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Pulmonary hypertension in extremely preterm infants: a call to standardize echocardiographic screening and follow-up policy. Eur J Pediatr 2021; 180:1855-1865. [PMID: 33528615 PMCID: PMC8105237 DOI: 10.1007/s00431-021-03931-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/06/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension (PH) is a frequent complication in extremely preterm born infants that seriously affects outcome. We aimed to describe the prevalence of PH in extremely preterm infants and the policy on screening and follow-up in the ten Dutch intensive care units (NICUs). We performed a retrospective cohort study at the University Medical Centre Groningen on infants with gestational age < 30 weeks and/or birthweight < 1000 g, born between 2012 and 2013. Additionally, we carried out a survey among the Dutch NICUs covering questions on the awareness of PH, the perceived prevalence, and policy regarding screening and following PH in extremely preterm infants. Prevalence of early-onset PH in our study was 26% and 5% for late-onset PH. PH was associated with poor survival and early-onset PH was associated with subsequent development of bronchopulmonary dysplasia (BPD). All the NICUs completed the questionnaire and we found that no standardized policy existed regarding screening and following PH in extremely preterm infants.Conclusion: Despite the frequent occurrence of PH and its clinically important consequences, (inter-)national standardized guidelines regarding screening and following of PH in extremely preterm infants are lacking. Standardizing screening and follow-up will enable early identification of infants with late-onset PH and allow for earlier treatment. Additionally, greater clarity is required regarding the prevalence of early PH as are new preventive treatment strategies to combat BPD. What is known? • Pulmonary hypertension (PH) substantially impairs the survival of extremely preterm infants. • PH is associated with bronchopulmonary dysplasia (BPD): Early-onset PH predicts the development of BPD. Late-onset PH is prevalent in infants with severe BPD. What is new? • Pulmonary hypertension (PH) is prevalent in preterm infants. Its consequences for morbidity and mortality justify a standardized policy aimed at early detection to improve prevention and treatment. • No structured policy exists in the Netherlands regarding screening/follow-up for PH in extremely preterm infants.
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Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia? CHILDREN-BASEL 2020; 7:children7120283. [PMID: 33321724 PMCID: PMC7763238 DOI: 10.3390/children7120283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.
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Alonso-Ojembarrena A, Raimondi F. Using LU score to predict extubation failure in preterm infants should consider gestational age at birth. Pediatr Pulmonol 2020; 55:3228. [PMID: 33022882 DOI: 10.1002/ppul.25093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II", Naples, Italy
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54
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Shepherd EG, De Luca D. New Imaging Tools Allow Bronchopulmonary Dysplasia to Enter the Age of Precision Medicine. Am J Respir Crit Care Med 2020; 202:924-926. [PMID: 32551806 PMCID: PMC7528804 DOI: 10.1164/rccm.202005-2067ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Edward G Shepherd
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, Ohio
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Paris Saclay University Hospitals, Paris, France and.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay University, Paris, France
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55
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Viscardi RM, Terrin ML, Magder LS, Davis NL, Dulkerian SJ, Waites KB, Ambalavanan N, Kaufman DA, Donohue P, Tuttle DJ, Weitkamp JH, Hassan HE, Eddington ND. Randomised trial of azithromycin to eradicate Ureaplasma in preterm infants. Arch Dis Child Fetal Neonatal Ed 2020; 105:615-622. [PMID: 32170033 PMCID: PMC7592356 DOI: 10.1136/archdischild-2019-318122] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/26/2020] [Accepted: 02/25/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To test whether azithromycin eradicates Ureaplasma from the respiratory tract in preterm infants. DESIGN Prospective, phase IIb randomised, double-blind, placebo-controlled trial. SETTING Seven level III-IV US, academic, neonatal intensive care units (NICUs). PATIENTS Infants 240-286 weeks' gestation (stratified 240-266; 270-286 weeks) randomly assigned within 4 days following birth from July 2013 to August 2016. INTERVENTIONS Intravenous azithromycin 20 mg/kg or an equal volume of D5W (placebo) every 24 hours for 3 days. MAIN OUTCOME MEASURES The primary efficacy outcome was Ureaplasma-free survival. Secondary outcomes were all-cause mortality, Ureaplasma clearance, physiological bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age, comorbidities of prematurity and duration of respiratory support. RESULTS One hundred and twenty-one randomised participants (azithromycin: n=60; placebo: n=61) were included in the intent-to-treat analysis (mean gestational age 26.2±1.4 weeks). Forty-four of 121 participants (36%) were Ureaplasma positive (azithromycin: n=19; placebo: n=25). Ureaplasma-free survival was 55/60 (92% (95% CI 82% to 97%)) for azithromycin compared with 37/61 (61% (95% CI 48% to 73%)) for placebo. Mortality was similar comparing the two treatment groups (5/60 (8%) vs 6/61 (10%)). Azithromycin effectively eradicated Ureaplasma in all azithromycin-assigned colonised infants, but 21/25 (84%) Ureaplasma-colonised participants receiving placebo were culture positive at one or more follow-up timepoints. Most of the neonatal mortality and morbidity was concentrated in 21 infants with lower respiratory tract Ureaplasma colonisation. In a subgroup analysis, physiological BPD-free survival was 5/10 (50%) (95% CI 19% to 81%) among azithromycin-assigned infants with lower respiratory tract Ureaplasma colonisation versus 2/11 (18%) (95% CI 2% to 52%) in placebo-treated infants. CONCLUSION A 3-day azithromycin regimen effectively eradicated respiratory tract Ureaplasma colonisation in this study. TRIAL REGISTRATION NUMBER NCT01778634.
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Affiliation(s)
- Rose Marie Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael L Terrin
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie L Davis
- Department of Pediatrics, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Susan J Dulkerian
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ken B Waites
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - David A Kaufman
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Pamela Donohue
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Deborah J Tuttle
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware, USA
| | - Jorn-Hendrik Weitkamp
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hazem E Hassan
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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Ralphe JL, Silva SG, Dail RB, Brandon DH. Body temperature instability and respiratory morbidity in the very low birth weight infant: a multiple case, intensive longitudinal study. BMC Pediatr 2020; 20:485. [PMID: 33081746 PMCID: PMC7574536 DOI: 10.1186/s12887-020-02351-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background Very low birth weight (VLBW) infant thermal instability upon neonatal intensive care unit admission has been associated with respiratory morbidity; however, the association between ongoing thermal instability and respiratory morbidity remains unclear. Methods A longitudinal data analysis was conducted on 12 VLBW infants. Chronic respiratory morbidity risk was defined as supplemental oxygen requirement (FiO2) or scheduled diuretic dosing at 36 weeks post-menstrual age. Acute respiratory morbidity was quantified as desaturations (SpO2<90%), bradycardia with desaturations (HR<100 and SpO2<90%), apnea, increase in FiO2 requirement, or increase in respiratory support. Multi-level, mixed-effects models and regression analysis examined the relationships between body temperature over the first 14 days of life and respiratory morbidities. Results Body temperature was not associated with chronic respiratory morbidity risk (p=0.2765). Desaturations, bradycardia with desaturations, increased FiO2 requirement, and increased respiratory support were associated with decreased body temperature (p<0.05). Apnea was associated with increased body temperature (p<0.05). The covariate-adjusted risk of desaturations (aOR=1.3), bradycardia with desaturations (aOR=2.2), increase in FiO2 requirement (aOR=1.2), and increase in respiratory support (aOR=1.2) were significantly greater during episodes of hypothermia. Conclusion VLBW infants are dependent on a neutral thermal environment for optimal growth and development. Therefore, the significant associations between hypothermia and symptoms of acute respiratory morbidity require further study to delineate if these are causal relationships that could be attenuated with clinical practice changes, or if these are concurrent symptoms that cluster during episodes of physiological instability.
