Tailoring Therapy to Bronchopulmonary Dysplasia Phenotype: A Ten-Year Experience in Precision Medicine
Abstract
Aims: To assess the impact of systemic afterload reduction on cardiorespiratory health in infants with a severe bronchopulmonary dysplasia (BPD)-systemic hypertension-left heart dysfunction (LHD) phenotype.
Methods: Ten-year data were prospectively collected and analysed. The cohort included extremely preterm infants with severe BPD-systemic hypertension-LHD pathophysiology, treated with systemic afterload reduction with captopril. Main outcome measures included improvement in oxygenation and echocardiographic measures of LHD.
Results: Twenty-six infants with gestation of 26.5 ± 2 weeks and median (interquartile range) birthweight of 900 (582, 1083) g were administered captopril at the corrected gestation median (range) of 40 weeks (37-67). On reassessment after five weeks, oxygen requirements (43 ± 16% to 26 ± 7%, p = 0.0001) and paired pCO2 decreased (64 ± 9 to 53 ± 9 mm Hg, p = 0.0001). Significant improvements were seen in cardiac indices (diastolic: trans-mitral E/A ratio [1 ± 0.07 to 0.94 ± 0.07, p = 0.0004] and iso-volumic relaxation time [ms] [65 ± 3 to 56 ± 4, p p p = 0.0002]). This coincided with improved aortic pulsatility (40 ± 13 to 50 ± 11 µm, p = 0.005).
Conclusions: Systemic hypertension-LHD pathology amongst infants with severe BPD may be under-recognised. Systemic afterload reduction is physiologically suited in a subset of infants with severe BPD.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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