Pulmonary hypertension and right ventricular dysfunction in growth-restricted, extremely low birth weight neonates

ABSTRACT This case series reports an acute episode of hypoxemia and systemic hypotension in seven infants under 1 kg, taking place several hours or days after birth, after a period of

stability and in the absence of significant lung disease. These patients were growth-restricted at birth and had a history of chronic fetal hypoxia and oligohydramnios. Pulmonary

hypertension and right ventricular dysfunction were found by echocadiography. Right ventricular ejection fraction was significantly depressed during the acute episode, compared to baseline

values measured after recovery. The timing of symptoms seemed related to ductus arteriosus closure or constriction. Oxygenation and right ventricular function improvement occurred within a

few days under ventilatory and inotropic support, while milrinone was administered in five cases. In conclusion, pulmonary hypertension is a rare but significant cause of hypoxemia in

preterm infants, and pulmonary vasodilator therapy should be considered in the presence of right ventricular dysfunction. Access through your institution Buy or subscribe This is a preview

of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only

$21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout

ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS SURVIVAL AND ASSOCIATED RISK

FACTORS FOR MORTALITY AMONG INFANTS WITH PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN IN MALAYSIA Article 15 February 2021 HEMODYNAMIC CONSEQUENCES OF RESPIRATORY INTERVENTIONS IN

PRETERM INFANTS Article Open access 11 June 2022 USE OF VASOPRESSIN IN NEONATAL HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY: CASE SERIES Article 19 September 2020 REFERENCES * Walther FJ,

Benders MJ, Leighton JO . Persistent pulmonary hypertension in premature neonates with severe respiratory distress syndrome. _Pediatrics_ 1992;90:899–909. CAS  PubMed  Google Scholar  *

Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M . A United States national reference for fetal growth. _Obstet Gynecol_ 1996;87:163–168. Article  CAS  PubMed  Google Scholar  * Sholler

GF, Colan SD, Sanders SP . Effect of isolated right ventricular outflow obstruction on left ventricular function in infants. _Am J Cardiol_ 1988;62:778–784. Article  CAS  PubMed  Google

Scholar  * Helbing WA, Bosch HG, Maliepaard C, et al. Comparison of echocardiographic methods with magnetic resonance imaging for assessment of right ventricular function in children. _Am J

Cardiol_ 1995;76:589–594. Article  CAS  PubMed  Google Scholar  * Clark SJ, Yoxall CW, Subdehar NV . Right ventricular volume measurements in ventilated preterm neonates. _Pediatr Cardiol_

2004;25:149–153. Article  CAS  PubMed  Google Scholar  * Skinner JR, Boys RJ, Hunter S, Hey EN . Pulmonary and systemic arterial pressure in hyaline membrane disease. _Arch Dis Child_

1992;67:366–373. Article  CAS  PubMed  PubMed Central  Google Scholar  * Evans N, Kluckow M, Currie A . Range of echocardiographic findings in term neonates with high oxygen requirements.

_Arch Dis Child Fetal Neonatal Ed_ 1998;708:F105–F111. Article  Google Scholar  * Naeye RL, Bernischke K, Hagstrom JWC, Marcus CC . Intrauterine growth of twins, as estimated from liveborn

birth weight data. _Pediatrics_ 1996;37:409–416. Google Scholar  * Lin CC, Santolaya-Forgas J . Current concepts of fetal growth restriction Part I. Causes, classification, and

pathophysiology. _Obstet Gynecol_ 1998;92:1044–1055. CAS  PubMed  Google Scholar  * Yagel S, Anteby Y, Shen O, Cohen SM, Friedman ZM, Achiron R . Placental blood flow measured by

simultaneous multigate spectral doppler imaging in pregnancies complicated by placental vascular anomalities. _Ultrasound obstet gynecol_ 1999;14:262–266. Article  CAS  PubMed  Google

Scholar  * Lackman F, Capewell V, Gagnon R, Richardson B . Fetal umbilical cord oxygen values and birth to placental weight ratio in relation to size at birth. _Am J Obstet Gynecol_

2001;185:674–682. Article  CAS  PubMed  Google Scholar  * Peliowski A, Finer NN, Etches PC, Tierney AJ, Ryan CA . Inhaled nitric oxide for premature infants after prolonged rupture of the

membranes. _J Pediatr_ 1995;126:450–453. Article  CAS  PubMed  Google Scholar  * Kourembanas S, Morita T, Christou H, et al. Hypoxic responses of vascular cells. _Chest_ 1998;114:25S–28S.

