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Current Opinion in Pediatrics Jun 2011Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infancy affecting mostly premature infants with significant morbidity and mortality. Improved survival of... (Review)
Review
PURPOSE OF REVIEW
Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infancy affecting mostly premature infants with significant morbidity and mortality. Improved survival of very immature infants has led to increased numbers of infants with this disorder. Acute and chronic lung injury and impaired postnatal lung growth are thought to be responsible for the development of BPD. Whereas changes in clinical practice have improved the clinical course and outcomes for infants with BPD, over the past decade, the overall incidence of BPD has not changed. This review will describe the prenatal and postnatal factors that contribute to the pathogenesis of BPD as well as current and experimental therapies for treatment of BPD.
RECENT FINDINGS
The factors that contribute to the pathogenesis of BPD are well described; however, recent studies have better defined how these factors modulate lung growth. Inflammation, proinflammatory cytokines and altered angiogenic gene signaling contribute to lung injury and impair prenatal and postnatal lung growth resulting in BPD; however, to date no therapy has been identified that potently and consistently prevents or reverses their effects on lung growth. We will discuss the cell signaling pathways affected in BPD and current therapies available for modulating these pathways.
SUMMARY
Despite current advances in neonatal care, BPD remains a heavy burden on healthcare resources. New treatments directed at either reducing lung injury or improving lung growth are under study.
Topics: Adrenal Cortex Hormones; Bronchopulmonary Dysplasia; Humans; Infant, Newborn; Infant, Premature; Transforming Growth Factor beta1; Vascular Endothelial Growth Factor A
PubMed: 21494147
DOI: 10.1097/MOP.0b013e328346577f -
Archives of Disease in Childhood. Fetal... Jan 2021Early decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary... (Observational Study)
Observational Study
OBJECTIVE
Early decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated.
DESIGN
Retrospective observational study.
SETTING
Tertiary level neonatal intensive care unit, referral centre for Southern Sweden.
PATIENTS
452 very preterm infants (<30 gestational weeks) born 2009-2015.
INTERVENTIONS
Regular clinical practice.
MAIN OUTCOME MEASURES
Mean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36 weeks' postmenstrual age) and the modifying influence of PaO (kPa) and total Hb (g/L) was evaluated.
RESULTS
The mean gestational age (GA) at birth was 26.4 weeks, and 213 (56%) infants developed BPD. A 10% increase in HbF was associated with a decreased prevalence of BPD, OR 0.64 (95% CI 0.49 to 0.83; p<0.001). This association remained when adjusting for mean PaO and Hb. Infants with an HbF in the lowest quartile had an OR of 27.1 (95% CI 11.6 to 63.4; p<0.001) for development of BPD as compared with those in the highest quartile. The area under the curve for HbF levels and development of BPD in the full statistical model was 0.871.
CONCLUSIONS
Early rapid postnatal decline in HbF levels was associated with development of BPD in very preterm infants. The association between HbF and BPD was not mediated by increased oxygen exposure. The potential benefit of minimising loss of endogenous blood components on BPD outcome will be investigated in a multicentre randomised trial.
Topics: Bronchopulmonary Dysplasia; Female; Fetal Hemoglobin; Gestational Age; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Male; Retrospective Studies
PubMed: 32847833
DOI: 10.1136/archdischild-2020-319181 -
Pediatric Critical Care Medicine : a... Mar 2010When the normal cardiopulmonary transition fails to occur, the result is persistent pulmonary hypertension of the newborn. Severe persistent pulmonary hypertension of... (Review)
Review
When the normal cardiopulmonary transition fails to occur, the result is persistent pulmonary hypertension of the newborn. Severe persistent pulmonary hypertension of the newborn is estimated to occur in 2 per 1000 live-born term infants, and some degree of pulmonary hypertension complicates the course of >10% of all neonates with respiratory failure. This review article discusses the vascular abnormalities that are associated with neonatal pulmonary hypertension, including recognition of its role in severe bronchopulmonary dysplasia in preterm infants. A systematic review of the evidence for common therapies including inhaled nitric oxide, high-frequency ventilation, surfactant, and extracorporeal life support is included. Finally, this field is rapidly evolving, and the rationale for promising new treatment approaches is reviewed, including inhibition of phosphodiesterases and scavengers of reactive oxygen species.
