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.