713 - Hospitalizations and Emergency Department Visits in Extremely Premature Infants with Bronchopulmonary Dysplasia and Pulmonary Hypertension at Five Years

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 713
Publication Number: 713.4

Ashley Phimister, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Stephanie S. Handler, Medical College of Wisconsin, Milwaukee, WI, United States; Edward C. Kirkpatrick, Medical College of Wisconsin, Miklwaukee, WI, United States

Presenting Author(s)

Ashley Phimister, MD (she/her/hers)

Pediatric Cardiology Fellow
Children's Hospital of Wisconsin
Milwaukee, Wisconsin, United States

Background: Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in infants and is a major contributor to prolonged hospitalizations, morbidity, late mortality, and the utilization of healthcare resources post-neonatal intensive care unit (NICU) discharge in premature infants. Infants born at less than 32-weeks gestation with BPD-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. Long term outcomes in patients with both BPD and pulmonary hypertension (PH) past one year have not been well documented.

Objective: The goal of this study was to describe the post-NICU outcomes in patients with both BPD and PH.

Design/Methods:

We conducted a single-center retrospective chart review of patients hospitalized in the NICU at Children’s Wisconsin born at < 28 weeks of estimated gestational age, carried the diagnosis of BPD, and were discharged on home oxygen therapy. All patients were screened for PH with regular serial echocardiograms and presence of PH was noted by established national guidelines. Patients with congenital diaphragmatic hernia or complex congenital heart disease were excluded. Hospitalizations and emergency department (ED) only visits were evaluated at 5 years follow up.

Results:

One hundred seventy-five patients born between 2012-2016 were included in the study, with a mean gestational age of 25.3 weeks (SD 1.3). Of 175, 76 (43%) had PH diagnosed on at least one echocardiogram. Patients with PH are more likely to require repeat hospitalization after initial discharge compared to patients without PH (72.4% vs 49.5%, P=0.002). Patients with PH also had significantly higher average number of re-admissions per patient (4 vs 2, P < 0.0001). The average number of days from initial hospital discharge to first re-admission was significantly shorter for patients with PH (190.2 with SD 3 vs 272.6 with SD 6 days, P=0.028). The percentage of patients with PH who had any ED only visit was not significantly different as compared to patients without PH (82.9% vs 73.7%, P=0.15). There was no significant difference in death at 5 years follow up between the two groups (5.3% in PH group vs 4.0% in non-PH group, P=0.73).

Conclusion(s):

Premature infants with BPD and PH are more likely to require earlier and more frequent hospital readmission in the 5 years following NICU discharge than those without PH. Moving forward, further outcomes including utilization of outpatient primary and specialty care resources along with school and neurodevelopmental outcomes in this patient population need to be investigated.