title: Risk Factors and Clinical Outcomes in Preterm Infants with Pulmonary Hypertension.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is a significant cause of morbidity in preterm infants, but no screening guidelines exist. We sought to identify risk factors and clinical outcomes associated with PH in preterm infants to develop a PH risk score.
  
  
  METHODS
  Retrospective analysis of two separate populations of preterm infants (NICU cohort n = 230; Clinic registry n = 580).
  
  
  RESULTS
  8.3% of the NICU cohort had PH after 4 weeks of age, while 14.8% of the clinic registry had PH after 2 months of age. Lower birth weights and longer initial hospitalizations were associated with PH in both populations (p<0.001 for all tests). Using adjusted logistic regression, patent ductus arteriosus (PDA) requiring ligation was associated with PH in both the NICU cohort (OR: 3.19; p = 0.024) and the clinic registry (OR: 2.67; p<0.001). Risk factors (birth weight ≤780 grams, home supplemental oxygen use, and PDA ligation) identified in the clinic registry (training dataset) were validated in the NICU cohort with 0-1 factors present were associated with ≤1.5% probability of having PH, any 2 factors with a 25% probability, and all 3 factors with a 40% probability.
  
  
  CONCLUSIONS
  Lower birth weight, PDA ligation, and respiratory support were associated with PH in both populations. A PH risk score based on clinical indicators from the training dataset predicted PH in the validation set. This risk score could help focus resources to preterm infants at higher risk for PH. Further work is needed to determine whether earlier or more aggressive management of ductal lesions could alter PH outcomes.
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Collaco
authors.affiliation: Division of Pediatric Cardiology, Nemours Children's Hospital, Orlando, Florida, United States of America.
authors.forename: Gul H
authors.initials: GH
authors.lastname: Dadlani
authors.affiliation: The Helen B. Taussig Congenital Heart Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America.
authors.forename: Melanie K
authors.initials: MK
authors.lastname: Nies
authors.affiliation: Division of Pediatric Cardiology, All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, Florida, United States of America.
authors.forename: Jenny
authors.initials: J
authors.lastname: Leshko
authors.affiliation: The Helen B. Taussig Congenital Heart Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America.|Division of Pediatric Cardiology, All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, Florida, United States of America.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Everett
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: McGrath-Morrow
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D007223:Infant; D007230:Infant, Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008026:Ligation; D016015:Logistic Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors