Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia

Shilpa Vyas-Read; Erica M Wymore; Isabella Zaniletti; Karna Murthy; Michael A Padula; William E Truog; William A Engle; Rashmin C Savani; Sushmita Yallapragada; J Wells Logan; Huayan Zhang; Erik B Hysinger; Theresa R Grover; Girija Natarajan; Leif D Nelin; Nicolas F M Porta; Karin P Potoka; Robert DiGeronimo; Joanne M Lagatta; Children’s Hospitals Neonatal Consortium Severe BPD Focus Group

doi:10.1038/s41372-019-0508-5

Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia

J Perinatol. 2020 Jan;40(1):149-156. doi: 10.1038/s41372-019-0508-5. Epub 2019 Sep 30.

Authors

Shilpa Vyas-Read¹, Erica M Wymore², Isabella Zaniletti³, Karna Murthy⁴, Michael A Padula⁵, William E Truog⁶, William A Engle⁷, Rashmin C Savani⁸, Sushmita Yallapragada⁸, J Wells Logan⁹, Huayan Zhang⁵, Erik B Hysinger¹⁰, Theresa R Grover², Girija Natarajan¹¹, Leif D Nelin⁹, Nicolas F M Porta⁴, Karin P Potoka¹², Robert DiGeronimo¹³, Joanne M Lagatta¹⁴; Children’s Hospitals Neonatal Consortium Severe BPD Focus Group

Affiliations

¹ Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA. svyasre@emory.edu.
² Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
³ Children's Hospital Association, Lenexa, KS, USA.
⁴ Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁵ Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁶ Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA.
⁷ Riley Hospital for Children, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
⁸ University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁹ Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁰ Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA.
¹¹ Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
¹² Department of Pediatrics, Division of Newborn Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
¹³ Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
¹⁴ Children's Hospital of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.

Abstract

Objective: To determine the relationship between interventricular septal position (SP) and right ventricular systolic pressure (RVSP) and mortality in infants with severe BPD (sBPD).

Study design: Infants with sBPD in the Children's Hospitals Neonatal Database who had echocardiograms 34-44 weeks' postmenstrual age (PMA) were included. SP and RVSP were categorized normal, abnormal (flattened/bowed SP or RVSP > 40 mmHg) or missing.

Results: Of 1157 infants, 115 infants (10%) died. Abnormal SP or RVSP increased mortality (SP 19% vs. 8% normal/missing, RVSP 20% vs. 9% normal/missing, both p < 0.01) in unadjusted and multivariable models, adjusted for significant covariates (SP OR 1.9, 95% CI 1.2-3.0; RVSP OR 2.2, 95% CI 1.1-4.7). Abnormal parameters had high specificity (SP 82%; RVSP 94%), and negative predictive value (SP 94%, NPV 91%) for mortality.

Conclusions: Abnormal SP or RVSP is independently associated with mortality in sBPD infants. Negative predictive values distinguish infants most likely to survive.

Publication types

Multicenter Study

MeSH terms

Blood Pressure*
Bronchopulmonary Dysplasia / diagnostic imaging
Bronchopulmonary Dysplasia / mortality*
Echocardiography*
Female
Heart Septal Defects, Ventricular / diagnostic imaging
Hospital Mortality*
Humans
Infant, Newborn
Infant, Premature*
Intensive Care Units, Neonatal
Male
Prognosis
Ventricular Septum / anatomy & histology
Ventricular Septum / diagnostic imaging*

Grants and funding

K23 HL136525/HL/NHLBI NIH HHS/United States