria: Major congenital malformations Structural airway or lung disease Congenital heart disease Lack of parental consent

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