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Affiliation(s)
- Jane L Ralphe
- University of Wisconsin-Madison School of Nursing, University of Wisconsin, 701 Highland Ave. Madison, WI, WI 53705, Madison, USA.
| | - Susan G Silva
- Duke University School of Nursing, Duke University, NC, Durham, USA.,Duke University School of Medicine, Duke University, NC, Durham, USA
| | - Robin B Dail
- University of South Carolina College of Nursing, University of South Carolina, SC, Columbia, USA
| | - Debra H Brandon
- Duke University School of Nursing, Duke University, NC, Durham, USA.,Duke University School of Medicine, Duke University, NC, Durham, USA
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57
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Whitehead HV, McPherson CC, Vesoulis ZA, Cohlan BA, Rao R, Warner B, Cole FS. The Challenge of Risk Stratification of Infants Born Preterm in the Setting of Competing and Disparate Healthcare Outcomes. J Pediatr 2020; 223:194-196. [PMID: 32711746 PMCID: PMC7476078 DOI: 10.1016/j.jpeds.2020.04.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Halana V. Whitehead
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine and St. Louis Children’s Hospital
| | - Christopher C. McPherson
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine and St. Louis Children’s Hospital
| | - Zachary A. Vesoulis
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine and St. Louis Children’s Hospital
| | - Barbara A. Cohlan
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine and St. Louis Children’s Hospital
| | - Rakesh Rao
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine and St. Louis Children’s Hospital
| | - Barbara Warner
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine and St. Louis Children’s Hospital
| | - F. Sessions Cole
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine and St. Louis Children’s Hospital
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Abstract
In the current era, the survival of extremely low-birth-weight infants has increased considerably because of new advances in technology; however, these infants often develop chronic dysfunction of the lung, which is called bronchopulmonary dysplasia (BPD). BPD remains an important cause of neonatal mortality and morbidity despite newer and gentler modes of ventilation. BPD results from the exposure of immature lungs to various antenatal and postnatal factors that lead to an impairment in lung development and aberrant growth of lung parenchyma and vasculature. However, we still struggle with a uniform definition for BPD that can help predict various short- and long-term pulmonary outcomes. With new research, our understanding of the pathobiology of this disease has evolved, and many new mechanisms of lung injury and repair are now known. By utilizing the novel ‘omic’ approaches in BPD, we have now identified various factors in the disease process that may act as novel therapeutic targets in the future. New investigational agents being explored for the management and prevention of BPD include mesenchymal stem cell therapy and insulin-like growth factor 1. Despite this, many questions remain unanswered and require further research to improve the outcomes of premature infants with BPD.
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Affiliation(s)
- Mitali Sahni
- Pediatrix Medical Group, Sunrise Children's Hospital, Las Vegas, NV, USA.,University of Nevada, Las Vegas, NV, USA
| | - Vineet Bhandari
- Neonatology Research Laboratory, Education and Research Building, Cooper University Hospital, Camden, NJ, USA
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59
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Preterm birth and sustained inflammation: consequences for the neonate. Semin Immunopathol 2020; 42:451-468. [PMID: 32661735 PMCID: PMC7508934 DOI: 10.1007/s00281-020-00803-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Abstract
Almost half of all preterm births are caused or triggered by an inflammatory process at the feto-maternal interface resulting in preterm labor or rupture of membranes with or without chorioamnionitis (“first inflammatory hit”). Preterm babies have highly vulnerable body surfaces and immature organ systems. They are postnatally confronted with a drastically altered antigen exposure including hospital-specific microbes, artificial devices, drugs, nutritional antigens, and hypoxia or hyperoxia (“second inflammatory hit”). This is of particular importance to extremely preterm infants born before 28 weeks, as they have not experienced important “third-trimester” adaptation processes to tolerate maternal and self-antigens. Instead of a balanced adaptation to extrauterine life, the delicate co-regulation between immune defense mechanisms and immunosuppression (tolerance) to allow microbiome establishment is therefore often disturbed. Hence, preterm infants are predisposed to sepsis but also to several injurious conditions that can contribute to the onset or perpetuation of sustained inflammation (SI). This is a continuing challenge to clinicians involved in the care of preterm infants, as SI is regarded as a crucial mediator for mortality and the development of morbidities in preterm infants. This review will outline the (i) role of inflammation for short-term consequences of preterm birth and (ii) the effect of SI on organ development and long-term outcome.
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60
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Dassios T, Ambulkar H, Greenough A. Treatment and respiratory support modes for neonates with respiratory distress syndrome. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1769598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Theodore Dassios
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Neonatal Intensive Care Centre, King’s College Hospital NHS Foundation Trust, London, UK
| | - Hemant Ambulkar
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Anne Greenough
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
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61
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Bonadies L, Zaramella P, Porzionato A, Perilongo G, Muraca M, Baraldi E. Present and Future of Bronchopulmonary Dysplasia. J Clin Med 2020; 9:jcm9051539. [PMID: 32443685 PMCID: PMC7290764 DOI: 10.3390/jcm9051539] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder among infants born extremely preterm. The pathogenesis of BPD involves multiple prenatal and postnatal mechanisms affecting the development of a very immature lung. Their combined effects alter the lung's morphogenesis, disrupt capillary gas exchange in the alveoli, and lead to the pathological and clinical features of BPD. The disorder is ultimately the result of an aberrant repair response to antenatal and postnatal injuries to the developing lungs. Neonatology has made huge advances in dealing with conditions related to prematurity, but efforts to prevent and treat BPD have so far been only partially effective. Seeing that BPD appears to have a role in the early origin of chronic obstructive pulmonary disease, its prevention is pivotal also in long-term respiratory outcome of these patients. There is currently some evidence to support the use of antenatal glucocorticoids, surfactant therapy, protective noninvasive ventilation, targeted saturations, early caffeine treatment, vitamin A, and fluid restriction, but none of the existing strategies have had any significant impact in reducing the burden of BPD. New areas of research are raising novel therapeutic prospects, however. For instance, early topical (intratracheal or nebulized) steroids seem promising: they might help to limit BPD development without the side effects of systemic steroids. Evidence in favor of stem cell therapy has emerged from several preclinical trials, and from a couple of studies in humans. Mesenchymal stromal/stem cells (MSCs) have revealed a reparatory capability, preventing the progression of BPD in animal models. Administering MSC-conditioned media containing extracellular vesicles (EVs) have also demonstrated a preventive action, without the potential risks associated with unwanted engraftment or the adverse effects of administering cells. In this paper, we explore these emerging treatments and take a look at the revolutionary changes in BPD and neonatology on the horizon.
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Affiliation(s)
- Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.B.); (P.Z.)
| | - Patrizia Zaramella
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.B.); (P.Z.)
| | - Andrea Porzionato
- Human Anatomy Section, Department of Neurosciences, University of Padova, 35128 Padova, Italy;
| | - Giorgio Perilongo
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy;
| | - Maurizio Muraca
- Institute of Pediatric Research “Città della Speranza”, Stem Cell and Regenerative Medicine Laboratory, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy;
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.B.); (P.Z.)
