Targeted Neonatal Echocardiography in Bronchopulmonary Dysplasia: A Framework for Screening and Management of Chronic Pulmonary Hypertension

Chronic pulmonary hypertension (cPH) associated with bronchopulmonary dysplasia (BPD) is a major contributor to morbidity and mortality in extremely preterm infants. Despite improvements in neonatal care, the burden of BPD and its pulmonary vascular complications remains significant. Early detection and standardized management of cPH are essential to improve outcomes. Echocardiography plays a central role in screening and guiding treatment, particularly in high-risk infants requiring respiratory support at or beyond 36 weeks postmenstrual age. The Targeted Neonatal Echocardiography—Quebec (TnECHO-Qc) collaborative has developed a province-wide screening and management algorithm for cPH in preterm infants with BPD. This initiative outlines a stepwise approach to echocardiographic evaluation, including specific criteria for identifying elevated pulmonary arterial pressures, grading severity, and scheduling follow-up based on clinical and imaging findings. Additional management elements encompass biomarker use, respiratory and nutritional optimization, and consideration of airway anomalies, reflux, and aspiration. Pharmacologic therapies, including inhaled nitric oxide and pulmonary vasodilators, are considered for moderate to severe cPH with a pre-capillary component (“pulmonary arterial hypertension”) after stabilization of ventilation and oxygenation, and guided by echocardiography follow-up. This collaborative initiative establishes a standardized, multidisciplinary framework to enable timely recognition and individualized management of chronic pulmonary hypertension (cPH) in preterm infants. The primary goal is to reduce adverse outcomes and support long-term health, with the effectiveness of the framework to be evaluated through longitudinal outcome assessments.