P2C176: Early Cardiac Dysfunction and Neurodevelopmental Outcome in Infants with Pulmonary Hypertension

Background: The mortality rate associated with pulmonary hypertension (PH) of the newborn ranges from 4% to 33%, 25% of infants who survive experience neurodevelopmental impairment. Right Ventricular (RV) systolic function has been described as a good predictor of PH severity, specifically fractional area change (RVFAC) has shown to correlate with respiratory support, need of ECMO and mortality. The objective of this study is to test the hypothesis that infants with PH who have RV systolic dysfunction will have a higher incidence of neurodevelopmental impairment and increased risk for short-term morbidities, compared to gestational age matched controls with PH without RV systolic dysfunction.

Methods: We performed a retrospective, single-center cohort study on infants born at ≥ 32 weeks’ gestation between 2015 and 2021 with echocardiogram confirmed diagnosis of PH within the first 28 days of life, and neurodevelopmental testing performed at either 3 months, 1 year or 2 years corrected age at our Neonatal Continuity Clinic. Infants transferred to VCU after 7 days of life, and those who had severe lethal malformation were excluded. Analysis of the infants’ echocardiograms was performed according to a standardized protocol by the pediatric cardiology team, who was blinded to the patients’ records. Statistical analyses including Fisher’s exact test and Mann-Whitney U, were performed in Stata version 16.1 (Stata Corp).

Results: 2192 infants were included in our study, out of which 95 were confirmed to have PH via echocardiogram within their first 28 days of life. Of these 95 infants with PH, 25 (26.3%) had neurodevelopmental testing. From this group of 25 infants, 10 infants had PH and RV systolic dysfunction, meeting criteria for cases, and these were matched with 10 controls. The RV fractional area change (RVFAC) was used as a surrogate marker for RV systolic dysfunction, this was not significantly different between cases and controls, p=0.32. Neurodevelopmental impairment was not statistically different between cases and controls, (50% vs 40%, p=1.0), and there was no significant association between RVFAC and neurodevelopmental delay, p=1.0. Although not significant, cases were noted to have a longer mean duration of mechanical ventilation (21 vs 9.8 days, p=0.08), time on ECMO (6.4 vs 3.3 days, p= 0.59), and length of stay (49.8 vs 31.6 days, p=0.18).

Conclusion: Our findings suggest that RV systolic dysfunction in infants with PH does not increase the risk for neurodevelopmental impairment. Higher rate of neurodevelopmental delay in infants with PH (45%) was observed in our sample, which highlighted the importance of standardized neurodevelopmental testing after their NICU stay. In our future work we will expand our sample size and control for confounding factors including hypoxic ischemic encephalopathy, sedation use, and ECMO.