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Pulmonary Hypertension in Bronchopulmonary Dysplasia

  • Steven H. AbmanEmail author
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

Pulmonary vascular disease (PVD) and related pulmonary hypertension (PH) contribute significantly to the pathogenesis, cardiorespiratory morbidities, and poor outcomes in preterm infants with BPD. Past studies have shown that persistent echocardiogram evidence of PH beyond the first few months of life is associated with up to 40 % mortality in infants with BPD. The association of PH with poor survival in BPD has continued into the recent era of the “new BPD,” especially in infants with severe disease who require prolonged support with mechanical ventilation. More recent studies have shown that adverse antenatal or early postnatal stimuli impair pulmonary vascular development and function, leading to disruption of angiogenesis and distal lung airspace growth. Consensus guidelines for the diagnosis, evaluation, and management of PH in infants with established BPD have recently been published by a consensus committee; however, clinical care remains controversial due to the lack of strong evidence-based data. Overall, understanding the pathogenesis and pathobiology of early PVD in BPD continues as an important challenge and may help to improve early and late cardiopulmonary outcomes after preterm birth. Future large-scale studies of interventions for the treatment of PH in established BPD are needed. In addition, strategies that specifically target the preservation of endothelial survival and function may also lead to novel approaches for the prevention of BPD and late PH.

Keywords

Pulmonary arterial hypertension Prematurity Bronchopulmonary dysplasia Pulmonary vascular disease Lung vascular development Inhaled nitric oxide 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Pediatric Heart Lung Center, Sections of Pediatric Pulmonary MedicineUniversity of Colorado School of Medicine and Children’s Hospital ColoradoAuroraUSA
  2. 2.Critical Care MedicineUniversity of Colorado School of Medicine and Children’s Hospital ColoradoAuroraUSA
  3. 3.Department of PediatricsUniversity of Colorado School of Medicine and Children’s Hospital ColoradoAuroraUSA

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