Topics: Administration, Inhalation; Bronchopulmonary Dysplasia; Extracorporeal Membrane Oxygenation; High-Frequency Ventilation; Humans; Hypertension, Pulmonary; Infant, Newborn; Nitric Oxide; Pulmonary Surfactants
PubMed: 20216169
DOI: 10.1097/PCC.0b013e3181c76cdc -
Association between Intermittent Hypoxemia and Severe Bronchopulmonary Dysplasia in Preterm Infants.American Journal of Respiratory and... Nov 2021Bronchopulmonary dysplasia increases the risk of disability in extremely preterm infants. Although the pathophysiology remains uncertain, prior exposure to intermittent...
Bronchopulmonary dysplasia increases the risk of disability in extremely preterm infants. Although the pathophysiology remains uncertain, prior exposure to intermittent hypoxemia may play a role in this relationship. To determine the association between prolonged episodes of intermittent hypoxemia and severe bronchopulmonary dysplasia. A analysis of extremely preterm infants in the Canadian Oxygen Trial who survived to 36 weeks' postmenstrual age was performed. Oxygen saturations <80% for ⩾1 minute and the proportion of time per day with hypoxemia were quantified using continuous pulse oximetry data that had been sampled every 10 seconds from within 24 hours of birth until 36 weeks' postmenstrual age. The study outcome was severe bronchopulmonary dysplasia as defined in the 2001 NIH Workshop Summary. Of 1,018 infants, 332 (32.6%) developed severe bronchopulmonary dysplasia. The median number of hypoxemic episodes ranged from 0.8/day (interquartile range, 0.2-1.1) to 60.2/day (interquartile range, 51.4-70.3) among the least and most affected 10% of infants. Compared with the lowest decile of exposure to hypoxemic episodes, the adjusted relative risk of severe bronchopulmonary dysplasia increased progressively from 1.72 (95% confidence interval, 1.55-1.90) at the 2nd decile to 20.40 (95% confidence interval, 12.88-32.32) at the 10th decile. Similar risk gradients were observed for time in hypoxemia. Significant differences in the rates of hypoxemia between infants with and without severe bronchopulmonary dysplasia emerged within the first week after birth. Prolonged intermittent hypoxemia beginning in the first week after birth was associated with an increased risk of developing severe bronchopulmonary dysplasia among extremely preterm infants. Clinical trial registered with www.isrctn.com (ISRCTN62491227) and www.clinicaltrials.gov (NCT00637169).
Topics: Bronchopulmonary Dysplasia; Canada; Female; Humans; Hypoxia; Infant, Extremely Premature; Infant, Newborn; Male; Respiratory Distress Syndrome, Newborn
PubMed: 34428130
DOI: 10.1164/rccm.202105-1150OC -
Chest Jul 2021Adults born preterm are at a higher risk of cardiopulmonary disease and premature death. Preterm birth is associated with abnormalities in right ventricular (RV)...
BACKGROUND
Adults born preterm are at a higher risk of cardiopulmonary disease and premature death. Preterm birth is associated with abnormalities in right ventricular (RV) structure and function, but the impact of bronchopulmonary dysplasia (BPD), a common complication of extremely preterm birth, on these parameters remains unknown.
RESEARCH QUESTION
Are preterm birth and BPD associated with alterations in RV structure and function in early adulthood?
STUDY DESIGN AND METHODS
Echocardiographic and spirometry data were obtained from the Health of Adults Born Preterm Investigation (HAPI). RV structure and performance were evaluated by using echocardiography, and respiratory function was assessed by using spirometry.
RESULTS
The study comprised 86 young adults born preterm before 30 weeks of gestation, including 28 with moderate to severe BPD, and 85 adults of the same age born full term. Individuals were assessed at a mean age of 23 years. RV systolic function was altered in the preterm group, with lower tricuspid annular plane systolic excursion and lower RV s' and RV outflow tract velocity time integral values, especially in those born preterm with BPD. Nine (36%) participants born preterm with BPD, six (13%) participants born preterm without BPD, and six (8%) participants born full term had a tricuspid annular plane systolic excursion value < 16 mm, a marker of RV systolic dysfunction (P value for the comparison between preterm no BPD and BPD, .032). No difference was found in RV diastolic function or estimates of pulmonary artery pressure between groups. Although respiratory function was altered in those born preterm, and more so in the case of BPD, no association was observed between spirometry indices of respiratory function and RV systolic function.
