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Chapter 42 - Pulmonary Hypertension and Prematurity

from Section 7 - Miscellaneous Lesions and Syndromes

Published online by Cambridge University Press:  09 September 2021

By
Sheila M. Rajashekara  and
Chandra Ramamoorthy
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Pulmonary hypertension in preterm infants is defined by the same guidelines used for adults and children: mean pulmonary arterial pressure =20 mm Hg, pulmonary capillary wedge pressure <15 mm Hg, and indexed pulmonary vascular resistance >3 Wood units/m2. Bronchopulmonary dysplasia, the major cause of chronic lung disease in preterm infants, is defined as the need for oxygen at 36 weeks postconceptual age in infants born at or before 32 weeks’ gestation. The disruption of growth and function of the pulmonary vasculature observed with bronchopulmonary dysplasia contributes to the development of pulmonary hypertension. Abnormal pulmonary vasculature develops increased pulmonary vascular resistance and mean pulmonary artery pressures. As many of 20%–40% of patients with bronchopulmonary dysplasia have persistent pulmonary hypertension and the combination is accompanied by significant morbidity and mortality. This chapter details the assessment and perioperative considerations involved in caring for a preterm infant with these conditions undergoing multiple surgical procedures.

Keywords

atrial septal defectbronchopulmonary dysplasiaEisenmenger syndromenoncardiac surgeryprematuritypulmonary hypertensionpulmonary hypertensive crisis
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 323 - 330
Publisher: Cambridge University Press
Print publication year: 2021

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References

Suggested Reading

Abman, S. H., Hansmann, G., Archer, S. L., et al. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation 2015; 132: 2037–99.CrossRefGoogle ScholarPubMed
Altit, G., Dancea, A., Renaud, C., et al. Pathophysiology, screening and diagnosis of pulmonary hypertension in infants with bronchopulmonary dysplasia – a review of the literature. Paediatr Respir Rev 2017; 23: 16–26.Google ScholarPubMed
Berkelhamer, S. K., Mestan, K. K., and Steinhorn, R. An update on the diagnosis and management of bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension. Semin Perinatol 2018; 42: 432–43.CrossRefGoogle ScholarPubMed
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O’Connor, M. G., Suther, D., Vera, K., et al. Pulmonary hypertension in the premature infant population: analysis of echocardiographic findings and biomarkers. Pediatr Pulmonol 2018; 53: 302–309. DOI: 10.1002/ppul.23913.Google Scholar

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