Article  CAS  PubMed  Google Scholar  * Tolsa JF, Muchlethaler V, Peyter AC . Late effects of perinatal hypoxia on the pulmonary circulation. _Pediatr Res_ 2003;54:607A. Google Scholar  *

Tsutsumi T, Ishii M, Eto G, Hota M, Kato H . Serial evaluation for myocardial performance in fetuses and neonates using a new doppler index. _Pediatr Int_ 1999;41:722–727. Article  CAS 

PubMed  Google Scholar  * Rizzo G, Capponi A, Rinaldo D, Arduini D, Romanini C . Ventricular ejection force in growth-retarded fetuses. _Ultrasound Obstet Gynecol_ 1995;5:247–255. Article 

CAS  PubMed  Google Scholar  * Gournay V, Savagnier C, Thiriez G, Kuster A, Roze JC . Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants. _Lancet_ 2002;359:1486–1488.

Article  CAS  PubMed  Google Scholar  * Clyman RI, Mauray F, Heymann MA, Roman C . Cardiovascular effects of patent ductus arteriosus in preterm lambs with respiratory distress. _J Pediatr_

1987;111:579–587. Article  CAS  PubMed  Google Scholar  * Van Meurs KP, Rhine WD, Asselin JM, Durand DJ, the Preemie NO Collaborative Group. Response of premature infants with severe

respiratory failure to inhaled nitric oxide. _Pediatr Pulmonol_ 1997;24:319–323. Article  CAS  PubMed  Google Scholar  * Cheung P-Y, Peliowski A, Robertson C . The outcome of very low birth

weight neonates (<1500 g) rescued by inhaled nitric oxide: neurodevelopment in early childhood. _J Pediatr_ 1998;133:735–739. Article  CAS  PubMed  Google Scholar  * Kinsella JP,

Walsh WF, Bose CL, et al. Inhaled nitric oxide in premature neonates with severe hypoxaemic respiratory failure: a randomised controlled trial. _Lancet_ 1999;354:1061–1065. Article  CAS 

PubMed  Google Scholar  * Schreiber MD, Gin-Mestan K, Marks JD, Huo D, Lee G, Srisuparp P . Inhaled nitric oxide in premature infants with the respiratory distress syndrome. _New Engl J Med_

2003;349:2099–2107. Article  CAS  PubMed  Google Scholar  * Chang AC, Atz AM, Wernowsky G, Redmond P, Wessel DL . Milrinone: systemic and pulmonary hemodynamic effects in neonates after

cardiac surgery. _Crit Care Med_ 1995;23:1907–1914. Article  CAS  PubMed  Google Scholar  * Bukowski R, Gahn D, Denning J, Saade G . Impairment of growth in fetuses destined to deliver

preterm. _Am J Obstet Gynecol_ 2001;185:463–467. Article  CAS  PubMed  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Neonatology, Bambino

Gesú Children's Hospital, Rome, Italy Olivier Danhaive MD * Division of Newborn Medicine, Children's Hospital, Boston, MA, USA Olivier Danhaive MD & Stella Kourembanas MD *

Department of Cardiology, Children's Hospital, Boston, MA, USA Renée Margossian MD & Tal Geva MD Authors * Olivier Danhaive MD View author publications You can also search for this

author inPubMed Google Scholar * Renée Margossian MD View author publications You can also search for this author inPubMed Google Scholar * Tal Geva MD View author publications You can also

search for this author inPubMed Google Scholar * Stella Kourembanas MD View author publications You can also search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints

and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Danhaive, O., Margossian, R., Geva, T. _et al._ Pulmonary Hypertension and Right Ventricular Dysfunction in Growth-Restricted, Extremely

Low Birth Weight Neonates. _J Perinatol_ 25, 495–499 (2005). https://doi.org/10.1038/sj.jp.7211299 Download citation * Published: 14 April 2005 * Issue Date: 01 July 2005 * DOI:

https://doi.org/10.1038/sj.jp.7211299 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not

currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative