151
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Sun Z, Shen Y, Chen X, Zhou X, Cheng R, Bao Z, Yang Y. Expression and potential regulation of miRNA‑431 during lung development of Sprague‑Dawley rats. Mol Med Rep 2019; 19:4980-4988. [PMID: 31059017 DOI: 10.3892/mmr.2019.10154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/27/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Zhong‑Yi Sun
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yan‑Qing Shen
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Xiao‑Qing Chen
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao‑Yu Zhou
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Rui Cheng
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Zhi‑Dan Bao
- Department of Neonates, Jiangyin People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 210008, P.R. China
| | - Yang Yang
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
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152
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Montigaud Y, Périnel S, Dubus JC, Leclerc L, Suau M, Goy C, Clotagatide A, Prévôt N, Pourchez J. Development of an ex vivo respiratory pediatric model of bronchopulmonary dysplasia for aerosol deposition studies. Sci Rep 2019; 9:5720. [PMID: 30952897 PMCID: PMC6450907 DOI: 10.1038/s41598-019-42103-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/20/2019] [Indexed: 01/03/2023] Open
Abstract
Ethical restrictions are limitations of in vivo inhalation studies, on humans and animal models. Thus, in vitro or ex vivo anatomical models offer an interesting alternative if limitations are clearly identified and if extrapolation to human is made with caution. This work aimed to develop an ex vivo infant-like respiratory model of bronchopulmonary dysplasia easy to use, reliable and relevant compared to in vivo infant data. This model is composed of a 3D-printed head connected to a sealed enclosure containing a leporine thorax. Physiological data and pleural-mimicking depressions were measured for chosen respiratory rates. Homogeneity of ventilation was assessed by 81mkrypton scintigraphies. Regional radioaerosol deposition was quantified with 99mtechnetium-diethylene triamine pentaacetic acid after jet nebulization. Tidal volumes values are ranged from 33.16 ± 7.37 to 37.44 ± 7.43 mL and compliance values from 1.78 ± 0.65 to 1.85 ± 0.99 mL/cmH2O. Ventilation scintigraphies showed a homogenous ventilation with asymmetric repartition: 56.94% ± 9.4% in right lung and 42.83% ± 9.36 in left lung. Regional aerosol deposition in lungs exerted 2.60% ± 2.24% of initial load of radioactivity. To conclude the anatomical model satisfactorily mimic a 3-months old BPD-suffering bronchopulmonary dysplasia and can be an interesting tool for aerosol regional deposition studies.
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Affiliation(s)
- Yoann Montigaud
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
| | - Sophie Périnel
- INSERM U 1059 Sainbiose, Université Jean Monnet, F-42023, Saint-Etienne, France.,CHU Saint-Etienne, Saint-Etienne, F-42055, France
| | - Jean-Christophe Dubus
- Médecine infantile, pneumo-allergologie, CRCM & CNRS, URMITE 6236, Assistance publique-Hôpitaux de Marseille, 13385, Marseille cedex 5, France
| | - Lara Leclerc
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
| | - Marie Suau
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
| | - Clémence Goy
- INSERM U 1059 Sainbiose, Université Jean Monnet, F-42023, Saint-Etienne, France.,CHU Saint-Etienne, Saint-Etienne, F-42055, France
| | - Anthony Clotagatide
- INSERM U 1059 Sainbiose, Université Jean Monnet, F-42023, Saint-Etienne, France.,CHU Saint-Etienne, Saint-Etienne, F-42055, France
| | - Nathalie Prévôt
- INSERM U 1059 Sainbiose, Université Jean Monnet, F-42023, Saint-Etienne, France.,CHU Saint-Etienne, Saint-Etienne, F-42055, France
| | - Jérémie Pourchez
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France.
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153
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Effect of Prophylaxis for Early Adrenal Insufficiency Using Low-Dose Hydrocortisone in Very Preterm Infants: An Individual Patient Data Meta-Analysis. J Pediatr 2019; 207:136-142.e5. [PMID: 30416014 DOI: 10.1016/j.jpeds.2018.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the effect of prophylaxis for early adrenal insufficiency using low-dose hydrocortisone on survival without bronchopulmonary dysplasia (BPD) in very preterm infants using an individual patient data meta-analysis. STUDY DESIGN All existing randomized controlled trials testing the efficacy of the prophylaxis of early adrenal insufficiency using low-dose hydrocortisone on survival without BPD were considered for inclusion when data were available. The primary outcome was the binary variable survival without BPD at 36 weeks of postmenstrual age. RESULTS Among 5 eligible studies, 4 randomized controlled trials had individual patient data available (96% of participants identified; n = 982). Early low-dose hydrocortisone treatment for 10-15 days was associated with a significant increase in survival without BPD (OR, 1.45; 95% CI, 1.11-1.90; P = .007; I2 = 0%), as well as with decreases in medical treatment for patent ductus arteriosus (OR, 0.72; 95% CI, 0.56-0.93; P = .01; I2 = 0%) and death before discharge (OR, 0.70; 95% CI, 0.51-0.97; P = .03; I2 = 0%). The therapy was associated with an increased risk of spontaneous gastrointestinal perforation (OR, 2.50; 95% CI, 1.33-4.69; P = .004; I2 = 31.9%) when hydrocortisone was given in association with indomethacin exposure. The incidence of late-onset sepsis was increased in infants exposed to hydrocortisone (OR, 1.34; 95% CI, 1.02-1.75; P = .04; I2 = 0%), but no adverse effects were reported for either death or 2-year neurodevelopmental outcomes as assessed in an aggregate meta-analysis. CONCLUSIONS This individual patient data meta-analysis showed that early low-dose hydrocortisone therapy is beneficial for survival without BPD in very preterm infants.
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154
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Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in premature infants who require mechanical ventilation and oxygen therapy. Despite advances in neonatal care resulting in improved survival and decreased morbidity, limited progress has been made in reducing rates of BPD. Therapeutic options to protect the vulnerable developing lung are limited as are strategies to treat lung injury, resulting in ongoing concerns for long-term pulmonary morbidity after preterm birth. Lung protective strategies and optimal nutrition are recognized to improve pulmonary outcomes. However, characterization of late outcomes is challenged by rapid advances in neonatal care. As a result, current adult survivors reflect outdated medical practices. Although neonatal pulmonary disease tends to improve with growth, compromised respiratory health has been documented in young adult survivors of BPD. With improved survival of premature infants but limited progress in reducing rates of disease, BPD represents a growing burden on health care systems. [Pediatr Ann. 2019;48(4):e148-e153.].
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155
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Sisman Y, Buchvald FF, Ring AM, Wassilew K, Nielsen KG. Long-Term Lung Function and Exercise Capacity in Postinfectious chILD. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:4-11. [PMID: 31032143 PMCID: PMC6484343 DOI: 10.1089/ped.2018.0973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/10/2019] [Indexed: 11/12/2022]
Abstract
Background: Severe postinfectious diffuse pulmonary disease may clinically mimic other entities of children's interstitial lung disease and is clinically challenging comprising various disease severities despite treatment. Long-term lung function trend and physical capacity in children with postinfectious diffuse pulmonary disease are rarely reported. We investigated trends in pulmonary function by long-term follow-up and assessed physical capacity in such patients. Methods: We performed a descriptive, single-center follow-up study in children with biopsy-verified postinfectious diffuse pulmonary disease. Patients with completed primary treatment course were eligible for follow-up, including pulmonary function and exercise (VO2peak) testing. Results: Thirty patients with postinfectious diffuse pulmonary disease were identified and included. Median (range) age at diagnose was 27.5 (2–172) months after a mean lag time of 23 months. H. influenzae and rhinovirus were the most frequent pathogens. Fifteen patients were available for follow-up after mean (range) 7.6 (2–15) years of treatment completion. Lung clearance index (LCI2.5), forced expiratory volume in 1 second (FEV1), and bronchodilator responsiveness were abnormal in 80%, 53%, and 44%, respectively. Diffusion capacity for monoxide was abnormal in 7% and total lung capacity in 33%. Only 8% demonstrated low VO2peak, while 40% reported difficulties during physical exertion. Longitudinal data on spirometry (n = 14) remained unchanged from end of treatment throughout follow-up. A significant association was found between zLCI2.5 and zFEV1 (multiple linear regression; r2 = 0.61; P = 0.0003). Conclusion: Postinfectious diffuse pulmonary disease in children carries a varying degree of chronic pulmonary impairment with onset of symptoms in the first months of life and a typical considerable lag time before diagnosis. Follow-up several years after the initial injury demonstrated moderate-to-severe peripheral airway impairment although no further lung function decline was found years after completion of treatment. Despite acceptable VO2peak, a considerable proportion struggled during heavy exercise.
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Affiliation(s)
- Yagmur Sisman
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik F Buchvald
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Astrid Madsen Ring
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katharina Wassilew
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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156
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van der Graaf M, Rojer LA, Helbing WA, Reiss IKM, Etnel JRG, Bartelds B. EXPRESS: Sildenafil for bronchopulmonary dysplasia and pulmonary hypertension: a meta-analysis. Pulm Circ 2019; 9:2045894019837875. [PMID: 30803328 PMCID: PMC6681505 DOI: 10.1177/2045894019837875] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/19/2019] [Indexed: 01/28/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most common complication in preterm infants and often complicated by pulmonary hypertension (PH), leading to substantial morbidity and mortality. Sildenafil is often used to treat PH and improve symptoms in this condition, even though evidence of safety and effectiveness is scarce. The aim of this study was to perform a systematic review and meta-analysis about the effectiveness and safety of chronic use of sildenafil in preterm infants with BPD-associated PH. Data sources were PubMed, EMBASE, and Medline. Studies reporting the effectiveness of sildenafil therapy in BPD-associated PH in newborns and infants were included. All-cause mortality, improvement in PH, improvement in respiratory scores, and adverse events were extracted. Five studies were included, yielding a total of 101 patients with 94.2 patient-years of total follow-up. The pooled mortality rate was 29.7%/year (95% confidence interval [CI] = 6.8–52.7). Estimated pulmonary arterial pressure improved > 20% in 69.3% (95% CI = 56.8–81.8) of patients within 1–6 months. Respiratory scores improved in 15.0% (95% CI = 0.0–30.4) of patients within 2–7 days. There were no serious adverse events during sildenafil therapy. This systematic review shows that in the treatment of BPD-associated PH in preterm infants, sildenafil may be associated with improvement in PAP and respiratory scores. However, there is no clear evidence of its effect on mortality rates. Considering BPD as a complex disease with variable expression patterns, these results support the need for a prospective registry and standardized approach.
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Affiliation(s)
- Marisa van der Graaf
- Department of Pediatrics, Division of
Cardiology, Erasmus University Medical Centre - Sophia Children’s Hospital,
Rotterdam, The Netherlands
| | - Leonne Arindah Rojer
- Department of Pediatrics, Division of
Cardiology, Erasmus University Medical Centre - Sophia Children’s Hospital,
Rotterdam, The Netherlands
| | - Willem Arnold Helbing
- Department of Pediatrics, Division of
Cardiology, Erasmus University Medical Centre - Sophia Children’s Hospital,
Rotterdam, The Netherlands
- Department of Pediatrics, Division of
Cardiology, Radboud University Medical Centre - Amalia Children’s Hospital,
Nijmegen, The Netherlands
| | - Irwin Karl Marcel Reiss
- Department of Pediatrics, Division of
Cardiology, Erasmus University Medical Centre - Sophia Children’s Hospital,
Rotterdam, The Netherlands
| | | | - Beatrijs Bartelds
- Department of Pediatrics, Division of
Cardiology, Erasmus University Medical Centre - Sophia Children’s Hospital,
Rotterdam, The Netherlands
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157
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Mowitz ME, Ayyagari R, Gao W, Zhao J, Mangili A, Sarda SP. Health Care Burden of Bronchopulmonary Dysplasia Among Extremely Preterm Infants. Front Pediatr 2019; 7:510. [PMID: 31921723 PMCID: PMC6921371 DOI: 10.3389/fped.2019.00510] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/25/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Infants born extremely preterm are at high risk of developing bronchopulmonary dysplasia (BPD). This study aimed to assess the incremental health care burden of BPD and associated comorbidities among extremely preterm infants in the United States. Methods: Health service claims in the Premier Perspective database were retrospectively analyzed for infants born at ≤28 weeks gestation who were admitted to neonatal intensive care during birth hospitalization and survived to a postmenstrual age of ≥36 weeks. Gestational age (GA) at birth and BPD status of infants was determined based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes recorded in the database. Results: Of the 12,017 infants included, 4,904 (40.8%) had BPD. BPD increased with decreasing GA: 67.4% of infants born at <24 weeks GA had BPD vs. 28.7% of those born at 27-28 weeks. Infants with BPD had significantly longer hospital stays following birth than those without (mean [standard deviation (SD)] 102 [34] vs. 83 [24] days, respectively, P < 0.001), and incurred higher total charges (mean [SD] $799,499 [$535,528] vs. $588,949 [$377,137], respectively, P < 0.001). Mean total charges incurred during index hospitalization decreased as GA at birth increased, with GA having a bigger effect than presence or absence of BPD. During their first year, infants with BPD had a higher in-hospital late mortality rate than those without (1.9 vs. 0.6%), and were more likely to have two or more hospital encounters following birth hospitalization (58.0 vs. 48.2%). Among infants who had two or more encounters after discharge, those with BPD experienced a higher percentage of pulmonary symptoms than those without (46.3 vs. 38.9%). Comparison with infants who did not have BPD, retinopathy of prematurity, or intraventricular hemorrhage showed that BPD is the main complication contributing to increased length of stay, costs, in-hospital mortality, and additional health care encounters. Conclusion: BPD is a key contributor to the large health care burden associated with extremely preterm birth. However, GA at birth has a bigger effect on health care costs for extremely preterm infants than the presence of BPD.
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Affiliation(s)
- Meredith E Mowitz
- Division of Neonatology, College of Medicine, University of Florida, Gainesville, FL, United States
| | | | - Wei Gao
- Analysis Group Inc., Boston, MA, United States
| | - Jing Zhao
- Analysis Group Inc., Boston, MA, United States
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158
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Tamai K, Nishihara M, Hirata K, Shiraishi J, Hirano S, Fujimura M, Yano S, Kanazawa T, Kitajima H. Physical fitness of non-disabled school-aged children born with extremely low birth weights. Early Hum Dev 2019; 128:6-11. [PMID: 30392918 DOI: 10.1016/j.earlhumdev.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/06/2018] [Accepted: 10/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The assessment of long-term outcomes in survivors born with extremely low birth weights (ELBWs) has become increasingly important. However, little has been reported on the physical fitness of non-disabled school-aged children born with ELBWs. AIMS To assess the physical fitness of non-disabled school-aged children born with ELBWs. STUDY DESIGN Retrospective cohort study. SUBJECTS We analyzed 169 ELBW infants without cerebral palsy or intellectual disability (based on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) Full Scale intelligence quotient (IQ) test < 70). OUTCOME MEASURES Physical fitness was assessed using the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, and softball throw tests. T-scores were calculated using national survey data. RESULTS The T-scores for the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, softball throw tests, and the overall T-score were 43.7 ± 7.5, 44.2 ± 10.5, 46.0 ± 9.7, 40.9 ± 8.0, 40.0 ± 9.8, 42.4 ± 8.1, and 42.9 ± 5.5, respectively. After adjusting for other age-related factors, the height (SD score), WISC-III Performance IQ score, and percent predicted forced vital capacity (FVC) independently predicted the overall T-scores. Their standardized partial regression coefficients (β) were 0.334 (p = 0.009), 0.190 (p = 0.022), and 0.187 (p = 0.032), respectively. CONCLUSIONS Our cohort's physical fitness at approximately 8 years of age was significantly impaired compared to average Japanese children of the same age. Height, FVC, and Performance IQ independently predicted physical fitness, with height being the strongest predictor.
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Affiliation(s)
- Kei Tamai
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan; Department of Neonatology, Okayama Medical Center, National Hospital Organization, 1711-1 Tamasu, Kita-ku, Okayama, Okayama 701-1192, Japan.
| | - Masahiro Nishihara
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Jun Shiraishi
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Suguru Yano
- Department of Education, Faculty of Health and Physical Education, Wakayama University, 930 Sakaedani, Wakayama, Wakayama 640-8510, Japan.
| | - Tadahiro Kanazawa
- Department of Comparative and Developmental Psychology, Faculty of Human Sciences, Osaka University, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
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159
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Shrestha AK, Bettini ML, Menon RT, Gopal VYN, Huang S, Edwards DP, Pammi M, Barrios R, Shivanna B. Consequences of early postnatal lipopolysaccharide exposure on developing lungs in mice. Am J Physiol Lung Cell Mol Physiol 2019; 316:L229-L244. [PMID: 30307313 PMCID: PMC6383495 DOI: 10.1152/ajplung.00560.2017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 12/19/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infants that is characterized by interrupted lung development. Postnatal sepsis causes BPD, yet the contributory mechanisms are unclear. To address this gap, studies have used lipopolysaccharide (LPS) during the alveolar phase of lung development. However, the lungs of infants who develop BPD are still in the saccular phase of development, and the effects of LPS during this phase are poorly characterized. We hypothesized that chronic LPS exposure during the saccular phase disrupts lung development by mechanisms that promote inflammation and prevent optimal lung development and repair. Wild-type C57BL6J mice were intraperitoneally administered 3, 6, or 10 mg/kg of LPS or a vehicle once daily on postnatal days (PNDs) 3-5. The lungs were collected for proteomic and genomic analyses and flow cytometric detection on PND6. The impact of LPS on lung development, cell proliferation, and apoptosis was determined on PND7. Finally, we determined differences in the LPS effects between the saccular and alveolar lungs. LPS decreased the survival and growth rate and lung development in a dose-dependent manner. These effects were associated with a decreased expression of proteins regulating cell proliferation and differentiation and increased expression of those mediating inflammation. While the lung macrophage population of LPS-treated mice increased, the T-regulatory cell population decreased. Furthermore, LPS-induced inflammatory and apoptotic response and interruption of cell proliferation and alveolarization was greater in alveolar than in saccular lungs. Collectively, the data support our hypothesis and reveal several potential therapeutic targets for sepsis-mediated BPD in infants.
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Affiliation(s)
- Amrit Kumar Shrestha
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Matthew L Bettini
- Section of Diabetes and Endocrinology, Department of Pediatrics, McNair Medical Institute, Baylor College of Medicine , Houston, Texas
| | - Renuka T Menon
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Vashisht Y N Gopal
- Department of Melanoma Medical Oncology and Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Shixia Huang
- Department of Molecular and Cellular Biology, Dan L. Duncan Cancer Center, Baylor College of Medicine , Houston, Texas
| | - Dean P Edwards
- Department of Molecular and Cellular Biology, Dan L. Duncan Cancer Center, Baylor College of Medicine , Houston, Texas
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Roberto Barrios
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital , Houston, Texas
| | - Binoy Shivanna
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
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160
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Ansems SM, Kirpalani H, Mercer-Rosa L, Wang Y, Hopper RK, Fraga MV, Jensen EA. Patent Ductus Arteriosus and the Effects of Its Late Closure in Preterm Infants with Severe Bronchopulmonary Dysplasia. Neonatology 2019; 116:236-243. [PMID: 31269508 PMCID: PMC6878755 DOI: 10.1159/000500269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The natural history and optimal management of a patent ductus arteriosus (PDA) among infants with established severe bronchopulmonary dysplasia (sBPD) remains uncertain. OBJECTIVES To describe the characteristics of PDA present at ≥36 weeks' postmenstrual age (PMA) and the effects of late surgical PDA closure in a referral cohort of very preterm infants with sBPD. STUDY DESIGN This retrospective cohort study was performed in a tertiary neonatal intensive care unit. Study infants were born at <32 weeks' gestation between 2010 and 2016, diagnosed with sBPD, and had an echocardiographic PDA at ≥36 weeks' PMA. We reviewed echocardiograms performed closest to 3 time points (≥36 weeks' PMA, hospital discharge, and 1 year of age) and assessed clinical outcomes among infants with versus without late PDA treatment. RESULTS Among 329 infants with sBPD, 59 had a PDA at ≥36 weeks' PMA. Most PDAs were small (n = 33) and shunted left to right (n = 53). The PDA closed spontaneously prior to discharge in 5 of 21 infants who did not undergo surgical closure and decreased in size in 3. The PDA spontaneously closed by 1 year of age in 6 out of 12 infants with an open duct at discharge. PDA surgery (n = 23) at ≥36 weeks' PMA was not associated with increased risk for the composite outcome of tracheostomy, systemic vasodilator at discharge, or death after adjusting for potential confounders (OR 3.2, 95% CI 0.81-13.0). CONCLUSIONS The majority of conservatively treated late PDAs closed spontaneously or decreased in size.PDA surgery was not associated with severe adverse clinical outcomes.
