Predictors of pulmonary hypertension in very low birth weight infants in the neonatal intensive care unit Open Access

Vyas-Read, Shilpa (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/6m311p73q?locale=en
Published

Abstract

Approximately 8-23% of premature infants develop pulmonary hypertension (PH), and up to 50% of infants with PH die by 3 years. As a result, professional societies recommend PH screening in premature infants. However, little evidence is available to guide which patients warrant screening, and this void may result in a delay of therapeutic intervention or follow-up.

The two Aims of this proposal were: 1) Determine clinical factors associated with PH 2) Develop a predictive model for PH>30 days of life.

Infants who had the following billing codes: < 32 weeks, birth weight < 1500 grams (BW), neonatal unit, and echocardiograph had records abstracted from a data warehouse. For Aim 1, echocardiographic PH at any point, and for Aim 2, echocardiographic PH >30 days, were the primary outcomes. . For Aim 2, early predictor variables on the outcome of PH> 30 days were evaluated and receiver-operating curves (ROC) were generated to determine cut-points for sensitivity analyses. . Odds ratios and 95% confidence intervals are expressed as (OR, CI) below.

559 infants were included in the overall study, and 92 (16.5%) had PH. For Aim 1, Black race (1.79, 1.02-3.14), atrial septal defect (ASD, 2.72, 1.45-5.11) and patent ductus arteriosus (2.04, 1.19-3.49) increased the odds of PH in multivariable analyses, whereas caffeine decreased the odds (0.49, 0.29 -0.84). 321 patients were included in Aim 2, and a model of birth (birth weight, Apgar 1 minute, Black Race) and early neonatal variables (caffeine, ASD), with positive-pressure ventilation controlled was determined. The ROC showed an area of 0.766, corresponding to a validated sensitivity 80%, specificity 44%, positive predictive value 21%, and a negative predictive value 92%.

Through this proposal, we have identified new factors that contribute to PH, such as race and caffeine. Further, we have developed a model that utilizes early neonatal factors to begin to predict PH. Future steps will include external validation of the model, and implementation of a formalized screening protocol in the neonatal intensive care unit.

Table of Contents

1. Introduction, pages 1-2

2. Background, pages 3-6

3. Methods, pages 7-14

4. Results, pages 15-21

5. Discussion, pages 22-29

6. References, pages 30-33

7. Figure 1, pages 34-35

8. Table 1, pages 36-37

9. Table 2, pages 38-39

10 Table 3, pages 40-41

11. Table 4, pages 42-43

12 Table 5, pages 44-45

13 Table 6, pages 46-48

14 Table 7, page 49

15 Figure 2, page 50

16 Table 8, page 51

17 Table 9, page 52

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