Pulmonary hypertension in extremely low birth weight infants:characteristics and outcomes

Background:To determine the characteristics and outcomes of pulmonary arterial hypertension(PAH)in extremely low birth weight(ELBW)infants.Methods:A retrospective case-control study of all ELBW infants admitted to a level III neonatal intensive care unit(NICU)between January 1,2003 and December 31,2010.Results:During the study period,450 ELBW infants were admitted.6.4%(29/450)were diagnosed with PAH and were matched to 26 controls.The mean gestational age of infants with PAH and their controls were similar[24.5±1.3 vs.24.9±1.8 weeks(P=0.26)];however the cases were smaller at birth than were controls[640.7±119.5 vs.727.0±184.5 g(P=0.04)].The diagnosis of PAH was made at a mean postnatal age of 131.8±53.7 days.Infants with PAH had a higher rate of intrauterine exposure to illicit maternal drug use[12/29(41%)vs.1/25(4%);P=0.001],a longer duration of initial mechanical ventilation[74.9±28.3 vs.59.1±27.8 days;(P=0.04)],a higher incidence of severe BPD[23/29(79%)vs.13/26(50%);P=0.02],and a greater NICU mortality rate[12/29(41%)vs.4/26(15%);P=0.04].Conclusion:PAH in ELBW infants is associated with maternal illicit drug use in pregnancy,longer exposure to mechanical ventilation,severe bronchopulmonary dysplasia and a significant increase in early mortality.

Improving health care usage in a very low birth weight population

Background:Prematurity is the biggest contributor to admissions in the neonatal intensive care unit(NICU).The period following hospital discharge is a vital continuum for the very low birth weight(VLBW)infant The objective of this study was to assess the impact of a unique discharge and follow-up process on the outcomes of VLBW infants leaving the NICU.Methods:All outpatient health care usage by VLBW infants born in the study year(cases)was retrospectively tracked through 12 months of age.A cohort of healthy newborn infants were matched by birthdate to each VLBW infant(controls)and similarly tracked.Results:In this study,there were 85 cases and 85 controls.The mean gestational age at birth for the cases was 29.1±2.7 weeks with a mean birth weight of 1079±263 g.That of the controls was 38.9±13 weeks and 3202±447 g.Over 90%of both populations had Medicaid coverage.All VLBW infants received care at the Special Care Developmental Follow-Up Clinic.When compared with the controls,VLBW infants discharged from the NICU made fewer acute,unscheduled visits to the Emergency Department or Urgent Care Clinic(2.3±2.5 vs.3.7±3.5;P=0.007)despite their high-risk medical and social status.Their growth pattern showed significant"catch-up"and was similar to the matched controls at the last scheduled visit for each group.Conclusions:Outcomes including health care utilization in high-risk infants can be improved through meticulous discharge planning and follow-up measures that utilize existing hospital infrastructure to provide affordable comprehensive care.