201 - Postneonatal Pulmonary Hypertension (PNPH)- How Much Screening is too Much?

PNPH (postneonatal pulmonary hypertension) is associated with increased severity of BPD. Consensus guidelines recommend screening for PNPH. We did not have a screening protocol and were concerned we were missing babies with PNPH. Using guidelines in the literature, we developed a screening protocol and management algorithm for PNPH.

Objective:

Our global aim was to improve recognition and management for infants with PNPH by increasing echocardiogram (ECHO) screening for eligible infants from 20% to 80% from January 2020 to December 2021. Additional aims included examining the prevalence of PNPH in our patients and assessing the outcome of the screening/treatment algorithm.

Design/Methods:

A workgroup was formed to guide implementation of ECHO screening and focused on infants admitted to Rainbow Babies & Children’s Hospital NICU from January 2020 who were born < 1500g and on any respiratory support at 28 days or 36 weeks postmenstrual age (PMA). A timeline was created for when infants should get first echo screen based on gestational age and respiratory support. Comparisons of PNPH requiring treatment vs. no treatment were done using Fisher exact test for categorical variables, t-test or Wilcoxon rank sum for normally or non-normally distributed continuous variables, respectively.  Infants evaluated by chart review prospectively.

Results:

Our study population was comprised of 118 who met screening criteria. Of these, 96 (81%) received screening ECHOs appropriately.  In all, there were 360 ECHOs done on these babies. First ECHO showed no PH in 67 infants and mild-moderate PH in 41 infants. 35 (85%) with mild-moderate PH on first screening ECHO did not go on to develop PNPH requiring treatment when monitored with monthly screening ECHOs. For the entire study population, 9 (8%) went on to develop PH requiring treatment.  We considered babies with severe PH to receive treatment for PNPH:  7 of these 9 received late sildenafil and 3 had late inhaled nitric oxide (after day 7). On univariate analysis, infants with PNPH requiring treatment compared to infants without PNPH, had a statistically lower gestational age and birth weight, and a significantly higher PMA at discharge and PMA when supplemental oxygen was stopped.

Conclusion(s):

Quality improvement methods increased the percentage of screening ECHOs. PNPH in our population was associated with factors previously identified in the literature. Our protocol required 360 echocardiograms to be done and we found nine babies who had PNPH requiring treatment.  We are using our data analysis to streamline the number of ECHOs but still identify all babies with PNPH.