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Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension

BACKGROUND: Pulmonary hypertension (PH) is a significant cause of morbidity in preterm infants, but no screening guidelines exist. We sought to identify risk factors and clinical outcomes associated with PH in preterm infants to develop a PH risk score. METHODS: Retrospective analysis of two separat...

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Autores principales: Collaco, Joseph M., Dadlani, Gul H., Nies, Melanie K., Leshko, Jenny, Everett, Allen D., McGrath-Morrow, Sharon A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055317/
https://www.ncbi.nlm.nih.gov/pubmed/27716811
http://dx.doi.org/10.1371/journal.pone.0163904
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author Collaco, Joseph M.
Dadlani, Gul H.
Nies, Melanie K.
Leshko, Jenny
Everett, Allen D.
McGrath-Morrow, Sharon A.
author_facet Collaco, Joseph M.
Dadlani, Gul H.
Nies, Melanie K.
Leshko, Jenny
Everett, Allen D.
McGrath-Morrow, Sharon A.
author_sort Collaco, Joseph M.
collection PubMed
description BACKGROUND: Pulmonary hypertension (PH) is a significant cause of morbidity in preterm infants, but no screening guidelines exist. We sought to identify risk factors and clinical outcomes associated with PH in preterm infants to develop a PH risk score. METHODS: Retrospective analysis of two separate populations of preterm infants (NICU cohort n = 230; Clinic registry n = 580). RESULTS: 8.3% of the NICU cohort had PH after 4 weeks of age, while 14.8% of the clinic registry had PH after 2 months of age. Lower birth weights and longer initial hospitalizations were associated with PH in both populations (p<0.001 for all tests). Using adjusted logistic regression, patent ductus arteriosus (PDA) requiring ligation was associated with PH in both the NICU cohort (OR: 3.19; p = 0.024) and the clinic registry (OR: 2.67; p<0.001). Risk factors (birth weight ≤780 grams, home supplemental oxygen use, and PDA ligation) identified in the clinic registry (training dataset) were validated in the NICU cohort with 0–1 factors present were associated with ≤1.5% probability of having PH, any 2 factors with a 25% probability, and all 3 factors with a 40% probability. CONCLUSIONS: Lower birth weight, PDA ligation, and respiratory support were associated with PH in both populations. A PH risk score based on clinical indicators from the training dataset predicted PH in the validation set. This risk score could help focus resources to preterm infants at higher risk for PH. Further work is needed to determine whether earlier or more aggressive management of ductal lesions could alter PH outcomes.
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spelling pubmed-50553172016-10-27 Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension Collaco, Joseph M. Dadlani, Gul H. Nies, Melanie K. Leshko, Jenny Everett, Allen D. McGrath-Morrow, Sharon A. PLoS One Research Article BACKGROUND: Pulmonary hypertension (PH) is a significant cause of morbidity in preterm infants, but no screening guidelines exist. We sought to identify risk factors and clinical outcomes associated with PH in preterm infants to develop a PH risk score. METHODS: Retrospective analysis of two separate populations of preterm infants (NICU cohort n = 230; Clinic registry n = 580). RESULTS: 8.3% of the NICU cohort had PH after 4 weeks of age, while 14.8% of the clinic registry had PH after 2 months of age. Lower birth weights and longer initial hospitalizations were associated with PH in both populations (p<0.001 for all tests). Using adjusted logistic regression, patent ductus arteriosus (PDA) requiring ligation was associated with PH in both the NICU cohort (OR: 3.19; p = 0.024) and the clinic registry (OR: 2.67; p<0.001). Risk factors (birth weight ≤780 grams, home supplemental oxygen use, and PDA ligation) identified in the clinic registry (training dataset) were validated in the NICU cohort with 0–1 factors present were associated with ≤1.5% probability of having PH, any 2 factors with a 25% probability, and all 3 factors with a 40% probability. CONCLUSIONS: Lower birth weight, PDA ligation, and respiratory support were associated with PH in both populations. A PH risk score based on clinical indicators from the training dataset predicted PH in the validation set. This risk score could help focus resources to preterm infants at higher risk for PH. Further work is needed to determine whether earlier or more aggressive management of ductal lesions could alter PH outcomes. Public Library of Science 2016-10-07 /pmc/articles/PMC5055317/ /pubmed/27716811 http://dx.doi.org/10.1371/journal.pone.0163904 Text en © 2016 Collaco et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Collaco, Joseph M.
Dadlani, Gul H.
Nies, Melanie K.
Leshko, Jenny
Everett, Allen D.
McGrath-Morrow, Sharon A.
Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension
title Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension
title_full Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension
title_fullStr Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension
title_full_unstemmed Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension
title_short Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension
title_sort risk factors and clinical outcomes in preterm infants with pulmonary hypertension
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055317/
https://www.ncbi.nlm.nih.gov/pubmed/27716811
http://dx.doi.org/10.1371/journal.pone.0163904
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