J Matern Fetal Neonatal Med. 2019 Nov 19:1-211. doi: 10.1080/14767058.2019.1695770. [Epub ahead of print]
https://www.ncbi.nlm.nih.gov/pubmed/31744358
Pulmonary hypertension in paediatrics. A feasible approach to bridge the gap between real world and guidelines.
Giuseppe C#1, Pier Paolo B#2, Francesco B3, Francesco M4, Vassilios F#5, Francesco F3, Francesco R6.
Author information
Abstract
Pulmonary hypertension (PH) is quite infrequent in paediatric age and its most common aetiologies include idiopathic pulmonary arterial hypertension, PH related to congenital heart diseases, bronchopulmonary dysplasia (chronic lung disease), persistence of pulmonary hypertension of the newborn, and congenital diaphragmatic hernia. The developed for adult patients PH classification shows limitations when applied to paediatric subjects, since the underlying causes are markedly different between the two ages. In 2011, the Pulmonary Vascular Research Institute Panama Task Force outlined the first specific paediatric pulmonary hypertensive vascular disease diagnostic classification, including 10 main categories and 109 subcategories, thus testifying PH complex pathophysiology during newborns/children growth and development. The unique, distinctive features of paediatric PH were recognized also during the fifth World Symposium on Pulmonary hypertension in 2013 and then confirmed in the recent 2018 sixth World Symposium. For the sake of uniformity, an attempt to adapt the adult classification to paediatric patients was made. However, all these commendable classifications are very complex and may be not of quick comprehension for clinicians. A clinical simpler and simplified method is now suggested, comprising only five groups: Neonatal, Cardiac, Developmental, Idiopathic, and Syndromic PH. This approach is not aimed at replacing the already existing classifications, but is mainly based on the kind of specialized physician (neonatologist, paediatric cardiologist, paediatrician, pulmonologist, general practitioner) who first faces and looks after the child with suspected PH. What is dramatically known is that paediatric PH is a severe disease which, when untreated or undertreated, may lead to increased morbidity and mortality.
KEYWORDS:
Children; congenital heart disease; newborns; pulmonary arterial hypertension; pulmonary hypertension; right heart catheterizationPMID: 31744358 DOI: 10.1080/14767058.2019.1695770
