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Clinics in Perinatology Sep 2012Although significant advances in respiratory care have been made in neonatal medicine, bronchopulmonary dysplasia (BPD) remains the most common serious pulmonary... (Review)
Review
Although significant advances in respiratory care have been made in neonatal medicine, bronchopulmonary dysplasia (BPD) remains the most common serious pulmonary morbidity in premature infants. The development of BPD is the result of the complex interactions between multiple perinatal and postnatal factors. Early identification of infants at the most risk of developing BPD through the use of estimators and models may allow a targeted approach at reducing BPD in the future.
Topics: Birth Weight; Bronchopulmonary Dysplasia; Cerebral Palsy; Gestational Age; Humans; Incidence; Infant, Newborn; Infant, Premature; Intellectual Disability; Predictive Value of Tests; Risk Factors
PubMed: 22954271
DOI: 10.1016/j.clp.2012.06.014 -
Jornal de Pediatria 2021
Topics: Biomarkers; Bronchopulmonary Dysplasia; Humans; Infant; Infant, Newborn; Infant, Premature; Respiration, Artificial
PubMed: 33183652
DOI: 10.1016/j.jped.2020.10.001 -
The Journal of Physiology Feb 2019Approximately 5-10% pregnancies are affected by fetal growth restriction. Preterm infants affected by fetal growth restriction have a higher incidence of...
KEY POINTS
Approximately 5-10% pregnancies are affected by fetal growth restriction. Preterm infants affected by fetal growth restriction have a higher incidence of bronchopulmonary dysplasia. The present study is the first to measure pulmonary artery thickness and stiffness. The findings show that impaired vasculogenesis may be a contributory factor in the higher incidence of bronchopulmonary dysplasia in preterm growth restricted infants. The study addresses the mechanistic link between fetal programming and vascular architecture and mechanics.
ABSTRACT
Bronchopulmonary dysplasia is the most common respiratory sequelae of prematurity and histopathologically features fewer, dysmorphic pulmonary arteries. The present study aimed to characterize pulmonary artery mechanics and cardiac function in preterm infants with fetal growth restriction (FGR) compared to those appropriate for gestational age (AGA) in the early neonatal period. This prospective study reviewed 40 preterm infants between 28 to 32 weeks gestational age (GA). Twenty infants had a birthweight <10th centile and were compared with 20 preterm AGA infants. A single high resolution echocardiogram was performed to measure right pulmonary arterial and right ventricular (RV) indices. The GA and birthweight of FGR and AGA infants were 29.8 ± 1.3 vs. 30 ± 0.9 weeks (P = 0.78) and 923.4 g ± 168 vs. 1403 g ± 237 (P < 0.001), respectively. Assessments were made at 10.5 ± 1.3 days after birth. The FGR infants had significantly thicker right pulmonary artery inferior wall (843.5 ± 68 vs. 761 ± 40 μm, P < 0.001) with reduced pulsatility (51.6 ± 7.6 μm vs. 59.7 ± 7.5 μm, P = 0.001). The RV contractility [fractional area change (28.7 ± 3.8% vs 32.5 ± 3.1%, P = 0.001), tricuspid annular peak systolic excursion (TAPSE) (5.2 ± 0.3% vs. 5.9 ± 0.7%, P = 0.0002) and myocardial performance index (0.35 ± 0.03 vs. 0.28 ± 0.02, P < 0.001)] was significantly impaired in FGR infants. Significant correlation between RV longitudinal contractility (TAPSE) and time to peak velocity/RV ejection time (measure of RV afterload) was noted (r = 0.5, P < 0.001). Altered pulmonary vascular mechanics and cardiac performance reflect maladaptive changes in response to utero-placental insufficiency. Whether managing pulmonary vascular disease will alter clinical outcomes remains to be studied prospectively.
Topics: Bronchopulmonary Dysplasia; Cardiac Output; Female; Fetal Growth Retardation; Heart Rate; Heart Ventricles; Humans; Infant, Newborn; Infant, Premature; Male; Myocardial Contraction; Pulmonary Artery
PubMed: 29746007
DOI: 10.1113/JP276040 -
Paediatric Respiratory Reviews Mar 2018Preterm infants with bronchopulmonary dysplasia (BPD) often suffer from life-long pulmonary impairments in pulmonary physical function. This review summarizes our... (Review)
Review
Preterm infants with bronchopulmonary dysplasia (BPD) often suffer from life-long pulmonary impairments in pulmonary physical function. This review summarizes our current understanding of the chronic pulmonary impairments and physical functional limitations associated with BPD from preterm birth to adulthood. It also identifies opportunities for intervention in children and adults living with chronic lung disease (CLD) after preterm birth.