INTERPRETATION
Preterm birth is associated in adulthood with alterations in RV systolic function, which are more pronounced in the case of BPD.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT03261609; URL: www.clinicaltrials.gov.
Topics: Adolescent; Adult; Bronchopulmonary Dysplasia; Echocardiography, Doppler; Female; Heart Ventricles; Humans; Incidence; Infant, Newborn; Infant, Premature; Male; Quebec; Risk Assessment; Systole; Ventricular Dysfunction, Right; Ventricular Function, Right; Young Adult
PubMed: 33549599
DOI: 10.1016/j.chest.2021.01.079 -
Annals of the New York Academy of... Nov 2020Owing to a high-volume industrial usage of the halogens chlorine (Cl ) and bromine (Br ), they are stored and transported in abundance, creating a risk for accidental or... (Review)
Review
Owing to a high-volume industrial usage of the halogens chlorine (Cl ) and bromine (Br ), they are stored and transported in abundance, creating a risk for accidental or malicious release to human populations. Despite extensive efforts to understand the mechanisms of toxicity upon halogen exposure and to develop specific treatments that could be used to treat exposed individuals or large populations, until recently, there has been little to no effort to determine whether there are specific features and or the mechanisms of halogen exposure injury in newborns or children. We established a model of neonatal halogen exposure and published our initial findings. In this review, we aim to contrast and compare the findings in neonatal mice exposed to Br with the findings published on adult mice exposed to Br and the neonatal murine models of bronchopulmonary dysplasia. Despite remarkable similarities across these models in overall alveolar architecture, there are distinct functional and apparent mechanistic differences that are characteristic of each model. Understanding the mechanistic and functional features that are characteristic of the injury process in neonatal mice exposed to halogens will allow us to develop countermeasures that are appropriate for, and effective in, this unique population.
Topics: Animals; Animals, Newborn; Bromine; Bronchopulmonary Dysplasia; Child; Chlorine; Humans; Infant, Newborn; Lung; Lung Injury; Mice
PubMed: 32738176
DOI: 10.1111/nyas.14445 -
Clinics in Perinatology Dec 2015The pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial, and the clinical phenotype of BPD is extremely variable. Several clinical and laboratory... (Review)
Review
The pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial, and the clinical phenotype of BPD is extremely variable. Several clinical and laboratory biomarkers have been proposed for the early identification of infants at higher risk of BPD and for determination of prognosis of infants with a diagnosis of BPD. The authors review available literature on prediction tools and biomarkers of BPD, using clinical variables and biomarkers based on imaging, lung function measures, and measurements of various analytes in different body fluids that have been determined to be associated with BPD either in a targeted manner or by unbiased omic profiling.
Topics: Biomarkers; Body Fluids; Breath Tests; Bronchoalveolar Lavage Fluid; Bronchopulmonary Dysplasia; Cytokines; Decision Support Techniques; Early Diagnosis; Echocardiography; Humans; Hypertension, Pulmonary; Infant, Newborn; Infant, Premature; Intercellular Signaling Peptides and Proteins; Lung; Magnetic Resonance Imaging; Prognosis; Radiography, Thoracic; Reactive Oxygen Species; Respiratory Function Tests; Tomography, X-Ray Computed; Transcriptome
PubMed: 26593076
DOI: 10.1016/j.clp.2015.08.004 -
Jornal de Pediatria 2005To present a wide-ranging review of the literature on broncopulmonary dysplasia, covering new definitions, pathophysiology, prevention, treatment, prognosis and... (Review)
Review
OBJECTIVE
To present a wide-ranging review of the literature on broncopulmonary dysplasia, covering new definitions, pathophysiology, prevention, treatment, prognosis and progression.
SOURCES OF DATA
The most relevant articles published on the subject since it was first described in 1967 were selected from MEDLINE search results.
SUMMARY OF THE FINDINGS
Bronchopulmonary dysplasia is considered one of the primary causes of chronic lung disease among infants. It is associated with frequent and prolonged hospital admissions, in particular for pulmonary diseases, with high rates of mortality and alterations to neuropsychomotor development and pondero-statural growth. Pathogenesis is complex, being primarily influenced by prematurity, infection, supplementary oxygen and mechanical ventilation. Prevention involves appropriate prenatal care, the prevention of premature delivery, prenatal corticosteroids, surfactant replacement therapy and "protective" ventilatory strategies. Treatment of bronchopulmonary dysplasia patients demands a multidisciplinary team. When indicated, oxygen supplementation is extremely important. Despite increased risk of morbidity and mortality during the first years of life, long term progress is favorable in the majority of cases.
