Value of Echocardiography in Assessing the Outcome of Bronchopulmonary Dysplasia of the Newborn

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Abstract
Cardiac catheterization of infants with bron-chopulmonary dysplasia has shown right ventricular hypertrophy and pulmonary hypertension in the majority of the survivors. This study was planned to determine whether serial echocardiographic assessments of the pulmonary vascular bed could help to establish short-term prognosis of bronchopulmonary dysplasia and to evaluate myocardial function of the survivors. Ten preterm infants were included in this study. They were classified according to four radiologic stages. A total of 50 echocardiographs were recorded allowing serial measurements of the right systolic time intervals. All infants that eventually expired had a ratio of the preejection period to the ejection time of the right ventricle above 0.3 prior to death (five patients). Infants with normal right preejection period to right ejection time ratio had a good out-come despite persistence of abnormal lung x-rays (four patients). Persistence of O2 dependence with abnormal right systolic time intervals after three months of life eventually led to death (two patients) or serious pulmonary insufficiency (one patient). The lungs as seen on chest x-rays of this patient remained unchanged (moderate stage IV) during six months, while the echocardiograph showed a progressive increase in right preejection period to right ejection time ratio. This infant has now developed cor pulmonale. Myocardial function evaluated on the last echocardiograph of the four infants who were considered cured was within normal limits. In conclusion, indirect assessment of pulmonary pressure by echocardiography can be used for clinical evaluation and ultimate prognosis of bronchopulmonary dysplasia and should be part of the follow-up evaluation of infants suffering from this disease.