Early Echocardiographic Indicators of Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia.

Premature infants, particularly those with bronchopulmonary dysplasia (BPD), experience significant disruptions in pulmonary vascular development, increasing their risk of pulmonary vascular disease (PVD). Objectives were to identify early subclinical changes in echocardiographic indices of pulmonary hemodynamics and right ventricular (RV) function at 7-10 days of age (T0) in neonates who develop BPD or die before 36 weeks postmenstrual age (PMA), compared to neonates without BPD. Additionally, to determine whether late changes in echocardiographic are present at 36-40 weeks PMA (T1) in those with BPD. In this prospective cohort study, preterm infants less than 33 weeks of gestation underwent serial echocardiography to evaluate indices of pulmonary hemodynamics and RV function, including pulmonary artery acceleration time (PAAT) and tricuspid annular plane systolic excursion (TAPSE). Among 104 preterm infants, 22 developed BPD. None met echocardiographic criteria for pulmonary hypertension based on tricuspid regurgitation jet velocity (TRJV). At T0, infants with BPD or who died before 36 weeks PMA had significantly lower PAAT values after adjustment for gestational age and birth weight (52.8 vs. 67.0 milliseconds). By T1, PAAT and TAPSE were similar between groups. However, paired comparisons from T0 to T1 revealed significant increases in PAAT, TAPSE, and s' values in both groups as they matured. Early echocardiographic assessment of pulmonary hemodynamics and RV function can identify subclinical pulmonary vascular remodeling in infants with BPD. A multiparametric approach may improve early identification of pulmonary vascular remodeling, especially when TRJV is inconclusive.