Pulmonary hypertension among preterm infants born at 22 through 32 weeks gestation in France: Prevalence, survival, morbidity and management in the EPIPAGE-2 cohort study

Sophie Breinig; Virginie Ehlinger; Jean-Christophe Rozé; Laurent Storme; Heloise Torchin; Xavier Durrmeyer; Gilles Cambonie; Christophe Delacourt; Pierre-Henri Jarreau; Lionel Berthomieu; Olivier Brissaud; Valérie Benhammou; Geraldine Gascoin; Catherine Arnaud; Pierre-Yves Ancel

doi:10.1016/j.earlhumdev.2023.105837

Pulmonary hypertension among preterm infants born at 22 through 32 weeks gestation in France: Prevalence, survival, morbidity and management in the EPIPAGE-2 cohort study

Early Hum Dev. 2023 Sep:184:105837. doi: 10.1016/j.earlhumdev.2023.105837. Epub 2023 Aug 3.

Authors

Affiliations

¹ Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 Avenue de Grande-Bretagne, Toulouse Cedex 9, France; Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France. Electronic address: s.breinig@orange.fr.
² Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France.
³ Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France.
⁴ Neonatal Intensive Care Unit, Lille University Hospital, Lille, France.
⁵ Neonatal Intensive Care Unit, Maternité Cochin-Port Royal, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁶ Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.
⁷ Neonatal and Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France.
⁸ Department of Pediatric Pneumology, Necker Children's Hospital, Paris University Hospital, Paris, France.
⁹ Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 Avenue de Grande-Bretagne, Toulouse Cedex 9, France.
¹⁰ Neonatal and Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France.
¹¹ INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris, France.
¹² Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France; Neonatal Intensive Care Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
¹³ Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France; Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France.

PMID: 37595540
DOI: 10.1016/j.earlhumdev.2023.105837

Abstract

Objective: To determine the prevalence, short-term prognosis and pharmacologic management of pulmonary hypertension (PH) among very preterm infants born before 32 weeks gestation (WG).

Study design: In the EPIPAGE-2 French national prospective population-based cohort of preterm infants born in 2011, those presenting with PH were identified and prevalence was estimated using multiple imputation. The primary outcome was survival without severe morbidity at discharge and was compared between infants with or without PH after adjusting for confounders, using generalized estimating equations models. Subgroup analysis was performed according to gestational age (GA) groups.

Results: Among 3383 eligible infants, 3222 were analyzed. The prevalence of PH was 6.0 % (95 % CI, 5.2-6.9), 14.5 % in infants born at 22-27⁺⁶ WG vs 2.7 % in infants born at 28-31⁺⁶ WG (P < .001). The primary outcome (survival without severe morbidity at discharge) occurred in 30.2 % of infants with PH vs 80.2 % of infants without PH (P < .001). Adjusted incidence rate ratios for survival without severe morbidity among infants with PH were 0.42 (0.32-0.57) and 0.52 (0.39-0.69) in infants born at 22-27⁺⁶ weeks gestation and those born at 28-31⁺⁶ weeks, respectively. Among infants with PH, 92.2 % (95 % CI, 87.7-95.2) received sedation and/or analgesia, 63.5 % (95 % CI, 56.6-69.9) received inhaled NO and 57.6 % (95 % CI, 50.9-64.0) received hemodynamic treatments.

Conclusion: In this population-based cohort of very preterm infants, the prevalence of PH was 6 %. PH was associated with a significant decrease of survival without severe morbidity in this population.

Keywords: EPIPAGE-2; Inhaled nitric oxide (iNO); Mortality; Neonatal morbidity; Preterm neonates; Prevalence; Prognosis; Pulmonary hypertension.