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Epidemiology and Evolution of
Bronchopulmonary Dysplasia and
Pulmonary Hypertension
S. Arjaans, BSc
Background
• Advances Perinatal Medicine
• More frequent in infants <1000 grams and/or <28 weeks of GA
• Immature lungs & lung injury
• Disrupted vascular growth and impaired alveolarization
• Intra-uterine & extra uterine factors
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Davidson et al. Journal of Clinical Medicine 2017
Background
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Epidemiology and Evolution of Bronchopulmonary Dysplasia and
Pulmonary Hypertension
• Epidemiology of PH
• Factors associated with development of PH
• Outcome of PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Epidemiology
• PH present in first week of life • Adaptive/maladaptive
• PPHN
• PH after first week of life • Different causes for development and/or persistence of
PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Literature Review
• Selected populations
– Retrospective cohorts
– Definition of PH
– Time of assessment of PH
– Populations with PH and BPD
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Epidemiology PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
• Different reported prevalence rates
• High Prevalence PH in first week of life
Extremely Preterm-Born Infants
S. Arjaans et al. Under review.
Epidemiology PH
PH prevalence in all infants:
12% (CI: 9% - 15%)
PH prevalence in selected infants with BPD:
20% (CI: 14% - 25%)
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Extremely Preterm-Born Infants
S. Arjaans et al. Under review.
Epidemiology PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Extremely Preterm-Born Infants
S. Arjaans et al. Under review.
Epidemiology PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Extremely Preterm-Born Infants
S. Arjaans et al. Under review.
Epidemiology PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Extremely Preterm-Born Infants
S. Arjaans et al. Under review.
Epidemiology PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Extremely Preterm-Born Infants
S. Arjaans et al. Under review.
Severe BPD and PH
P value < .001
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Extremely Preterm-Born Infants
S. Arjaans et al. Under review.
Epidemiology and Evolution of Bronchopulmonary Dysplasia and
Pulmonary Hypertension
• Epidemiology of PH
• Factors associated with development of PH
• Outcome of PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Factors associated with the development of PH
Nagiub et al. Paediatric Respiratory Reviews. 2016
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Additional Factors associated with the development of PH
Placental histopathological changes due to
maternal vascular underperfusion:
2.45 (95% CI 1.43, 5.01)
Kunjunju et al. J Perinatol. 2017 S. Arjaans et al. In preparation
Mourani et al. Am J Respir Crit Care Med. 2015
Development of BPD
Relative risk: 1.12 (1.03 – 1.23)
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Early PH associated with development of BPD at 36 weeks PMA
Early PH associated with development of PH at 36 weeks PMA
Development of late PH
Relative risk: 2.85 (1.28 – 6.33) Mourani et al. Am J Respir Crit Care Med. 2015
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Epidemiology and Evolution of Bronchopulmonary Dysplasia and
Pulmonary Hypertension
• Epidemiology of PH
• Factors associated with development of PH
• Outcome of PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Outcome PH
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Extremely Preterm-Born Infants
Mortality prior to discharge NICU
S. Arjaans et al. Under review.
Khemani et al. Pediatrics 2007
Outcome PH
Extremely Preterm-Born Infants
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Survival infants with PH After 36 weeks PMA
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
S. Arjaans et al. In preparation.
Resolution rate of PH After 36 weeks PMA
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
S. Arjaans et al. In preparation.
Survival & Resolution Combined
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
S. Arjaans et al. In preparation.
Conclusions
• Prevalence PH is 12%; In severe BPD: 39%
• Factors associated development PH have an overlap with risk factors BPD
• First year of life a poor survival
• After first year of life more resolution of PH
• Prevalence & outcome insufficiently known
High need for standardized prospective studies
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans
Thank you!
Epidemiology and Evolution of Bronchopulmonary Dysplasia and Pulmonary Hypertension, S. Arjaans