Association of Right Ventricular Dysfunction with Risk of Neurodevelopmental Impairment in Infants with Pulmonary Hypertension

Author:

Romero Orozco Rossana1ORCID,Mohammed Tazuddin A.12ORCID,Carter Kerri12,Brown Shaaron3,Miller Stephen2ORCID,Sabo Roy T.4,Joseph Meredith Campbell5,Truong Uyen6,Nair Megha2,Anderson Victoria7,Xu Jie2,Voynow Judith A.12ORCID,Hendricks-Muñoz Karen D.12

Affiliation:

1. Department of Pediatrics, Children’s Hospital of Richmond at VCU, Virginia Commonwealth University, Richmond, VA 23298, USA

2. Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA

3. Department of Physical Therapy, Children’s Hospital of Richmond at VCU, Virginia Commonwealth University, Richmond, VA 23298, USA

4. Department of Biostatistics, School of Public Health, Virginia Commonwealth University, Richmond, VA 23219, USA

5. Department of Pediatrics, UF Health Shands Children’s Hospital, University of Florida, Gainesville, FL 32610, USA

6. Department of Pediatrics, Children’s National Hospital, Washington, DC 20010, USA

7. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA

Abstract

(1) Background: Pulmonary hypertension (PH) increases pulmonary vascular resistance and right ventricular (RV) afterload. Assessment of RV systolic function in PH using RV fractional area change (RV FAC) as a marker directly correlates with mortality and the need for extracorporeal membrane oxygenation (ECMO). However, few studies have assessed neurodevelopmental outcomes. We hypothesize that cardiac RV systolic dysfunction with lower RV FAC is associated with worse neurodevelopmental impairment (NI). (2) Methods: Retrospective study of 42 subjects with PH to evaluate neurodevelopmental outcomes in the first two years of life based on (i) subjective assessment of RV systolic function and (ii) RV FAC, a specific echocardiographic marker for RV function. (3) Results: Subjects from the initial study cohort (n = 135) with PH who had long-term follow-up were divided into RV dysfunction (study, n = 20) and non-RV dysfunction (control, n = 22) groups. RV FAC in the study vs. control group (0.18 vs. 0.25) was lower (p = 0.00017). There was no statistically significant difference in NI either with RV dysfunction or lower RV FAC. Although not significant, RV dysfunction was associated with longer mean duration of mechanical ventilation, time on ECMO, and length of stay. In the initial cohort (135), mortality was 16.3% and the percentage of NI was 62%. (4) Conclusions: Neonatal pulmonary hypertension is associated with a high degree of neurodevelopment impairment. Early RV systolic dysfunction, as identified by RV FAC, was not an optimal predictive biomarker for infants with PH and neurodevelopmental impairment.

Funder

the Children’s Hospital of Richmond

he Biostatistics, Epidemiology and Research Design

the National Center for Advancing Translational Sciences

Publisher

MDPI AG

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