- Correspondence: ; Tel.: +39-049-821-3560; Fax: +39-049-821-3502
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Sheehan S, Baer G, Romine M, Hudson L, Lim R, Papadopoulos E, Campbell M, Daniel G, McCune S. Advancing Therapeutic Development for Pulmonary Morbidities Associated with Preterm Birth. Ther Innov Regul Sci 2020; 54:1312-1318. [PMID: 33258093 DOI: 10.1007/s43441-020-00153-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/10/2020] [Indexed: 01/25/2023]
Abstract
Chronic pulmonary and respiratory conditions associated with preterm birth are incompletely characterized, complicating long-term treatment and development of more effective therapies. Stakeholders face challenges in the development of validated, clinically meaningful endpoints that adequately measure morbidities and predict or represent health outcomes for preterm neonates. We propose in this paper a research agenda, informed by the input of experts from a 2018 workshop we convened on this topic, to advance endpoint and treatment development. We discuss the necessity of further evaluation of existing endpoints and the improved characterization of disease endotypes. We also discuss key steps to the development of optimized short- and long-term endpoints that can be linked to meaningful health outcomes. Finally, we discuss the importance of limiting variability in data collection and the application of new clinical trial endpoints as well as the critical nature of multi-stakeholder collaboration to advancing therapeutic development for this vulnerable patient population.
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Affiliation(s)
- Sarah Sheehan
- Duke-Margolis Center for Health Policy, Washington, DC, USA.
- Duke-Margolis Center for Health Policy, 1201 Pennsylvania Ave. NW Suite 500, Washington, DC, 20004, USA.
| | - Gerri Baer
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Morgan Romine
- Duke-Margolis Center for Health Policy, Washington, DC, USA
| | | | - Robert Lim
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Gregory Daniel
- Duke-Margolis Center for Health Policy, Washington, DC, USA
| | - Susan McCune
- U.S. Food and Drug Administration, Silver Spring, MD, USA
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63
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Gao S, Xiao T, Ju R, Ma R, Zhang X, Dong W. The application value of lung ultrasound findings in preterm infants with bronchopulmonary dysplasia. Transl Pediatr 2020; 9:93-100. [PMID: 32477908 PMCID: PMC7237972 DOI: 10.21037/tp.2020.03.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the association between ultrasound findings and preterm infants with bronchopulmonary dysplasia (BPD). METHODS Preterm infants with a gestation age of less than 28 weeks or birthweight less than 1,500 g admitted to the neonatal intensive care unit (NICU) in the Chengdu Women's & Children's Central Hospital from June 2018 to June 2019 were enrolled in the study and divided into 2 groups: the BPD group and the non-BPD group. All clinical data and lung ultrasound were retrospectively analyzed. RESULTS A total of 81 neonates (gestational age =29.71±2.27 weeks; birth weight =1,189.5±184.5 g) were enrolled in our center. The regression analysis showed that gestational age [odds ratio (OR) =0.57; 95% confidence interval (CI): 0.42-0.77, P=0.0002], birthweight (OR =0.99; 95% CI: 0.99-1.00, P<0.0001), mild asphyxia (OR =3.3; 95% CI: 1.24-8.74, P=0.0165), anemia (OR =4.43; 95% CI: 1.34-14.64, P=0.0146), blood transfusion (OR =3.68; 95% CI: 1.38-9.79, P=0.0090), respiratory failure (OR =6.58; 95% CI: 1.27-34.08, P=0.0486), heart failure (OR =6.58; 95% CI: 1.27-34.08, P=0.0248), and "debris" lung ultrasound findings (OR =21.82; 95% CI: 2.63-181.11, P=0.0043) were correlated with BPD. CONCLUSIONS BPD-related lung ultrasound findings can be a kind of imaging marker to diagnose BPD.
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Affiliation(s)
- Shuqiang Gao
- Department of Newborn Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Tiantian Xiao
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Rongchuan Ma
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Xiaolong Zhang
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Wenbin Dong
- Department of Newborn Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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Effect of Different Probes and Expertise on the Interpretation Reliability of Point-of-Care Lung Ultrasound. Chest 2020; 157:924-931. [DOI: 10.1016/j.chest.2019.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 11/09/2019] [Indexed: 01/19/2023] Open
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65
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Voynow JA, Fisher K, Sunday ME, Cotten CM, Hamvas A, Hendricks-Muñoz KD, Poindexter BB, Pryhuber GS, Ren CL, Ryan RM, Sharp JK, Young SP, Zhang H, Greenberg RG, Herring AH, Davis SD. Urine gastrin-releasing peptide in the first week correlates with bronchopulmonary dysplasia and post-prematurity respiratory disease. Pediatr Pulmonol 2020; 55:899-908. [PMID: 31995668 PMCID: PMC7071969 DOI: 10.1002/ppul.24665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/04/2020] [Indexed: 11/07/2022]
Abstract
RATIONALE Bronchopulmonary dysplasia (BPD) is associated with post-prematurity respiratory disease (PRD) in survivors of extreme preterm birth. Identifying early biomarkers that correlate with later development of BPD and PRD may provide insights for intervention. In a preterm baboon model, elevated gastrin-releasing peptide (GRP) is associated with BPD, and GRP inhibition mitigates BPD occurrence. OBJECTIVE We performed a prospective cohort study to investigate whether urine GRP levels obtained in the first postnatal week were associated with BPD, PRD, and other urinary biomarkers of oxidative stress. METHODS Extremely low gestational age infants (23-28 completed weeks) were enrolled in a US multicenter observational study, The Prematurity and Respiratory Outcomes Program (http://clinicaltrials.gov/ct2/show/NCT01435187). We used multivariable logistic regression to examine the association between urine GRP in the first postnatal week and multiple respiratory outcomes: BPD, defined as supplemental oxygen use at 36 + 0 weeks postmenstrual age, and post-PRD, defined by positive quarterly surveys for increased medical utilization over the first year (PRD score). RESULTS A total of 109 of 257 (42%) infants had BPD, and 120 of 217 (55%) had PRD. On adjusted analysis, GRP level more than 80 was associated with BPD (adjusted odds ratio [aOR], 1.83; 95% confidence interval [CI], 1.03-3.25) and positive PRD score (aOR, 2.46; 95% CI, 1.35-4.48). Urine GRP levels correlated with duration of NICU ventilatory and oxygen support and with biomarkers of oxidative stress: allantoin and 8-hydroxydeoxyguanosine. CONCLUSIONS Urine GRP in the first postnatal week was associated with concurrent urine biomarkers of oxidative stress and with later diagnoses of BPD and PRD.
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Affiliation(s)
- Judith A Voynow
- Division of Pediatric Pulmonology, Duke University, Durham, North Carolina.,Division of Pediatric Pulmonology, Children's Hospital of Richmond, Richmond, Virginia
| | - Kimberley Fisher
- Division of Neonatology, Duke University, Durham, North Carolina
| | - Mary E Sunday
- Department of Pathology, Duke University, Durham, North Carolina
| | - Charles M Cotten
- Division of Neonatology, Duke University, Durham, North Carolina
| | - Aaron Hamvas
- Division of Neonatology, Washington University, St Louis, Missouri.,Division of Neonatology, Northwestern University, Chicago, Illinois
| | | | - Brenda B Poindexter
- Division of Neonatology, Indiana University, Indianapolis, Indiana.,Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Clement L Ren
- Division of Pediatric Pulmonology, University of Rochester, Rochester, New York.,Division of Pediatric Pulmonology, Indiana University, Indianapolis, Indiana
| | - Rita M Ryan
- Division of Neonatology, State University of New York at Buffalo, Buffalo, New York.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Jack K Sharp
- Division of Pediatric Pulmonology, Duke University, Durham, North Carolina.,Division of Pediatric Pulmonology, State University of New York at Buffalo, Buffalo, New York.,Division of Pediatric Pulmonology, Baylor College of Medicine, Houston, Texas
| | - Sarah P Young
- Division of Medical Genetics, Duke University, Durham, North Carolina
| | - Haoyue Zhang
- Division of Medical Genetics, Duke University, Durham, North Carolina
| | - Rachel G Greenberg
- Division of Neonatology and The Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Amy H Herring
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Stephanie D Davis
- Division of Pediatric Pulmonology, Indiana University, Indianapolis, Indiana.,Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
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66
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Isayama T, Shah PS. Need for an International Consensus on the Definition of Bronchopulmonary Dysplasia. Am J Respir Crit Care Med 2020; 200:1323-1324. [PMID: 31322422 PMCID: PMC6857496 DOI: 10.1164/rccm.201906-1127le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Tetsuya Isayama
- National Center for Child Health and DevelopmentTokyo, Japan
| | - Prakesh S Shah
- Mount Sinai HospitalToronto, Ontario, Canadaand.,University of TorontoToronto, Ontario, Canada
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67
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Humberg A, Härtel C, Rausch TK, Stichtenoth G, Jung P, Wieg C, Kribs A, von der Wense A, Weller U, Höhn T, Olbertz DM, Felderhoff-Müser U, Rossi R, Teig N, Heitmann F, Schmidtke S, Bohnhorst B, Vochem M, Segerer H, Möller J, Eichhorn JG, Wintgens J, Böttger R, Hubert M, Dördelmann M, Hillebrand G, Roll C, Jensen R, Zemlin M, Mögel M, Werner C, Schäfer S, Schaible T, Franz A, Heldmann M, Ehlers S, Kannt O, Orlikowsky T, Gerleve H, Schneider K, Haase R, Böckenholt K, Linnemann K, Herting E, Göpel W. Active perinatal care of preterm infants in the German Neonatal Network. Arch Dis Child Fetal Neonatal Ed 2020; 105:190-195. [PMID: 31248963 DOI: 10.1136/archdischild-2018-316770] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine if survival rates of preterm infants receiving active perinatal care improve over time. DESIGN The German Neonatal Network is a cohort study of preterm infants with birth weight <1500 g. All eligible infants receiving active perinatal care are registered. We analysed data of patients discharged between 2011 and 2016. SETTING 43 German level III neonatal intensive care units (NICUs). PATIENTS 8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care. INTERVENTIONS Participating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25-P75) and low (<P25) survival. We compared these survival rates with data in 2014-2016. MAIN OUTCOME MEASURES Death by any cause before discharge. RESULTS Total survival increased from 85.8% in 2011-2013 to 87.4% in 2014-2016. This increase was due to reduced mortality of NICUs with low survival rates in 2011-2013. Survival increased in these centres from 53% to 64% in the 22-24 weeks strata and from 73% to 84% in the 25-26 weeks strata. CONCLUSIONS Our data support previous reports that active perinatal care of very immature infants improves outcomes at the border of viability and survival rates at higher gestational ages. The high total number of surviving infants below 24 weeks of gestation challenges national recommendations exclusively referring to gestational age as the single criterion for providing active care. However, more data are needed before recommendations for parental counselling should be reconsidered. TRIAL REGISTRATION Approval by the local institutional review board for research in human subjects of the University of Lübeck (file number 08-022) and by the local ethic committees of all participating centres has been given.
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Affiliation(s)
| | | | - Tanja K Rausch
- Institute for Medical Biometry and Statistics Lübeck, Lübeck, Germany
| | | | - Philipp Jung
- Pediatrics, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Christian Wieg
- Children's Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Angela Kribs
- Neonatology and Pediatric Intensive Care, University Hospital of Cologne, Cologne, Germany
| | - Axel von der Wense
- Department of Neonatology, Children's Hospital Hamburg-Altona, Hamburg, Germany
| | - Ursula Weller
- Department of Paediatrics, Evangelical Klinikum Bethel, Bielefeld, Germany
| | - Thomas Höhn
- Department of Paediatrics, University of Düsseldorf, Düsseldorf, Germany
| | - Dirk M Olbertz
- Department of Neonatology, Klinikum Südstadt Rostock, Rostock, Germany
| | | | | | - Norbert Teig
- Paediatrics, University Hospital, Bochum, Germany
| | | | - Susanne Schmidtke
- Department of Neonatology, Asklepios Hospital Hamburg-Barmbek, Hamburg-Barmbek, Germany
| | - Bettina Bohnhorst
- Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Matthias Vochem
- Department of Neonatology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Hugo Segerer
- Neonatology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Jens Möller
- Department of Paediatrics, Saarbrücken General Hospital, Saarbrücken, Germany
| | - Joachim G Eichhorn
- Department of Paediatrics, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Jürgen Wintgens
- Department of Paediatrics, Hospital Mönchengladbach, Mönchengladbach, Germany
| | - Ralf Böttger
- Department of Neonatology, Universitatsklinikum Magdeburg, Magdeburg, Germany
| | - Mechthild Hubert
- Department of Neonatology and Pediatric Intensive Care, DRK Children's Hospital, Siegen, Germany
| | - Michael Dördelmann
- Department of Paediatrics, Diakonissen Hospital Flensburg, Flensburg, Germany
| | | | - Claudia Roll
- Neonatology and Paediatric Intensive Care, Vest Children's Hospital Datteln, University Witten-Herdecke, Datteln, Germany
| | - Reinhard Jensen
- Department of Paediatrics, Westküstenklinikum Heide, Heide, Germany
| | - Michael Zemlin
- General Pediatrics and Neonatology, Saarland University, Homburg/Saar, Germany
| | - Michael Mögel
- Department of Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Claudius Werner
- Department of Paediatrics, University of Münster, Münster, Germany
| | - Stefan Schäfer
- Children's Hospital (Städtisches Klinikum) Nürnberg, Nürnberg, Germany
| | - Thomas Schaible
- Department of Paediatrics, University Medical Center Mannheim, Mannheim, Germany
| | - Axel Franz
- Neonatology, University of Tübingen, Tübingen, Germany
| | - Michael Heldmann
- HELIOS Children's Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Silke Ehlers
- Department of Neonatology, Bürgerhospital Frankfurt, Frankfurt, Germany
| | - Olaf Kannt
- Helios Klinik Schwerin, Schwerin, Germany
| | | | - Hubert Gerleve
- Department of Paediatrics, Christophorus Kliniken Coesfeld, Coesfeld, Germany
| | - Katja Schneider
- Department of Paediatrics, GFO Hospitals Bonn, Bonn, Germany
| | - Roland Haase
- Children's Hospital, University of Halle, Halle/Saale, Germany
| | - Kai Böckenholt
- Children's Hospital of the City of Cologne, Köln, Germany
| | - Knud Linnemann
- Department of Paediatrics, University of Greifswald, Greifswald, Germany
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68
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Levy PT, Jain A, Nawaytou H, Teitel D, Keller R, Fineman J, Steinhorn R, Abman SH, McNamara PJ. Risk Assessment and Monitoring of Chronic Pulmonary Hypertension in Premature Infants. J Pediatr 2020; 217:199-209.e4. [PMID: 31735418 DOI: 10.1016/j.jpeds.2019.10.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/28/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Amish Jain
- Department of Pediatrics, University of Toronto and Department of Pediatrics and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hythem Nawaytou
- Division of Cardiology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - David Teitel
- Division of Cardiology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Roberta Keller
- Cardiovascular Research Institute and the Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Jeffery Fineman
- Division of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Robin Steinhorn
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Steven H Abman
- Pediatric Heart Lung Center, Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
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69
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Mourani PM, Mandell EW, Meier M, Younoszai A, Brinton JT, Wagner BD, Arjaans S, Poindexter BB, Abman SH. Early Pulmonary Vascular Disease in Preterm Infants Is Associated with Late Respiratory Outcomes in Childhood. Am J Respir Crit Care Med 2020; 199:1020-1027. [PMID: 30303395 DOI: 10.1164/rccm.201803-0428oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Early pulmonary vascular disease (PVD) after preterm birth is associated with a high risk for developing bronchopulmonary dysplasia (BPD), but its relationship with late respiratory outcomes during early childhood remains uncertain. OBJECTIVES To determine whether PVD at 7 days after preterm birth is associated with late respiratory disease (LRD) during early childhood. METHODS This was a prospective study of preterm infants born before 34 weeks postmenstrual age (PMA). Echocardiograms were performed at 7 days and 36 weeks PMA. Prenatal and early postnatal factors and postdischarge follow-up survey data obtained at 6, 12, 18, and 24 months of age were analyzed in logistic regression models to identify early risk factors for LRD, defined as a physician diagnosis of asthma, reactive airways disease, BPD exacerbation, bronchiolitis, or pneumonia, or a respiratory-related hospitalization during follow-up. MEASUREMENTS AND MAIN RESULTS Of the 221 subjects (median, 27 wk PMA; interquartile range, 25-28 and 920 g; interquartile range, 770-1090 g) completing follow-up, 61% met LRD criteria. Gestational diabetes and both mechanical ventilator support and PVD at 7 days were associated with LRD. The combination of PVD and mechanical ventilator support at 7 days was among the strongest prognosticators of LRD (odds ratio, 8.1; confidence interval, 3.1-21.9; P < 0.001). Modeled prenatal and early postnatal factors accurately informed LRD (area under the curve, 0.764). Adding BPD status at 36 weeks PMA to the model did not change the accuracy (area under the curve, 0.771). CONCLUSIONS Early echocardiographic evidence of PVD after preterm birth in combination with other perinatal factors is a strong risk factor for LRD, suggesting that early PVD may contribute to the pathobiology of BPD.
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Affiliation(s)
- Peter M Mourani
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,2 Section of Critical Care
| | - Erica W Mandell
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,3 Section of Neonatology
| | - Maxene Meier
- 4 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | | | - John T Brinton
- 6 Section of Pulmonary Medicine, Children's Hospital Colorado and the University of Colorado Anschutz Medical Center, Aurora, Colorado.,4 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - Brandie D Wagner
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,4 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - Sanne Arjaans
- 7 University Medical Center Groningen and University of Groningen, Groningen, the Netherlands; and
| | - Brenda B Poindexter
- 8 Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Steven H Abman
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,6 Section of Pulmonary Medicine, Children's Hospital Colorado and the University of Colorado Anschutz Medical Center, Aurora, Colorado
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70
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Proportional assist ventilation (PAV) versus neurally adjusted ventilator assist (NAVA): effect on oxygenation in infants with evolving or established bronchopulmonary dysplasia. Eur J Pediatr 2020; 179:901-908. [PMID: 31980954 PMCID: PMC7220976 DOI: 10.1007/s00431-020-03584-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 11/11/2022]
Abstract
Both proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) provide pressure support synchronised throughout the respiratory cycle proportional to the patient's respiratory demand. Our aim was to compare the effect of these two modes on oxygenation in infants with evolving or established bronchopulmonary dysplasia. Two-hour periods of PAV and NAVA were delivered in random order to 18 infants born less than 32 weeks of gestation. Quasi oxygenation indices ("OI") and alveolar-arterial ("A-a") oxygen gradients at the end of each period on PAV, NAVA and baseline ventilation were calculated using capillary blood samples. The mean "OI" was not significantly different on PAV compared to NAVA (7.8 (standard deviation (SD) 3.2) versus 8.1 (SD 3.4), respectively, p = 0.70, but lower on both than on baseline ventilation (mean baseline "OI" 11.0 (SD 5.0)), p = 0.002, 0.004, respectively). The "A-a" oxygen gradient was higher on PAV and baseline ventilation than on NAVA (20.8 (SD 12.3) and 22.9 (SD 11.8) versus 18.5 (SD 10.8) kPa, p = 0.015, < 0.001, respectively).Conclusion: Both NAVA and PAV improved oxygenation compared to conventional ventilation. There was no significant difference in the mean "OI" between the two modes, but the mean "A-a" gradient was better on NAVA.What is Known:• Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) can improve the oxygenation index (OI) in prematurely born infants.• Both PAV and NAVA can provide support proportional to respiratory drive or demand throughout the respiratory cycle.What is New:• In infants with evolving or established BPD, using capillary blood samples, both PAV and NAVA compared to baseline ventilation resulted in improvement in the "OI", but there was no significant difference in the "OI" on PAV compared to NAVA.• The "alveolar-arterial" oxygen gradient was better on NAVA compared to PAV.
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71
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Davis JM, Pursley DM. Preventing long-term respiratory morbidity in preterm neonates: is there a path forward? Pediatr Res 2020; 87:9-10. [PMID: 31698412 DOI: 10.1038/s41390-019-0641-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Jonathan M Davis
- Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, The Tufts Clinical and Translational Research Institute, Tufts University School of Medicine, Boston, MA, USA.
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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72
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Jobe AH. Unanticipated Deaths in Randomized Controlled Trials of Very Premature Infants. J Pediatr 2019; 215:252-256. [PMID: 31378520 DOI: 10.1016/j.jpeds.2019.06.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Alan H Jobe
- Department of Pediatrics, Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
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73
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Dell'Orto V, Raschetti R, Centorrino R, Montane A, Tissieres P, Yousef N, De Luca D. Short- and long-term respiratory outcomes in neonates with ventilator-associated pneumonia. Pediatr Pulmonol 2019; 54:1982-1988. [PMID: 31456358 DOI: 10.1002/ppul.24487] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/09/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critical care settings and might have important long-term consequences in neonates. Our aim is to clarify the short- and long-term respiratory outcomes of neonates affected by VAP. METHODS Prospective, population-based, cohort study with 12 months follow-up based on clinical examinations and diary-based respiratory morbidity score, conducted in an academic tertiary referral neonatal unit with dedicated follow-up program. RESULTS A total of 199 inborn neonates consecutively ventilated for at least 48 hours were eligible for the study. One hundred fifty-one were finally enrolled and classified as "exposed" or "unexposed" to VAP, if they fulfilled (or not) VAP criteria once during their stay. Bronchopulmonary dysplasia (BPD) incidence was significantly higher in exposed (75%) than in unexposed babies (26.8%; relative risk [RR]: 2.8 [1.9-4.0]; Adj RR: 3.5 [1.002-12.7]; P = .049; number needed to harm = 2.07), although the composite BPD/mortality did not differ. Exposed patients showed longer intensive care unit stay (87 [43-116] vs 14 [8-52] days; St.β = 0.24; P < .0001) and duration of ventilation (15 [10-25] vs 5 [4-8] days; St.β = 0.29; P < .0001) than unexposed neonates. Exposed patients also showed less ventilator-free days (11 [5-17.7] vs 22 [14-24] days; St.β = -0.15; P = .05) compared to unexposed. Respiratory infections, use of drugs, rehospitalization for respiratory reasons, home oxygen therapy, their composite outcome, and diary-based clinical respiratory morbidity score were similar between the cohorts. CONCLUSION Neonatal VAP seems associated to higher incidence of BPD, longer ventilation, and intensive care stay but it does not affect long-term respiratory morbidity.
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Affiliation(s)
- Valentina Dell'Orto
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Roberto Raschetti
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Roberta Centorrino
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Amelie Montane
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Pierre Tissieres
- Institute for Integrative Biology (I2BC), South Paris-Saclay University, Orsay, France
| | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France.,Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
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74
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Abstract
In the absence of effective interventions to prevent preterm births, improved survival of infants who are born at the biological limits of viability has relied on advances in perinatal care over the past 50 years. Except for extremely preterm infants with suboptimal perinatal care or major antenatal events that cause severe respiratory failure at birth, most extremely preterm infants now survive, but they often develop chronic lung dysfunction termed bronchopulmonary dysplasia (BPD; also known as chronic lung disease). Despite major efforts to minimize injurious but often life-saving postnatal interventions (such as oxygen, mechanical ventilation and corticosteroids), BPD remains the most frequent complication of extreme preterm birth. BPD is now recognized as the result of an aberrant reparative response to both antenatal injury and repetitive postnatal injury to the developing lungs. Consequently, lung development is markedly impaired, which leads to persistent airway and pulmonary vascular disease that can affect adult lung function. Greater insights into the pathobiology of BPD will provide a better understanding of disease mechanisms and lung repair and regeneration, which will enable the discovery of novel therapeutic targets. In parallel, clinical and translational studies that improve the classification of disease phenotypes and enable early identification of at-risk preterm infants should improve trial design and individualized care to enhance outcomes in preterm infants.
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75
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Jobe AH, Abman SH. Bronchopulmonary Dysplasia: A Continuum of Lung Disease from the Fetus to the Adult. Am J Respir Crit Care Med 2019; 200:659-660. [PMID: 31091958 PMCID: PMC6775887 DOI: 10.1164/rccm.201904-0875ed] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Alan H Jobe
- Cincinnati Children's HospitalUniversity of Cincinnati School of MedicineCincinnati, Ohioand
| | - Steven H Abman
- Deptartment of PediatricsUniversity of Colorado Denver Anschutz Medical CenterAurora, Colorado
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76
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Jensen EA, Dysart K, Gantz MG, McDonald S, Bamat NA, Keszler M, Kirpalani H, Laughon MM, Poindexter BB, Duncan AF, Yoder BA, Eichenwald EC. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach. Am J Respir Crit Care Med 2019; 200:751-759. [PMID: 30995069 PMCID: PMC6775872 DOI: 10.1164/rccm.201812-2348oc] [Citation(s) in RCA: 536] [Impact Index Per Article: 107.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/16/2019] [Indexed: 01/06/2023] Open
Abstract
Rationale: Current diagnostic criteria for bronchopulmonary dysplasia rely heavily on the level and duration of oxygen therapy, do not reflect contemporary neonatal care, and do not adequately predict childhood morbidity.Objectives: To determine which of 18 prespecified, revised definitions of bronchopulmonary dysplasia that variably define disease severity according to the level of respiratory support and supplemental oxygen administered at 36 weeks' postmenstrual age best predicts death or serious respiratory morbidity through 18-26 months' corrected age.Methods: We assessed infants born at less than 32 weeks of gestation between 2011 and 2015 at 18 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.Measurements and Main Results: Of 2,677 infants, 683 (26%) died or developed serious respiratory morbidity. The diagnostic criteria that best predicted this outcome defined bronchopulmonary dysplasia according to treatment with the following support at 36 weeks' postmenstrual age, regardless of prior or current oxygen therapy: no bronchopulmonary dysplasia, no support (n = 773); grade 1, nasal cannula ≤2 L/min (n = 1,038); grade 2, nasal cannula >2 L/min or noninvasive positive airway pressure (n = 617); and grade 3, invasive mechanical ventilation (n = 249). These criteria correctly predicted death or serious respiratory morbidity in 81% of study infants. Rates of this outcome increased stepwise from 10% among infants without bronchopulmonary dysplasia to 77% among those with grade 3 disease. A similar gradient (33-79%) was observed for death or neurodevelopmental impairment.Conclusions: The definition of bronchopulmonary dysplasia that best predicted early childhood morbidity categorized disease severity according to the mode of respiratory support administered at 36 weeks' postmenstrual age, regardless of supplemental oxygen use.
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Affiliation(s)
- Erik A. Jensen
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Dysart
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marie G. Gantz
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina
| | - Scott McDonald
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina
| | - Nicolas A. Bamat
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin Keszler
- Department of Pediatrics, Women and Infant’s Hospital of Rhode Island, Brown University, Providence, Rhode Island
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew M. Laughon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brenda B. Poindexter
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Andrea F. Duncan
- Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas; and
| | - Bradley A. Yoder
- Division of Neonatology, University of Utah, Salt Lake City, Utah
| | - Eric C. Eichenwald
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network*
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina
- Department of Pediatrics, Women and Infant’s Hospital of Rhode Island, Brown University, Providence, Rhode Island
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas; and
- Division of Neonatology, University of Utah, Salt Lake City, Utah
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77
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Valenzuela-Stutman D, Marshall G, Tapia JL, Mariani G, Bancalari A, Gonzalez Á. Bronchopulmonary dysplasia: risk prediction models for very-low- birth-weight infants. J Perinatol 2019; 39:1275-1281. [PMID: 31337853 DOI: 10.1038/s41372-019-0430-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our objective is to develop risk prediction models for moderate/severe bronchopulmonary dysplasia (BPD) and BPD and/or death in very-low-birth-weight infants (VLBWI) at birth, 3, 7, and 14 postnatal days. STUDY DESIGN It is a multicenter study including 16,407 infants weighing 500-1500 g (2001-2015) from the Neocosur Network. BPD was defined as oxygen dependency at 36 weeks. Variables were selected using forward logistic regression models. Predictive values were evaluated using the ROC curve. RESULTS In total, 2580 (15.7%) presented BPD and 6121 (37.3%) BPD/death. The AUC values for the BPD models were 0.788, 0.818, 0.827, and 0.894 respectively. For BPD/death, the AUC values were 0.860, 0.869, 0.867, and 0.906. BW and gestational age had higher contribution at birth; at later ages, the length of oxygen therapy and ventilation had the highest contribution. All AUC values were statistically significant when compared with a neutral value of 0.5 (p-value < 0.001). CONCLUSIONS We developed high predictive power models for moderate/severe BPD and BPD/death at four postnatal ages.
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Affiliation(s)
- Daniela Valenzuela-Stutman
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Guillermo Marshall
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - José L Tapia
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gonzalo Mariani
- Unidad de Neonatologia, Instituto Universitario Hospital Italiano Buenos Aires, Potosí, Argentina
| | - Aldo Bancalari
- Servicio de Neonatología, Hospital Guillermo Grant Benavente y Departamento de Pediatría, Facultad de Medicina, Universidad de Concepción, Concepcion, Chile
| | - Álvaro Gonzalez
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
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78
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Davis JM, Pilon AL, Shenberger J, Breeze JL, Terrin N, Mazela J, Gulszinka E, Lauderbach R, Parad R. The role of recombinant human CC10 in the prevention of chronic pulmonary insufficiency of prematurity. Pediatr Res 2019; 86:254-260. [PMID: 31086287 PMCID: PMC9487981 DOI: 10.1038/s41390-019-0419-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/16/2019] [Accepted: 04/21/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preterm neonates can develop chronic pulmonary insufficiency of prematurity (CPIP) later in infancy. Recombinant human CC10 protein (rhCC10) is an anti-inflammatory agent that could potentially prevent CPIP. METHODS The safety and efficacy of a single intratracheal dose of rhCC10 in reducing CPIP at 12 months corrected gestational age (CGA) was evaluated in a Phase II double-blind, randomized, placebo-controlled, multisite clinical trial. Eighty-eight neonates were randomized: 22 to placebo and 22 to 1.5 mg/kg rhCC10 in the first cohort and 21 to placebo and 23 to 5 mg/kg rhCC10 in the second cohort. Neonates were followed to 12 months CGA. RESULTS With CPIP defined as signs/symptoms, medical visits, hospital readmissions, and use of medications for respiratory complications at 12 months CGA, no significant differences were observed between rhCC10 or placebo groups. Only 5% of neonates had no evidence of CPIP at 12 months CGA. CONCLUSIONS A single dose of rhCC10 was not effective in reducing CPIP at 12 CGA. Since most neonates had evidence of CPIP using these exploratory endpoints, it is essential to develop more robust outcome measures for clinical trials of respiratory medications in high-risk premature neonates.
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Affiliation(s)
- Jonathan M. Davis
- Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, MA,Tufts Clinical and Translational Science Institute, Tufts University, and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | | | | | - Janis L. Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - Norma Terrin
- Tufts Clinical and Translational Science Institute, Tufts University, and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - Jan Mazela
- Ginekologiczno-Położniczy Szpital Kliniczny UM, Poznan, Poland
| | | | - Ryszard Lauderbach
- Samodzielny Publiczny Zakład Opieki Zdrowotnej Szpital Uniwersytecki w Krakowie, Krakow, Poland
| | - Richard Parad
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA
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79
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Noteworthy Professional News. Adv Neonatal Care 2019. [DOI: 10.1097/anc.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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80
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Abstract
Introduction: Bronchopulmonary dysplasia (BPD) is a common long-term adverse complication of very premature delivery. Affected infants can suffer chronic respiratory morbidities including lung function abnormalities and reduced exercise capacity even as young adults. Many studies have investigated possible preventative strategies; however, it is equally important to identify optimum management strategies for infants with evolving or established BPD. Areas covered: Respiratory support modalities and established and novel pharmacological treatments. Expert opinion: Respiratory support modalities including proportional assist ventilation and neurally adjusted ventilatory assist are associated with short term improvements in oxygenation indices. Such modalities need to be investigated in appropriate RCTs. Many pharmacological treatments are routinely used with a limited evidence base, for example diuretics. Stem cell therapies in small case series are associated with promising results. More research is required before it is possible to determine if such therapies should be investigated in large RCTs with long-term outcomes.
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Affiliation(s)
- Emma Williams
- a Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London , UK.,b The Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London , UK
| | - Anne Greenough
- a Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London , UK.,c NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London , London , UK
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81
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Zhao W, Ma L, Cai C, Gong X. Caffeine Inhibits NLRP3 Inflammasome Activation by Suppressing MAPK/NF-κB and A2aR Signaling in LPS-Induced THP-1 Macrophages. Int J Biol Sci 2019; 15:1571-1581. [PMID: 31360100 PMCID: PMC6643212 DOI: 10.7150/ijbs.34211] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022] Open
Abstract
Excessive inflammation induced by various risk factors is associated with the development of bronchopulmonary dysplasia (BPD). Caffeine exerts potent anti-inflammatory effects as a clinical preventive medicine for BPD. Recently, NLRP3 inflammasome activation has been demonstrated to be essential for the pathogenesis of BPD. In the present study, we aimed to investigate the effects of caffeine on NLRP3 inflammasome activation in LPS-induced THP-1 macrophages and to explore the underlying the detailed mechanism. We found that caffeine significantly reduced NLRP3 expression, ASC speck formation, and caspase 1 cleavage and therefore decreased IL-1β and IL-18 secretion in THP-1 macrophages. Caffeine also markedly decreased the phosphorylation levels of MAPK and NF-κB pathway members, further suppressing the translocation of NF-κB in THP-1 macrophages. Moreover, silencing of the caffeine-antagonized adenosine A2a receptor (A2aR) significantly decreased cleaved caspase 1 expression in THP-1 macrophages by reducing ROS production. Given these findings, we conclude that caffeine inhibits NLRP3 inflammasome activation by suppressing MAPK/NF-κB signaling and A2aR-associated ROS production in LPS-induced THP-1 macrophages.
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Affiliation(s)
- Weiming Zhao
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Li Ma
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Cai
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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82
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Abstract
Rates of bronchopulmonary dysplasia (BPD) are increasing. After preterm birth, there are important developmental periods in which neonates are more vulnerable to stressful events. These periods are opportunities for pharmacologic interventions. Many drugs remain inadequately tested and no new drugs have been approved in more than 25 years for BPD prevention or therapy. More progress is needed in defining appropriate end points based on the pathophysiology of BPD and postdischarge chronic pulmonary insufficiency of prematurity and to develop effective new drugs. In addition, much work is needed to better define perinatal factors, early postnatal findings, and physiologic phenotypes or endotypes.
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83
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Challenges in Designing Clinical Trials to Test New Drugs in the Pregnant Woman and Fetus. Clin Perinatol 2019; 46:399-416. [PMID: 31010567 DOI: 10.1016/j.clp.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The need for new drugs in pregnancy is widely recognized. This review identifies several unique challenges and describes some solutions. Specific studies and drug development programs need careful planning that accounts for the needs of regulatory agencies. The perinatal (obstetric/pediatric) community needs to establish collaborations to develop methodologies, to facilitate data sharing, and to lobby for research and access to medicines. There is a need to gather and present information that promotes proportionate judgments of the balance between potential benefits and risks. This will require researchers to look beyond their traditional ways of working.
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84
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Kjellberg M, Sanchez-Crespo A, Jonsson B. Ten-year-old children with a history of bronchopulmonary dysplasia have regional abnormalities in ventilation perfusion matching. Pediatr Pulmonol 2019; 54:602-609. [PMID: 30887678 DOI: 10.1002/ppul.24273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/16/2019] [Indexed: 01/25/2023]
Abstract
AIM The ratio of ventilation to blood flow is an important determinant for regional gas exchange in the lung and hypoxemia is one of the clinical hallmarks in infants with bronchopulmonary dysplasia (BPD). We have previously demonstrated ventilation/perfusion ratio (V/Q) abnormalities in infants with BPD at 36 weekś postconceptional age. The status of V/Q matching in older children with a history of BPD in infancy is unknown. In this study, we examined if 10-year-old children with a history of BPD had V/Q impairments. METHODS Three-dimensional V/Q-scintigraphy (SPECT) was performed in 26 children. RESULTS In the BPD group, lung volume with mismatch, (V>Q) was larger compared to areas with reverse mismatch (Q>V), 26.2% and 11.8%, respectively, implying that perfusion defects contribute more than ventilation defects in the V/Q mismatch. Also, the mean fractional distribution of V and Q to V/Q in children with BPD was reduced compared to healthy children, 31% and 51% compared to 64% and 89%, respectively (P < 0.01). CONCLUSION At 10 years of age children with a history of BPD had ventilation/perfusion abnormalities, with prominent perfusion defects. These V/Q abnormalities suggest the presence of residual alveolar-capillary impairment.
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Affiliation(s)
- Malin Kjellberg
- Institute of Women's and Children's Health, Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Alejandro Sanchez-Crespo
- Institution of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Univeristy Hospital, Stockholm, Sweden
| | - Baldvin Jonsson
- Institute of Women's and Children's Health, Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden
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85
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McGraw MD, Sherlock LG, Bailey KL, Abman SH. Developmental Origins of Chronic Lung Diseases. Mechanical Stretch, Micro-RNAs, and Hydrogels. Am J Respir Cell Mol Biol 2019; 59:267-270. [PMID: 29641225 DOI: 10.1165/rcmb.2018-0092ro] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Matthew D McGraw
- 1 Breathing Institute and Pediatric Heart-Lung Center, Division of Pediatrics, and
| | - Laura G Sherlock
- 2 Division of Pediatrics, Section of Neonatal-Perinatal Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; and
| | - Kolene L Bailey
- 3 Division of Pulmonary and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Steven H Abman
- 1 Breathing Institute and Pediatric Heart-Lung Center, Division of Pediatrics, and
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86
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Yen E, Davis JM, Milne CP. Impact of Regulatory Incentive Programs on the Future of Pediatric Drug Development. Ther Innov Regul Sci 2019; 53:609-614. [PMID: 30983385 DOI: 10.1177/2168479019837522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Surveys evaluating industry experience with performing pediatric studies under the Best Pharmaceutical for Children Act (BPCA) and Pediatric Research Equity Act (PREA) regulatory regime were conducted by Tufts Center for the Study of Drug Development (Tufts CSDD) in 2000, 2006, and 2016. These survey results are being used to assess the future impact of regulatory incentive programs on generating pediatric specific labeling information and development of age-appropriate drug formulations. A second perspective will be provided through the experience and expertise of neonatal/pediatric clinicians and researchers with a focus on the urgent need for the study of new and existing drugs in this vulnerable population (especially with 90% of drugs in neonates still being used off-label). This group will also address the impact of existing regulations and the likely trajectory of future pediatric drug development efforts after nearly 2 decades of regulatory incentives (both mandatory and voluntary). Finally, this review will provide input on approaches that are needed to continue to advance pediatric drug development with an emphasis on rare diseases.
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Affiliation(s)
- Elizabeth Yen
- 1 Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
| | - Jonathan M Davis
- 1 Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA.,2 The Tufts Clinical and Translational Research Institute, Boston, MA, USA
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87
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Higgins RD, Jobe AH. Reply. J Pediatr 2019; 207:264. [PMID: 30591266 PMCID: PMC6636836 DOI: 10.1016/j.jpeds.2018.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Rosemary D. Higgins
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver
National Institute of Child Health and Human Development (NICHD, National Institutes
of Health (NIH), Bethesda, MD
| | - Alan H. Jobe
- Department of Pediatrics, Cincinnati Children’s
Hospital Medical Center and University of Cincinnati, Cincinnati, OH
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88
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Costeloe K, Turner MA, Padula MA, Shah PS, Modi N, Soll R, Haumont D, Kusuda S, Göpel W, Chang YS, Smith PB, Lui K, Davis JM, Hudson LD. Sharing Data to Accelerate Medicine Development and Improve Neonatal Care: Data Standards and Harmonized Definitions. J Pediatr 2018; 203:437-441.e1. [PMID: 30293637 DOI: 10.1016/j.jpeds.2018.07.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Kate Costeloe
- Paediatric Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
| | - Michael A Padula
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Prakesh S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Lunenfeld Tannebaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Neena Modi
- Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Roger Soll
- Vermont Oxford Network, Neonatology, University of Vermont College of Medicine, Burlington, VT
| | - Dominique Haumont
- Department of Neonatology, Saint-Pierre University Hospital, Brussels, Belgium
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Wolfgang Göpel
- Neonatology and Paediatric Intensive Care, University of Lübeck, Department of Paediatrics, Lübeck, Germany
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Kei Lui
- Discipline of Paediatrics, School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Jonathan M Davis
- Department of Paediatrics, Floating Hospital for Children, Tufts Medical Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
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89
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Taglauer E, Abman SH, Keller RL. Recent advances in antenatal factors predisposing to bronchopulmonary dysplasia. Semin Perinatol 2018; 42:413-424. [PMID: 30389227 PMCID: PMC6286866 DOI: 10.1053/j.semperi.2018.09.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bronchopulmonary dysplasia (BPD) remains a major cause of late morbidities and death after preterm birth. BPD is characterized by an arrest of vascular and alveolar growth and high risk for pulmonary hypertension; yet mechanisms contributing to its pathogenesis and early strategies to prevent BPD are poorly understood. Strong epidemiologic studies have shown that the "new BPD" reflects the long-lasting impact of antenatal factors on lung development, partly due to placental dysfunction, as reflected in recent data from animal models. Improved understanding of mechanisms through which antenatal stress alters placental function and contributes to BPD may lead to preventive therapies.
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Affiliation(s)
| | - Steven H. Abman
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO USA
| | - Roberta L. Keller
- Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
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90
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Thébaud B. Stem cell-based therapies in neonatology: a new hope. Arch Dis Child Fetal Neonatal Ed 2018; 103:F583-F588. [PMID: 29973349 DOI: 10.1136/archdischild-2017-314451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 01/01/2023]
Abstract
Despite progress made in neonatal intensive care, complications of extreme preterm birth still contribute as the main cause of death to children below 5 years of age. Stem cell-based therapies-mesenchymal stromal cells in particular-offer a new hope in preventing and/or restoring organ damage in extreme preterm infants. Early phase clinical trials, fueled by promising preclinical studies on lung and brain injury, have begun. While the enthusiasm in the neonatal community is palpable, much more needs to be learnt about cell-based therapies. Maintaining the balance between temptation and a cautious, evidence-based approach will be critical for cell therapies to fulfil their promise in substantially improving the outcome of extreme preterm infants.
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Affiliation(s)
- Bernard Thébaud
- Regenerative Medicine Program, Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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91
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Stavis RL, La Gamma EF. History of chronic pulmonary insufficiency of prematurity. J Pediatr 2018; 198:328. [PMID: 29550233 DOI: 10.1016/j.jpeds.2018.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Robert L Stavis
- Division of Neonatology Main Line Health Bryn Mawr, Pennsylvania; Department of Pediatrics Nemours/Alfred I. duPont Hospital for Children Wilmington, Delaware
| | - Edmund F La Gamma
- Division of Newborn Medicine Maria Fareri Children's Hospital Westchester Medical Center-New York Medical College Valhalla, New York
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92
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Jensen EA, Wright CJ. Bronchopulmonary Dysplasia: The Ongoing Search for One Definition to Rule Them All. J Pediatr 2018; 197:8-10. [PMID: 29605396 DOI: 10.1016/j.jpeds.2018.02.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Erik A Jensen
- Department of Pediatrics Division of Neonatology The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine Philadelphia, Pennsylvania.
| | - Clyde J Wright
- Section of Neonatology Department of Pediatrics University of Colorado School of Medicine and Children's Hospital Colorado Aurora, Colorado
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