Subclinical cardiac dysfunction in preschool children with a history of bronchopulmonary dysplasia: a pilot cohort study.

backgroundBronchopulmonary dysplasia (BPD) is a prevalent complication of prematurity associated with long-term respiratory and cardiovascular sequelae. While adolescent and adult outcomes have been extensively documented, early childhood cardiac function in BPD survivors remains poorly characterized. This study aimed to evaluate subclinical cardiac alterations in preschool-aged children with a history of BPD using detailed echocardiography and 24-hour Holter monitoring.

methodsIn this prospective cohort study, 122 children were classified into three groups: preschool children with BPD (≤ 32 weeks gestation or < 1500 g; Group 1), gestational age- and birth weight-matched preterm controls without BPD (Group 2), and healthy term controls (Group 3). Perinatal and neonatal data were extracted from medical records. Comprehensive echocardiography including M-mode, Doppler, and tissue Doppler imaging (TDI) assessed right and left ventricular systolic and diastolic function, interventricular septal mechanics, and myocardial performance index. Autonomic regulation was evaluated using 24-hour Holter monitoring. Statistical significance was defined as p < 0.05.

resultsDemographics including age, sex, height, and weight were comparable across groups. Chronic pulmonary changes on chest radiography were present in 31.25% of BPD children, significantly higher than in preterm controls (p = 0.013). Conventional systolic echocardiographic indices (ejection fraction, fractional shortening) were within normal limits in all groups. However, BPD children exhibited right ventricular diastolic dysfunction, with decreased E/A ratio, prolonged isovolumic relaxation time (IVRT), and altered systolic-diastolic timing. TDI revealed subclinical interventricular septal systolic impairment. Left ventricular systolic function was preserved, with mild prolongation of LV diastolic relaxation. No significant differences were observed in heart rate variability or blood pressure percentiles among groups.

conclusionsPreschool children with a history of BPD exhibit subclinical right ventricular and septal dysfunction despite preserved left ventricular systolic performance, normal autonomic regulation, and age-appropriate blood pressure. These findings highlight the early cardiovascular impact of BPD-related pulmonary pathology and underscore the importance of longitudinal cardiac surveillance in this high-risk population to guide preventive interventions.