The role of pulmonary hypertension on bronchopulmonary dysplasia

Abstract

50 years ago, Northway described Broncopulmonary Dysplasia (BPD) in preterm infants exposed to mechanical ventilation. Since then, their survival has increased, nevertheless a “new BPD” has appeared and its incidence has not diminished. One of the characteristics of this pathology is the the abnormal vascular remodeling, which in its most severe expression is known as Pulmonary Hypertension (PH); with an incidence of 17% in patients with BPD, which is proportional to the severity of the disease (33% in severe BPD), and as mortality factor (up to 48% 2-year mortality in PH-BPD). Thereby, it is important to know the diagnostic methods and therapeutic alternatives, topics discussed in this review. Considering the high mortality in BPD associated PH, screening strategies in at risk population become important.

The gold standard is cardiac catheterization; however, transthorathic echocardiography is a useful tool for the screening and diagnosis of PH in displasic patients, using cuantitive measures and cualitative changes in the evaluation. Seric type-B natriuretic peptide has shown to be useful for follow-up; regarding images, CT scan is used in severe cases. In terms of therapy; inhaled Nitric Oxide as a pulmonary vasodilator, phosphodiesterase inhibitors –sildenafil–, endotelin antagonists -bosentan-, and prostacyclin analogues -iloprost-, have been proposed. Their use, dosis and treatment lenght still lack support of high quality evidence, but diverse clinical experiences have been described. Interdisciplinary care is also important, highlighting to optimize nutrition. Therefore, the challenge is to effectively prevent BPD and its complications. A PH screening protocol should be associated with risk stratification and treatment guidelines.