Topics: Adult; Bronchopulmonary Dysplasia; Child; Exercise Tolerance; Humans; Physical Conditioning, Human; Respiratory Function Tests; Time
PubMed: 29031795
DOI: 10.1016/j.prrv.2017.07.002 -
Stem Cells (Dayton, Ohio) May 2022Late lung development is a period of alveolar and microvascular formation, which is pivotal in ensuring sufficient and effective gas exchange. Defects in late lung...
Late lung development is a period of alveolar and microvascular formation, which is pivotal in ensuring sufficient and effective gas exchange. Defects in late lung development manifest in premature infants as a chronic lung disease named bronchopulmonary dysplasia (BPD). Numerous studies demonstrated the therapeutic properties of exogenous bone marrow and umbilical cord-derived mesenchymal stromal cells (MSCs) in experimental BPD. However, very little is known regarding the regenerative capacity of resident lung MSCs (L-MSCs) during normal development and in BPD. In this study we aimed to characterize the L-MSC population in homeostasis and upon injury. We used single-cell RNA sequencing (scRNA-seq) to profile in situ Ly6a+ L-MSCs in the lungs of normal and O2-exposed neonatal mice (a well-established model to mimic BPD) at 3 developmental timepoints (postnatal days 3, 7, and 14). Hyperoxia exposure increased the number and altered the expression profile of L-MSCs, particularly by increasing the expression of multiple pro-inflammatory, pro-fibrotic, and anti-angiogenic genes. In order to identify potential changes induced in the L-MSCs transcriptome by storage and culture, we profiled 15 000 Ly6a+ L-MSCs after in vitro culture. We observed great differences in expression profiles of in situ and cultured L-MSCs, particularly those derived from healthy lungs. Additionally, we have identified the location of Ly6a+/Col14a1+ L-MSCs in the developing lung and propose Serpinf1 as a novel, culture-stable marker of L-MSCs. Finally, cell communication analysis suggests inflammatory signals from immune and endothelial cells as main drivers of hyperoxia-induced changes in L-MSCs transcriptome.
Topics: Animals; Animals, Newborn; Bronchopulmonary Dysplasia; Endothelial Cells; Humans; Hyperoxia; Infant, Newborn; Lung; Mesenchymal Stem Cells; Mice; Sequence Analysis, RNA
PubMed: 35445270
DOI: 10.1093/stmcls/sxab023 -
Jornal de Pediatria 2021To evaluate the impact of invasive mechanical ventilation associated with two serum inflammatory cytokines and clinical indicators, on the second day of life, as...
OBJECTIVES
To evaluate the impact of invasive mechanical ventilation associated with two serum inflammatory cytokines and clinical indicators, on the second day of life, as predictors of bronchopulmonary dysplasia in very low birth weight preterm infants. It was hypothesized that the use of invasive mechanical ventilation in the first hours of life is associated with biomarkers that may predict the chances of preterm infants to develop bronchopulmonary dysplasia.
METHODS
Prospective cohort of 40 preterm infants with gestational age <34 weeks and birth weight <1500 g. The following were analyzed: clinical variables; types of ventilator support used (there is a higher occurrence of bronchopulmonary dysplasia when oxygen supplementation is performed by long periods of invasive mechanical ventilation); hospitalization time; quantification of two cytokines (granulocyte and macrophage colony stimulating factor [GM-CSF] and eotaxin) in blood between 36 and 48 h of life. The preterm infants were divided in two groups: with and without bronchopulmonary dysplasia.
RESULTS
The GM-CSF levels presented a significantly higher value in the bronchopulmonary dysplasia group (p = 0.002), while eotaxin presented higher levels in the group without bronchopulmonary dysplasia (p = 0.02). The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin (100% sensitivity and 80% specificity; receiver operating characteristic area = 0.9013, CI = 0.7791-1.024, p < 0.0001).
CONCLUSIONS
The duration of invasive mechanical ventilation performed in the first 48 h of life in the very low birth weight infants is a significant clinical predictor of bronchopulmonary dysplasia. The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin, suggesting increased lung injury and consequent progression of the disease.
Topics: Biomarkers; Bronchopulmonary Dysplasia; Humans; Infant; Infant, Newborn; Infant, Premature; Prospective Studies; Respiration, Artificial
PubMed: 32407675
DOI: 10.1016/j.jped.2020.03.006 -
Clinics in Perinatology Sep 1992The immaturity of the lung of the very prematurely delivered newborn appears to make it hypersusceptible to injury by those very therapeutic measures that the infant... (Review)
Review
The immaturity of the lung of the very prematurely delivered newborn appears to make it hypersusceptible to injury by those very therapeutic measures that the infant requires shortly after birth--mechanical ventilation and hyperoxia. There is good experimental evidence to relate the immature lung's susceptibility to early hyperoxia-induced lung damage to deficient antioxidant defensive systems. Less than fully adequate nutritional support of these tiny newborns can have extremely detrimental effects on their lungs' ability to resist and repair on-going injury and to continue developing normally. Promising experimental means of possible protection from hyperoxic lung damage and progression to chronic lung disease (bronchopulmonary dysplasia) are reviewed.
