Sepúlveda-Ramos Orlando Aldair; López-Zarco Maridelia; Flores-Pulido, Andrey Arturo

ABSTRACT

Introduction: pulmonary arterial hypertension (PAH) is a major complication in pediatric patients with Down syndrome (DS) and congenital heart disease (CHD). However, evidence regarding factors associated with its development is limited, particularly in the Latin American population. Objective: to identify clinical, perinatal, and echocardiographic factors associated with PAH in pediatric patients with DS and CHD. Material and methods: a retrospective, analytical, crosssectional study was conducted on patients aged ≤ 2 years, comparing variables of interest using bivariate analysis and multivariate logistic regression. Results: a total of 112 patients were analyzed, 66 (58.9%) of whom presented with PAH. These patients underwent the corrective procedure at an older age (p = 0.001) and also exhibited lower peripheral oxygen saturation (p = 0.001), greater growth retardation (p = 0.012), lower gestational age (p = 0.002), and a higher frequency of prolonged neonatal hospitalization (p = 0.041) and invasive mechanical ventilation for ≥ 7 days (p = 0.006). They also presented with higher systolic pulmonary artery pressure (p = 0.001), right ventricular hypertrophy (p = 0.033), interventricular septal flattening (p = 0.002), and reduced tricuspid annulus displacement (p = 0.04). In the multivariable analysis, only oxygen saturation ≤ 93% (OR 46.58; 95%CI 13.10-165.69) and invasive mechanical ventilation for ≥ 7 days (OR 8.40; 95%CI 1.32-53.46) remained associated with PAH, while growth retardation remained borderline (OR 3.29; 95% CI 1.00-10.87) and gestational age ≤ 35 weeks lost significance (OR 1.41; 95%CI 0.39-5.05). Conclusions: our results suggest that integrating neonatal history with clinical, nutritional, and echocardiographic assessments during follow-up could facilitate the development of early detection strategies and personalized medicine for this high-risk pediatric population.

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