Atrial Septal Defect Closure Is Associated With Improved Clinical Status in Patients ≤ 10 kg With Bronchopulmonary Dysplasia

Authors

Melissa K Webb
Milenka Cuevas Guaman
S Kristen Sexson Tejtel
Neil Cambronero
Ryan D Coleman
Corey A Chartan
Betul Yilmaz Furtun
Shaine A Morris
Nidhy P Varghese
Natalie M Villafranco

Publication Date

10-1-2023

Journal

Pulmonary Circulation

DOI

10.1002/pul2.12299

PMID

37868716

PMCID

PMC10588322

PubMedCentral® Posted Date

10-20-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

neonatal lung disease & BPD, pediatrics, pulmonary hypertension

Abstract

Patients with bronchopulmonary dysplasia (BPD) have shown clinical improvement after secundum atrial septal defect (ASD) closure. We sought to determine if this post‐ASD closure improvement is secondary to the expected course in BPD patients or related to the closure itself. A novel BPD‐ASD score was created to assess patients' clinical status (higher score = worse disease) and applied to 10 BPD‐ASD inpatients weighing ≤ 10 kg who underwent ASD closure. The score and its subcomponents were retrospectively calculated serially ranging from 8 weeks pre‐ to 8 weeks post‐intervention, and pre‐ and post‐intervention score slopes were created. These slopes were compared using mixed regression modeling with an interaction term. There was a significant difference in pre‐ versus post‐intervention slope with the most score drop the first week post‐intervention (−2.1 + /− 0.8, p = 0.014). The mean score also dropped through weeks 2 (slope −0.8 + /− 0.8, p = 0.013) and 4 (slope −1.0 + /− 0.5, p = 0.001) post‐intervention. There was a significant difference in pre‐ and post‐intervention slopes for diuretics (p = 0.018) and the combined score of respiratory support, FiO2 need, and respiratory symptoms (p = 0.018). This study demonstrated significant improvement in BPD‐ASD score, diuretic need, and respiratory status after ASD closure in BPD‐ASD patients ≤ 10 kg that was outside of the natural course of BPD. Our study was limited by its small, single‐center, retrospective nature. Future studies should be performed in a larger multicenter population to both validate the scoring system and compare to non‐intervention infants.