Topics: Animals; Antioxidants; Bronchopulmonary Dysplasia; Free Radicals; Gestational Age; Humans; Infant Nutritional Physiological Phenomena; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Lipid Peroxidation; Neonatology; Oxygen Inhalation Therapy; Rats
PubMed: 1526071
DOI: No ID Found -
Seminars in Fetal & Neonatal Medicine Apr 2022Lung immaturity and acute respiratory failure are the major problems in the care of extremely preterm infants. Most infants with gestational age (GA) 22-24 weeks will... (Review)
Review
Lung immaturity and acute respiratory failure are the major problems in the care of extremely preterm infants. Most infants with gestational age (GA) 22-24 weeks will need mechanical ventilation and many will depend on some type of respiratory support, invasive and non-invasive for extended periods. There is ongoing gap in knowledge regarding optimal respiratory support and applying strategies that are effective in more mature populations is not easy or even suitable because lung maturation differs in smaller infants. Better strategies on how to avoid lung damage and to promote growth and development of the immature lung are warranted since increased survival is accompanied by increasing rates of bronchopulmonary dysplasia and concerns over long-standing reductions in lung function. This review focuses on some aspects of respiratory care of infants born at 22-24 weeks of GA.
Topics: Bronchopulmonary Dysplasia; Gestational Age; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Lung; Respiration, Artificial; Respiratory Distress Syndrome, Newborn
PubMed: 35400604
DOI: 10.1016/j.siny.2022.101328 -
Pediatric Pulmonology Apr 2022Clinical management of neonatal bronchopulmonary dysplasia (BPD) is often imprecise and can vary widely between different institutions and providers, due to limited...
RATIONALE
Clinical management of neonatal bronchopulmonary dysplasia (BPD) is often imprecise and can vary widely between different institutions and providers, due to limited objective measurements of disease pathology severity. There is critical need to improve guidance on the application and timing of interventional treatments, such as tracheostomy.
OBJECTIVES
To generate an imaging-based clinical tool for early identification of those patients with BPD who are likely to require later tracheostomy and long-term mechanical ventilation.
METHODS
We conducted a prospective cohort study of n = 61 infants (55 BPD, 6 preterm non-BPD). Magnetic resonance imaging (MRI) scores of lung parenchymal disease were used to create a binomial logistic regression model for predicting tracheostomy requirement. This model was further investigated using clinical variables and MRI-quantified tracheomalacia (TM).
MEASUREMENTS AND MAIN RESULTS
A model for predicting tracheostomy requirement was created using MRI parenchymal score. This model had 89% accuracy, 100% positive predictive value (PPV), and 85% negative predictive value (NPV), compared with 84%, 60%, and 83%, respectively, when using only relevant clinical variables. In a subset of patients with airway MRI (n = 36), a model including lung and TM measurements had 83% accuracy, 92% PPV, and 78% NPV.
CONCLUSIONS
MRI-based measurements of parenchymal disease and TM can be used to predict need for tracheostomy in infants with BPD, more accurately than clinical factors alone. This prediction model has strong potential as a clinical tool for physicians and families for early determination of tracheostomy requirement.
Topics: Bronchopulmonary Dysplasia; Humans; Infant; Infant, Newborn; Infant, Premature; Lung; Magnetic Resonance Imaging; Prospective Studies; Tracheomalacia; Tracheostomy
PubMed: 35029053
DOI: 10.1002/ppul.25826 -
Journal of Perinatal Medicine Jan 2013Bronchopulmonary dysplasia (BPD), defined as oxygen dependency for at least 28 days after birth, is a common adverse outcome of very premature birth. Affected children... (Review)
Review
Bronchopulmonary dysplasia (BPD), defined as oxygen dependency for at least 28 days after birth, is a common adverse outcome of very premature birth. Affected children require frequent readmissions to hospital in the fi rst 2 years, and although lung growth and remodelling results in progressive improvement in lung function, airflow abnormalities may remain. Indeed, the most severely affected experience troublesome respiratory symptoms as adolescents and young adults. As a consequence, many potential preventative strategies have been investigated, and some have resulted in a reduction in BPD but with a negative risk/benefit ratio, for example, postnatal corticosteroids. Others therapies, namely antenatal corticosteroids and postnatal surfactant, have resulted in significant benefits to infants, including reductions in respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and neonatal death, but have not impacted favourably on the incidence of BPD, perhaps due to the increased survival of very immature infants. In one major trial, it has been shown that BPD can be reduced without adverse effects by caffeine administration. Avoidance of high oxygen concentrations at resuscitation is also a promising approach to reduce BPD.
Topics: Adolescent; Adult; Bronchopulmonary Dysplasia; Female; Glucocorticoids; Humans; Infant, Newborn; Pregnancy; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn; Xanthines
PubMed: 23096098
DOI: 10.1515/jpm-2012-0084