Physiology-Based Diagnosis and Management of Bronchopulmonary Dysplasia Associated Pulmonary Hypertension (BPD-PH)

TL;DR

This review discusses the evolving understanding of BPD-PH in preterm infants and proposes a physiology-based approach for diagnosis and management.

Contribution

The paper introduces a pragmatic algorithm for screening and managing BPD-PH based on physiological markers.

Findings

BPD-PH is linked to higher mortality and worse outcomes in preterm infants.

Impaired pulmonary vascular development is central to BPD-PH pathophysiology.

Echocardiographic markers help classify BPD-PH for targeted management.

Abstract

Bronchopulmonary dysplasia (BPD) remains a major long-term morbidity among preterm infants. As lung-protective strategies advance and survival of extremely premature neonates improves, BPD has evolved from a ventilator-induced inflammatory and fibrotic process to a disease marked by arrested pulmonary vascular and alveolar development—pulmonary vascular disease. Within this evolving phenotype, pulmonary hypertension (PH) has emerged as a critical yet underrecognized complication. BPD-associated pulmonary hypertension (BPD-PH) is increasingly linked to higher mortality and worse clinical outcomes, but its pathophysiology, screening strategies to detect early changes, and optimal management remain incompletely understood. This review delineates the pathophysiology of BPD-PH, linking impaired pulmonary vascular development with subsequent maladaptation influenced by genetic, prenatal, and postnatal factors. The phenotypic and hemodynamic spectrum of BPD-PH is further subclassified using echocardiographic markers to support a physiology-based approach to diagnosis and management. We also propose a pragmatic algorithm for screening, evaluation, and longitudinal follow-up. Collectively, this review highlights the need for physiology-driven strategies and clinical studies to improve outcomes in these neonates.

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