Hospitalizations and outcomes in extremely premature infants with bronchopulmonary dysplasia and pulmonary hypertension at 5 years.

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in premature infants and is frequently complicated by pulmonary hypertension (PH), which worsens prognosis and increases healthcare utilization. Long-term outcomes beyond 1 year for extremely premature infants (< 28 weeks gestation) with BPD and PH remain poorly characterized. We conducted a single-center retrospective review of infants born < 28 weeks gestation between January 2012 and April 2016, diagnosed with BPD and discharged on home oxygen. Patients were stratified by the presence or absence of PH, defined by echocardiographic criteria. Outcomes assessed through 5 years post-NICU discharge included hospital readmissions, emergency department (ED) visits, duration of home oxygen, and mortality. Among 175 infants (mean gestational age 25.3 weeks), 84 (48%) had PH. Compared to those without PH, infants with PH had lower birth weight (677 g vs. 772 g, P = 0.0006), longer NICU stay (median 109.5 vs. 88 days, P = 0.002), and more frequent tracheostomy (20.2% vs. 8.8%, P = 0.03). At 5 years, PH patients were more likely to have ≥ 1 hospitalization (71.4% vs. 48.4%, P = 0.002) and had higher median readmissions (2 vs. 0, P < 0.0001). ED visit frequency and mortality did not differ significantly. Most PH resolved by one year post-discharge. WHAT IS KNOWN: • In patients with BPD, PH has been associated with increase hospitalizations by one year of age compared to non-PH infants. WHAT IS NEW: • This study follows premature infants with BPD and PH for 5 years to decribe their clinical outcome.Premature infants with BPD and PH requrie more healthcare resources than those without PH. There is an ongoing need for tragetedoutpatient strategies to reduce long-term morbidity. CONCLUSIONS: Extremely premature infants with BPD and PH experience greater healthcare utilization up to 5 years despite PH resolution in most cases. These findings highlight the need for targeted outpatient strategies to reduce long-term morbidity in this high-risk population.