Pulmonary Hypertension Growing Problem Among U.S. Children

A hefty increase in hospitalization rates for children with a form of high blood pressure once most common in those with congenital heart disease has been found by a review of 15 years’ worth of data in a national pediatric medical database.

Johns Hopkins researchers reporting on the analysis say hospitalizations nationwide for pulmonary hypertension (PH) overall doubled between 1997 and 2012, with national hospital charges to treat the children rising from the millions to the billions of dollars. The report also showed a majority of those hospitalized in 2012 did not have congenital heart diseases.

Overall, pulmonary hypertension in children is still relatively rare. Although the precise incidence and prevalence of pediatric pulmonary hypertension is not well-known, United Kingdom and Netherlands registry data give an incidence for idiopathic pulmonary hypertension (IPAH) of 0.48–0.7 cases per million, respectively.

More Extreme Preemies Surviving

Pediatric cardiologist Melanie K. Nies, M.D., an assistant professor of pediatrics at the Johns Hopkins University School of Medicine and faculty member at the Johns Hopkins Children’s Center, says:

“Though the reason for the trend of increased hospitalization is not entirely clear, it likely reflects several components, including better recognition of PH, broader inclusion of patients with PH and a growing population of patients who survived extreme prematurity, a risk factor for PH.”

As researchers had suspected, Nies explains, the latest reported data show that patients without congenital heart defects in 2012 accounted for the majority of PH hospitalizations, at 56.4 percent, compared to 43.6 percent for patients with congenital heart defects.

Calls For National Registry

One surprise from their analysis, she adds, is that only 33.9 percent of hospitalizations for PH were at children’s hospitals, even though these specialized centers are often the best equipped to deal with this condition.

“That there’s a growing population of pediatric pulmonary hypertension patients is something that we suspected,” she says, “but actually having the data to back it up will be important for resource allocation and promoting the best multidisciplinary care for these medically fragile patients.”

Nies says there is a need for a national registry to track patient outcomes over time and to provide a foundation for clinical trials to test new treatments.

Pulmonary hypertension is an increase of blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, leg swelling and other symptoms.

Bryan G. Maxwell, Melanie K. Nies, Chinwe C. Ajuba-Iwuji, John D. Coulson, and Lewis H. Romer
Trends in Hospitalization for Pediatric Pulmonary Hypertension
Pediatrics 2015; 136:241-250 doi: 10.1542/peds.2014-3834

Photo: by Steve Ford Elliott CC BY 2.0