CONCLUSIONS
Bronchopulmonary dysplasia has been and continues to be studied in great depth with the objective of identifying its causes and possible prevention and treatment strategies. Controversies remain with respect of these issues and also about the prognosis of these patients, in particular when the subject is long-term progress of "new" bronchopulmonary dysplasia patients.
Topics: Bronchopulmonary Dysplasia; Humans; Infant; Infant, Newborn; Prognosis
PubMed: 15858670
DOI: No ID Found -
BMC Pediatrics Sep 2022Bronchopulmonary dysplasia (BPD) is one of the most common and serious sequelae of prematurity. Prompt diagnosis using prediction tools is crucial for early intervention...
BACKGROUND
Bronchopulmonary dysplasia (BPD) is one of the most common and serious sequelae of prematurity. Prompt diagnosis using prediction tools is crucial for early intervention and prevention of further adverse effects. This study aims to develop a BPD-free survival prediction tool based on the concept of the developmental origin of BPD with machine learning.
METHODS
Datasets comprising perinatal factors and early postnatal respiratory support were used for initial model development, followed by combining the two models into a final ensemble model using logistic regression. Simulation of clinical scenarios was performed.
RESULTS
Data from 689 infants were included in the study. We randomly selected data from 80% of infants for model development and used the remaining 20% for validation. The performance of the final model was assessed by receiver operating characteristics which showed 0.921 (95% CI: 0.899-0.943) and 0.899 (95% CI: 0.848-0.949) for the training and the validation datasets, respectively. Simulation data suggests that extubating to CPAP is superior to NIPPV in BPD-free survival. Additionally, successful extubation may be defined as no reintubation for 9 days following initial extubation.
CONCLUSIONS
Machine learning-based BPD prediction based on perinatal features and respiratory data may have clinical applicability to promote early targeted intervention in high-risk infants.
Topics: Bronchopulmonary Dysplasia; Female; Fetal Growth Retardation; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Machine Learning
PubMed: 36100848
DOI: 10.1186/s12887-022-03602-w -
Scientific Reports Aug 2021Bronchopulmonary dysplasia is a chronic pulmonary disease with a high incidence in premature infants, and there is still no effective treatment. The purpose of our study...
Bronchopulmonary dysplasia is a chronic pulmonary disease with a high incidence in premature infants, and there is still no effective treatment. The purpose of our study was to analyze the association between the use of probiotics and BPD in premature infants. We retrospectively collected clinical data of infants with gestational age < 32 weeks admitted to the NICU of The First Hospital of Jilin University from January 1, 2019 to March 31, 2020. Demographic and clinicopathological data of the inclusion population were collected. The outcome was the incidence of BPD or death. The χ tests was used to compare the categorical variables. The t test and non-parametric Wilcoxon rank-sum test were used to compare the continuous data. Univariate and multivariate logistic regression were used to analyze the association between probiotics and BPD. A total of 318 newborns met the inclusion criteria, of which 94 received probiotics and 224 received no probiotics. There were 16 deaths and 115 newborns with BPD in the included population. The results of univariate analysis showed differences in the maternal diabetes, the proportion of systemic antibiotics given to mother within 24 h before birth, the receiving rate of invasive mechanical ventilation, the prevalence of BPD/death, PDA, RDS and Ivh between newborns with and without probiotics (p < 0.05); The results of unadjusted univariate logistic regression model showed that probiotic (OR 0.034, 95% CI 0.012-0.096) was the factor affecting BPD in preterm infants (p < 0.05). Multivariate logistic regression result (OR 0.037, 95% CI 0.013-0.105) was consistent with univariate analysis (P < 0.001). Probiotics are associated with a reduced risk of BPD in preterm infants < 32 weeks of age. More prospective studies with large samples are still needed.
Topics: Adult; Bronchopulmonary Dysplasia; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Premature; Male; Pregnancy; Pregnancy in Diabetics; Probiotics
PubMed: 34426616
DOI: 10.1038/s41598-021-96489-z