Tailoring Therapy to Bronchopulmonary Dysplasia Phenotype: A Ten-Year Experience in Precision Medicine

Aims: To assess the impact of systemic afterload reduction on cardiorespiratory health in infants with a severe bronchopulmonary dysplasia (BPD)–systemic hypertension–left heart dysfunction (LHD) phenotype. Methods: Ten-year data were prospectively collected and analysed. The cohort included extremely preterm infants with severe BPD–systemic hypertension–LHD pathophysiology, treated with systemic afterload reduction with captopril. Main outcome measures included improvement in oxygenation and echocardiographic measures of LHD. Results: Twenty-six infants with gestation of 26.5 ± 2 weeks and median (interquartile range) birthweight of 900 (582, 1083) g were administered captopril at the corrected gestation median (range) of 40 weeks (37–67). On reassessment after five weeks, oxygen requirements (43 ± 16% to 26 ± 7%, p = 0.0001) and paired pCO2 decreased (64 ± 9 to 53 ± 9 mm Hg, p = 0.0001). Significant improvements were seen in cardiac indices (diastolic: trans-mitral E/A ratio [1 ± 0.07 to 0.94 ± 0.07, p = 0.0004] and iso-volumic relaxation time [ms] [65 ± 3 to 56 ± 4, p < 0.0001], and systolic: mean velocity of circumferential fibre shortening [circ/s] [1.6 ± 0.2 to 1.9 ± 0.2, p < 0.0001] and left ventricular output [mL/kg/min] [177 ± 34 to 230 ± 54, p = 0.0002]). This coincided with improved aortic pulsatility (40 ± 13 to 50 ± 11 µm, p = 0.005). Conclusions: Systemic hypertension–LHD pathology amongst infants with severe BPD may be under-recognised. Systemic afterload reduction is physiologically suited in a subset of infants with severe BPD.