Asunto(s)
Insuficiencia Cardíaca , Trasplante de Células Madre Hematopoyéticas , Derrame Pleural , Insuficiencia Renal , Insuficiencia Respiratoria , Niño , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Derrame Pleural/etiología , Insuficiencia Renal/etiología , Insuficiencia Renal/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapiaRESUMEN
OBJECTIVE: To investigate racial and ethnic differences in pulmonary hypertension subtypes and survival differences in a pediatric population. STUDY DESIGN: This was a retrospective analysis of a cohort of patients with pulmonary hypertension (aged ≤18 years) enrolled in the Pediatric Pulmonary Hypertension Network registry between 2014 and 2018, comprising patients at eight Pediatric Centers throughout North America (n = 1417). RESULTS: Among children diagnosed after the neonatal period, pulmonary arterial hypertension was more prevalent among Asians (OR, 1.83; 95% CI, 1.21-2.79; P = .0045), lung disease-associated pulmonary hypertension among blacks (OR, 2.09; 95% CI, 1.48-2.95; P < .0001), idiopathic pulmonary arterial hypertension among whites (OR, 1.58; 95% CI, 1.06-2.41; P = .0289), and pulmonary veno-occlusive disease among Hispanics (OR, 6.11; 95% CI, 1.34-31.3; P = .0184). Among neonates, persistent pulmonary hypertension of the newborn (OR, 4.07; 95% CI, 1.54-10.0; P = .0029) and bronchopulmonary dysplasia (OR, 8.11; 95% CI, 3.28-19.8; P < .0001) were more prevalent among blacks, and congenital diaphragmatic hernia was more prevalent among whites (OR, 2.29; 95% CI, 1.25-4.18; P = .0070). An increased mortality risk was observed among blacks (HR, 1.99; 95% CI, 1.03-3.84; P = .0396), driven primarily by the heightened mortality risk among those with lung disease-associated pulmonary hypertension (HR, 2.84; 95% CI, 1.15-7.04; P = .0241). CONCLUSIONS: We found significant racial variability in the prevalence of pulmonary hypertension subtypes and survival outcomes among children with pulmonary hypertension. Given the substantial burden of this disease, further studies to validate phenotypic differences and to understand the underlying causes of survival disparities between racial and ethnic groups are warranted.
Asunto(s)
Pediatría/métodos , Hipertensión Arterial Pulmonar/etnología , Sistema de Registros , Adolescente , Negro o Afroamericano , Niño , Preescolar , Etnicidad , Femenino , Hispánicos o Latinos , Humanos , Lactante , Recién Nacido , Masculino , América del Norte/epidemiología , Prevalencia , Hipertensión Arterial Pulmonar/diagnóstico , Hipertensión Arterial Pulmonar/mortalidad , Grupos Raciales , Análisis de Regresión , Reproducibilidad de los Resultados , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Población BlancaRESUMEN
Long-term survivors of bronchopulmonary dysplasia develop chronic obstructive lung disease. Herein we report in vivo histopathology from bronchial biopsies of 3 adolescent survivors of severe bronchopulmonary dysplasia. Thickened basement membranes with lymphocytic infiltrates and signs of immature neoangiogenesis in the absence of T-helper lymphocytes or eosinophils suggest the presence of an ongoing active airway process.