Steven Abman, MD and Thomas H. Shaffer, MSE, PhD
In this episode, “Recent Advances in the Management of Pulmonary Hypertension in BPD,” Dr. Abman and Dr. Shaffer deliberate the role of pulmonary hypertension therapy in the management of bronchopulmonary dysplasia (BPD).
There has been a recent explosion of interest in the pathophysiology of lung circulation and pulmonary hypertension in premature infants with BPD. These infants can exhibit many different phenotypes of pulmonary vascular disease. Some manifest pulmonary hyperreactivity in the immediate postnatal period and can benefit from vasodilators shortly after birth as an acute life-saving therapy. The majority of pulmonary vascular disease is, however seen in older neonates with established BPD, and can pose significant challenges in the treatment of lung disease. Cardiac catheterization may have a diagnostic role in a select population where there is a specific question to be answered, but otherwise should not be used routinely. Otherwise, echocardiography and laboratory markers can be used to guide initiation of vasodilator therapy such as inhaled nitric oxide and endothelin receptor agonists in infants with evidence of extrapulmonary right to left shunt.