Friederike Häfner, Caroline Johansson, Larissa Schwarzkopf, Kai Förster, Yvonne Kraus, Andreas W. Flemmer, Georg Hansmann, Hannes Sallmon, Ursula Felderhoff‐Müser, Sabine Witt, Lars Schwettmann, Anne Hilgendorff
Helmholtz Munich. Dr. von Hauner Children’s Hospital and LMU University Hospital. IFT Institute für Therapieforschung Centre for Mental Health and Addiction Research. Hannover Medical School. Medical University of Graz. University Hospital and Essen University of Duisburg-Essen. Carl von Ossietzky University of Oldenburg.
Germany and Austria
Pulmonary Circulation
Pulm Circ 2023;
DOI: 10.1002/pul2.12320
Abstract
Pulmonary hypertension (PH) is the most severe complication in preterm infants with bronchopulmonary dysplasia (BPD) and associated with significant mortality. Diagnostic and treatment strategies, however, still lack standardization. By the use of a survey study (PH in BPD), we assessed clinical practice (diagnosis, treatment, follow-up) in preterm infants with early postnatal persistent pulmonary hypertension of the newborn (PPHN) as well as at risk for or with established BPD-associated PH between 06/2018 and 10/2020 in two-thirds of all German perinatal centers with >70 very low birthweight infants/year including their cardiology departments and outpatient units. Data were analyzed descriptively by measures of locations and distributional shares. In routine postnatal care, clinical presentation and echocardiography were reported as the main diagnostic modalities to screen for PPHN in preterm infants, whereas biomarkers brain natriuretic peptide/N-terminal pro b-type natriuretic peptide were infrequently used. For PPHN treatment, inhaled nitric oxide was used in varying frequency. The majority of participants agreed to prescribe diuretics and steroids (systemic/inhaled) for infants at risk for or with established BPD-associated PH and strongly agreed on recommending respiratory syncytial virus immunization and the use of home monitoring upon discharge. Reported oxygen saturation targets, however, varied in these patients in in- and outpatient care. The survey reveals shared practices in diagnostic and therapeutic strategies for preterms with PPHN and BPD-associated PH in Germany. Future studies are needed to agree on detailed echo parameters and biomarkers to diagnose and monitor disease next to a much-needed agreement on the use of pulmonary vasodilators, steroids, and diuretics as well as target oxygen saturation levels.
Category
Class III. Pulmonary Hypertension Associated with Lung Disease
Diagnostic Testing for Pulmonary Vascular Disease. Non-invasive Testing
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes