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The Journal of Pediatrics Feb 2017
Topics: Bronchopulmonary Dysplasia; Humans; Infant Care; Infant, Newborn; Infant, Premature; Patient Care Team; Respiration, Artificial; Tracheostomy
PubMed: 27908648
DOI: 10.1016/j.jpeds.2016.10.082 -
Pediatrics Jul 2021The National Institute of Child Health and Human Development Neonatal Research Network recently proposed new, severity-based diagnostic criteria for bronchopulmonary...
BACKGROUND AND OBJECTIVES
The National Institute of Child Health and Human Development Neonatal Research Network recently proposed new, severity-based diagnostic criteria for bronchopulmonary dysplasia (BPD). This study provides the first benchmark epidemiological data applying this definition.
METHODS
Retrospective cohort study of infants born from 22 to 29 weeks' gestation in 2018 at 715 US hospitals in the Vermont Oxford Network. Rates of BPD, major neonatal morbidities, and common respiratory therapies, stratified by BPD severity, were determined.
RESULTS
Among 24 896 infants, 2574 (10.3%) died before 36 weeks' postmenstrual age (PMA), 12 198 (49.0%) did not develop BPD, 9192 (36.9%) developed grade 1 or 2 BPD, and 932 (3.7%) developed grade 3 BPD. Rates of mortality before 36 weeks' PMA and grade 3 BPD decreased from 52.7% and 9.9%, respectively, among infants born at 22 weeks' gestation to 17.3% and 0.8% among infants born at 29 weeks' gestation. Grade 1 or 2 BPD peaked in incidence (51.8%) among infants born at 25 weeks' gestation. The frequency of severe intraventricular hemorrhage or cystic periventricular leukomalacia increased from 4.8% among survivors without BPD to 23.4% among survivors with grade 3 BPD. Similar ranges were observed for late onset sepsis (4.8%-31.4%), surgically treated necrotizing enterocolitis (1.4%-17.1%), severe retinopathy of prematurity (1.2%-23.0%), and home oxygen therapy (2.0%-67.5%).
CONCLUSIONS
More than one-half of very preterm infants born in the United States died before 36 weeks' PMA or developed BPD. Greater BPD severity was associated with more frequent development of major neonatal morbidities, in-hospital mortality, and use of supplemental respiratory support at discharge.
Topics: Bronchopulmonary Dysplasia; Cerebral Intraventricular Hemorrhage; Gestational Age; Humans; Incidence; Infant; Infant, Newborn; Infant, Premature; Leukomalacia, Periventricular; Retrospective Studies; Severity of Illness Index; Vermont
PubMed: 34078747
DOI: 10.1542/peds.2020-030007 -
Respiratory Research Feb 2023Ibuprofen is a nonsteroidal anti-inflammatory drug that is commonly used to stimulate closure of a patent ductus arteriosus (PDA) in very premature infants and may lead...
BACKGROUND
Ibuprofen is a nonsteroidal anti-inflammatory drug that is commonly used to stimulate closure of a patent ductus arteriosus (PDA) in very premature infants and may lead to aberrant neonatal lung development and bronchopulmonary dysplasia (BPD).
METHODS
We investigated the effect of ibuprofen on angiogenesis in human umbilical cord vein endothelial cells (HUVECs) and the therapeutic potential of daily treatment with 50 mg/kg of ibuprofen injected subcutaneously in neonatal Wistar rat pups with severe hyperoxia-induced experimental BPD. Parameters investigated included growth, survival, lung histopathology and mRNA expression.
RESULTS
Ibuprofen inhibited angiogenesis in HUVECs, as shown by reduced tube formation, migration and cell proliferation via inhibition of the cell cycle S-phase and promotion of apoptosis. Treatment of newborn rat pups with ibuprofen reduced pulmonary vessel density in the developing lung, but also attenuated experimental BPD by reducing lung inflammation, alveolar enlargement, alveolar septum thickness and small arteriolar wall thickening.
CONCLUSIONS
In conclusion, ibuprofen has dual effects on lung development: adverse effects on angiogenesis and beneficial effects on alveolarization and inflammation. Therefore, extrapolation of the beneficial effects of ibuprofen to premature infants with BPD should be done with extreme caution.
Topics: Infant, Newborn; Animals; Rats; Humans; Ibuprofen; Endothelial Cells; Animals, Newborn; Rats, Wistar; Lung; Bronchopulmonary Dysplasia; Hyperoxia
PubMed: 36732726
DOI: 10.1186/s12931-023-02342-4 -
The European Respiratory Journal May 2020
Topics: Bronchopulmonary Dysplasia; Crime; Dysbiosis; Gastrointestinal Microbiome; Humans; Infant; Infant, Newborn; Infant, Premature
PubMed: 32381633
DOI: 10.1183/13993003.00551-2020 -
Respiratory Care Sep 2009Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease that results from complications related to the lung injury during the treatment of...
Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease that results from complications related to the lung injury during the treatment of respiratory distress syndrome, or develops in older infants when abnormal lung growth occurs. The definition and classification of BPD have changed since the original diagnosis was established many years ago. The incidence of BPD continues to grow as lower-birth-weight infants continue to survive. The primary focus of all treatment associated with premature infants is on prevention of BPD. Surfactant replacement, invasive and noninvasive ventilation techniques, management of the patent ductus arteriosus, cautious management of oxygen therapy, caffeine, inhaled nitric oxide, and changes in delivery room practices have been studied to assess their effects on the development of the disease. Other strategies used to reduce the long-term effects of this chronic lung disease include bronchodilators, inhaled and systemic steroids, nutrition management, and selected ventilator strategies. The prevention of BPD is targeted at minimizing effects of this pulmonary disease and preventing the long-term sequelae associated with its treatment.
Topics: Bronchodilator Agents; Bronchopulmonary Dysplasia; Humans; Infant, Newborn; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Pulmonary Surfactants; Steroids
PubMed: 19712501
DOI: No ID Found -
Gene Dec 2018With the progress of modern medicine, oxygen therapy has become a crucial measure for the treatment of premature infants. As an environmental stimulus, in the normal... (Review)
Review
With the progress of modern medicine, oxygen therapy has become a crucial measure for the treatment of premature infants. As an environmental stimulus, in the normal development of lungs, oxygen plays a very important regulatory role. However, the problem is that long-term exposure to hyperoxia can interfere with the development of lungs, leading to irreversible developmental abnormalities. Now, the incidence of bronchopulmonary dysplasia (BPD) is increasing year by year. The existing related research shows that although BPD is a multi-factor triggered disease, its main risk factors are the premature exposure to hyperoxia and the role of reactive oxygen species (ROS). As for premature infants, especially very premature babies and those with very low birth weight, prolonged exposure to high oxygen can affect and alter the normal developmental trajectories of lung tissue and vascular beds, triggering developmental disorders, such as BPD. In the relevant studies about human BPD, a large number of them support that ROS is associated with impaired lung development. Neonates, due to the damage in the development of alveolar, are specific to hyperoxia-induced inflammatory damage. This review while focusing on the role of oxidative stress in the pathogenesis of BPD, suggests that antioxidant measures may be effective to guard against BPD of preterm infants.
Topics: Age Factors; Antioxidants; Bronchopulmonary Dysplasia; Cohort Studies; Humans; Infant, Premature; Oxidative Stress; Reactive Oxygen Species
PubMed: 30098433
DOI: 10.1016/j.gene.2018.08.031 -
International Journal of Molecular... Jul 2023Bronchopulmonary dysplasia (BPD) is a chronic lung disease commonly seen in preterm infants, and is triggered by infection, mechanical ventilation, and oxygen toxicity.... (Review)
Review
Bronchopulmonary dysplasia (BPD) is a chronic lung disease commonly seen in preterm infants, and is triggered by infection, mechanical ventilation, and oxygen toxicity. Among other problems, lifelong limitations in lung function and impaired psychomotor development may result. Despite major advances in understanding the disease pathologies, successful interventions are still limited to only a few drug therapies with a restricted therapeutic benefit, and which sometimes have significant side effects. As a more promising therapeutic option, mesenchymal stem cells (MSCs) have been in focus for several years due to their anti-inflammatory effects and their secretion of growth and development promoting factors. Preclinical studies provide evidence in that MSCs have the potential to contribute to the repair of lung injuries. This review provides an overview of MSCs, and other stem/progenitor cells present in the lung, their identifying characteristics, and their differentiation potential, including cytokine/growth factor involvement. Furthermore, animal studies and clinical trials using stem cells or their secretome are reviewed. To bring MSC-based therapeutic options further to clinical use, standardized protocols are needed, and upcoming side effects must be critically evaluated. To fill these gaps of knowledge, the MSCs' behavior and the effects of their secretome have to be examined in more (pre-) clinical studies, from which only few have been designed to date.
Topics: Infant, Newborn; Animals; Humans; Bronchopulmonary Dysplasia; Infant, Premature; Lung; Stem Cells; Mesenchymal Stem Cells; Mesenchymal Stem Cell Transplantation
PubMed: 37446407
DOI: 10.3390/ijms241311229 -
Early Human Development May 2023There is lack of evidence synthesis on the global consequences of bronchopulmonary dysplasia (BPD) in adolescence. (Review)
Review
BACKGROUND
There is lack of evidence synthesis on the global consequences of bronchopulmonary dysplasia (BPD) in adolescence.
AIM
Assess the impact of bronchopulmonary dysplasia on respiratory and non-respiratory outcomes in adolescents.
METHODS
A systematic review of studies assessing the outcomes of adolescents aged 10 to 19 years-old with BPD was conducted. We independently screened studies published until 6th March 2023 in PubMed® and Scopus® databases. Data on methodologic design, sample descriptive and findings were extracted from each study. Risk of bias was assessed using quality assessment tools.
RESULTS
Thirty-one studies were included. Adolescents with a history of BPD present with more respiratory symptoms (wheezing, respiratory exacerbations, need for respiratory medication) and twenty-five studies showed a reduction in pulmonary function, with varying impact according to BPD severity and no differences before and after the surfactant era. Spirometry evaluation throughout the years is not consensual, but methacholine and salbutamol response in BPD groups is increased compared to non-BPD groups. Markers of eosinophilic airway inflammation are not increased as in asthma patients. Exercise potential is identical, but data regarding physical capacity and activity are inconsistent. More frequent radiologic abnormalities translate into higher high-resolution computed tomography scores, with linear (72.2 %) and triangular subpleural opacities (58.3 %) as the most common findings. There is a higher risk for special needs in education, but quality of life seems to be equal to non-BPD adolescents.
CONCLUSIONS
BPD negatively impacts both pulmonary and non-pulmonary outcomes in adolescents.
Topics: Infant, Newborn; Humans; Adolescent; Child; Young Adult; Adult; Bronchopulmonary Dysplasia; Quality of Life; Lung; Asthma; Spirometry
PubMed: 36965348
DOI: 10.1016/j.earlhumdev.2023.105756 -
International Journal of Molecular... Feb 2023Preterm birth is a major contributor to neonatal morbidity and mortality. Complications of prematurity such as bronchopulmonary dysplasia (BPD, affecting the lung),... (Review)
Review
Preterm birth is a major contributor to neonatal morbidity and mortality. Complications of prematurity such as bronchopulmonary dysplasia (BPD, affecting the lung), pulmonary hypertension associated with BPD (BPD-PH, heart), white matter injury (WMI, brain), retinopathy of prematurity (ROP, eyes), necrotizing enterocolitis (NEC, gut) and sepsis are among the major causes of long-term morbidity in infants born prematurely. Though the origins are multifactorial, inflammation and in particular the imbalance of pro- and anti-inflammatory mediators is now recognized as a key driver of the pathophysiology underlying these illnesses. Here, we review the involvement of the interleukin (IL)-1 family in perinatal inflammation and its clinical implications, with a focus on the potential of these cytokines as therapeutic targets for the development of safe and effective treatments for early life inflammatory diseases.
Topics: Infant; Pregnancy; Female; Infant, Newborn; Humans; Interleukin-1; Premature Birth; Infant, Premature; Anti-Inflammatory Agents; Bronchopulmonary Dysplasia; Infant, Newborn, Diseases; Inflammation; Retinopathy of Prematurity
PubMed: 36769133
DOI: 10.3390/ijms24032795 -
Pediatric Pulmonology Jul 2022Preterm infants and young children with bronchopulmonary dysplasia (BPD) are at increased risk for acute care utilization and chronic respiratory symptoms during early...
INTRODUCTION
Preterm infants and young children with bronchopulmonary dysplasia (BPD) are at increased risk for acute care utilization and chronic respiratory symptoms during early life. Identifying risk factors for respiratory morbidities in the outpatient setting could decrease the burden of care. We hypothesized that public insurance coverage was associated with higher acute care usage and respiratory symptoms in preterm infants and children with BPD after initial neonatal intensive care unit (NICU) discharge.
METHODS
Subjects were recruited from BPD clinics at 10 tertiary care centers in the United States between 2018 and 2021. Demographics and clinical characteristics were obtained through chart review. Surveys for clinical outcomes were administered to caregivers.
RESULTS
Of the 470 subjects included in this study, 249 (53.0%) received employer-based insurance coverage and 221 (47.0%) received Medicaid as sole coverage at least once between 0 and 3 years of age. The Medicaid group was twice as likely to have sick visits (adjusted odd ratio [OR]: 2.06; p = 0.009) and emergency department visits (aOR: 2.09; p = 0.028), and three times more likely to be admitted for respiratory reasons (aOR: 3.04; p = 0.001) than those in the employer-based group. Additionally, those in the Medicaid group were more likely to have nighttime respiratory symptoms (aOR: 2.62; p = 0.004).
CONCLUSIONS
Children with BPD who received Medicaid coverage were more likely to utilize acute care and have nighttime respiratory symptoms during the first 3 years of life. More comprehensive studies are needed to determine whether the use of Medicaid represents a barrier to accessing care, lower socioeconomic status, and/or a proxy for detrimental environmental exposures.
Topics: Bronchopulmonary Dysplasia; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Infant, Premature; Insurance Coverage; Morbidity; Patient Discharge; United States
PubMed: 35437911
DOI: 10.1002/ppul.25933