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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SCREENING
Masking
NONE
Enrollment
350
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
Presence of pulmonary hypertension
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
Time frame: 3-10 days of life (time depending on the timing of the first echocardiography)
Presence of pulmonary hypertension
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
Time frame: at 28 days of life
Presence of pulmonary hypertension
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
Time frame: at 36 weeks PMA
Presence of pulmonary hypertension
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
Time frame: at 6 months of age
Presence of pulmonary hypertension
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
Time frame: at 12 months of age
Presence of bronchopulmonary dysplasia
Assessment of supplemental oxygen
Time frame: at 28 days of life
Presence of bronchopulmonary dysplasia
Classification of BPD with an oxygen reduction test
Time frame: at 36 weeks PMA
Birth weight
Birth weight in grams
Time frame: at birth
Gestational age
Gestational age in weeks
Time frame: at birth
Small for gestational age
Birth weight \<P3
Time frame: at birth
Oligohydramnios
Presence of oligohydramnios during pregnancy
Time frame: at birth
Maternal hypertensive disorders
Presence of maternal hypertensive disorders during pregnancy (pre-eclampsia, hypertension, HELLP)
Time frame: at birth
ROP
Presence of retinopathy of prematurity
Time frame: at 36 weeks
NEC
Presence of necrotizing enterocolitis
Time frame: at 36 weeks
PDA
Presence of patent ductus arteriosus
Time frame: at 36 weeks
Sepsis
Presence of sepsis
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Time frame: up to discharge from the NICU, an average of 16 weeks
VAP
Presence of ventilator associated pneumonia
Time frame: at 36 weeks