Table 1.

Approach to Pulmonary Hypertension in BPD

Screening echocardiograms for:

Severe BPD at 36 weeks

Infants with prolonged ventilator and/or oxygen requirements

Cyanotic episodes

Marked hypercarbia

Persistent pulmonary edema, diuretic dependence

Poor growth, IUGR, oligohydramnios

General evaluation and treatment for factors contributing to persistent respiratory disease and PH

Ensure adequate oxygenation (awake, asleep, feeds)

Assess the adequacy of ventilation

Chronic aspiration (barium swallow, swallowing study, pH probe, impedance study)

Structural airway disease: malacia, subglottic stenosis

Optimal treatment of reactive airways disease

Neurological abnormalities: hydrocephalus

Ensure optimal nutrition

Consider cardiac catheterization when work-up fails to reveal a clear etiology for poor clinical status or when optimal management of these factors fail to achieve clinical improvement

Assess severity of PH

Anatomic heart disease/shunt lesions

Structural vascular abnormalities (eg, arterial stenosis, pulmonary venous obstruction, systemic to pulmonary collateral vessels, others)

Catheter-based interventions

Assess cardiac function (LV diastolic dysfunction)

Acute vasoreactivity/hypoxia testing for selection of chronic therapy

BPD: bronchopulmonary dysplasia, IUGR: intrautuerine growth restrcition, PH: pulmonary hypertension, LV left ventricular