Pulmonary Hypertension Screening in Patients with Bronchopulmonary Dysplasia Clinical Pathway — ICU and Inpatient

Echocardiogram Screening and Evidence of Pulmonary Hypertension

Considerations for Echocardiogram Screening

Infants with BPD are at risk for pulmonary hypertension. The development of pulmonary hypertension contributes to the higher rates of morbidity and mortality in this population.
Routine PH screening is not indicated for premature infants at 36 weeks PMA without BPD.
If an infant without BPD develops signs and symptoms that may be consistent with PH, including the development of a need for respiratory support after 36 weeks PMA, consider obtaining an echocardiogram as PH may be present in these infants.
BNP is not indicated as part of the screening process for PH.
There are some limitations in the use of echocardiogram as a screening test for PH, and the timing of disease development is not entirely understood.
Incidence of PH is highest in infants with grade 2-3 BPD; therefore, repeat screens are recommended regularly for this subset of infants with BPD.
PH in patients with BPD can develop after 36 weeks PMA.

Echocardiogram Evidence of Pulmonary Hypertension (PH)

Evidence of PH	Right ventricular (RV) pressure estimate by tricuspid valve regurgitant velocity > 40 mmHg or > 1/2 systemic systolic pressure Ventricular septal flattening or bowing position Bi-directional or right-to-left flow at the PDA Evidence of pulmonary vein stenosis
Supporting Evidence	Right ventricular dysfunction Right atrial or ventricular enlargement Right ventricular hypertrophy Bi-directional or right-to-left flow at the PFO or ASD

Role of Cardiology Consultation

Formal consultation can be determined by local routine and obtain guidance on need for treatment, additional testing or follow-up.
For an echocardiogram obtained close to discharge, completion of cardiology consultation could occur as outpatient if an option for outpatient follow-up is available.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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