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Affiliation(s)
- Sophia M Ansems
- University of Groningen, Groningen, The Netherlands, .,Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA,
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yan Wang
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rachel K Hopper
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - María V Fraga
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Erik A Jensen
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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161
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Méndez-Abad P, Zafra-Rodríguez P, Lubián-López S, Benavente-Fernández I. Myocardial Function Maturation in Very-Low-Birth-Weight Infants and Development of Bronchopulmonary Dysplasia. Front Pediatr 2019; 7:556. [PMID: 32010652 PMCID: PMC6978685 DOI: 10.3389/fped.2019.00556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/19/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Myocardial function in very-low-birth-weight infants (VLBWIs) develops during early postnatal life, but different patterns of temporal evolution that might be related to the development of bronchopulmonary dysplasia (BPD) are not completely understood. Methods: A prospective cohort study including VLBWIs admitted to our NICU from January 2015 to 2017 was conducted. Plasma N-terminal pro B type natriuretic peptide (NTproBNP) levels were measured, and echocardiograms were performed at 24 and 72 h of life and weekly thereafter until 36 weeks of postmenstrual age (PMA). We measured the tricuspid annular plane systolic excursion (TAPSE) by M-mode; the lateral tricuspid E', A', and S' waves; and the myocardial performance index (MPI) by tissue doppler imaging (TDI). The subjects were divided into non-BPD and BPD groups. Results: We included 101 VLBWIs. The TAPSE and E', A', and S' waves increased while MPI-TDI decreased over time. Birth gestational age (GA) and postnatal PMA impacted these parameters, which evolved differently in those who developed BPD compared to those in the non-BPD group. The NTproBNP levels at 14 days of life and different echocardiographic parameters were associated with the development of BPD in different multivariate models. Conclusion: TAPSE and TDI values depend on GA and PMA and follow a different temporal evolution that is related to the later development of BPD. Combined biochemical and echocardiographic biomarkers can help identify which VLBWIs are at higher risk of developing BDP.
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Affiliation(s)
- Paula Méndez-Abad
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Pamela Zafra-Rodríguez
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Simón Lubián-López
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
| | - Isabel Benavente-Fernández
- Department of Neonatology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Institute for Research and Innovation in Biomedical Sciences (INiBICA), Cádiz, Spain
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162
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Faggiano S, Ronda L, Raboni S, Sartor F, Cavatorta V, Sgarbi E, Caivano G, Pertile M, Mozzarelli A. Phospholipid components of the synthetic pulmonary surfactant CHF5633 probed by fluorescence spectroscopy. Int J Pharm 2018; 553:290-297. [PMID: 30366070 DOI: 10.1016/j.ijpharm.2018.10.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
Abstract
CHF5633 (Chiesi Farmaceutici, Italy) is a synthetic pulmonary surfactant currently under clinical development for the treatment of Respiratory Distress Syndrome in premature infants. The product is composed of phospholipids in liposomal organization, together with two peptide analogues of human surfactant proteins B and C. Phospholipids in liposomes can undergo oxidation of unsaturated lipids and hydrolysis, with formation of fatty acids and lysolipids, both affecting the physico-chemical properties of the formulation. We exploited two fluorescence probes, Prodan and ADIFAB, to evaluate the stability of the phospholipid components of CHF5633. While Prodan enters the phospholipid bilayer and probes the polarity of this environment, ADIFAB binds free fatty acids in the aqueous phase, allowing to determine their concentration. Changes of Prodan fluorescence emission indicated an increase in the polarity of the phospholipid bilayer as a function of time. This behavior is coupled with an increase in fatty acids concentration in the aqueous phase, as determined by ADIFAB, and an increase in lysolipids concentration, as determined by HPLC-MS. Prodan and ADIFAB resulted efficient probes to monitor phospholipids hydrolysis in liposomes, reporting an increased stability of CHF5633 at pH values higher than 6.5.
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Affiliation(s)
- Serena Faggiano
- Department of Food and Drug, University of Parma, Parma, Italy; Institute of Biophysics, CNR, Pisa, Italy
| | - Luca Ronda
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Interdepartmental Center Biopharmanet-TEC, University of Parma, Parma, Italy.
| | - Samanta Raboni
- Department of Food and Drug, University of Parma, Parma, Italy; Institute of Biophysics, CNR, Pisa, Italy
| | - Franco Sartor
- CMC Department R&D, Chiesi Farmaceutici, Parma, Italy
| | | | - Elisa Sgarbi
- CMC Department R&D, Chiesi Farmaceutici, Parma, Italy
| | | | | | - Andrea Mozzarelli
- Department of Food and Drug, University of Parma, Parma, Italy; Institute of Biophysics, CNR, Pisa, Italy; Interdepartmental Center Biopharmanet-TEC, University of Parma, Parma, Italy; National Institute of Biostructures and Biomolecules, Rome, Italy
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163
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Does inhaled budesonide for bronchopulmonary dysplasia affect the neurodevelopmental outcomes? J Perinatol 2018; 38:1607-1609. [PMID: 30291320 DOI: 10.1038/s41372-018-0239-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/13/2018] [Indexed: 11/08/2022]
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164
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Kumar KR, Clark DA, Kim EM, Perry JD, Wright K, Thomas SA, Thompson EJ, Greenberg RG, Smith PB, Benjamin DK, Laughon MM, Clark RH, Hornik CP. Association of Atrial Septal Defects and Bronchopulmonary Dysplasia in Premature Infants. J Pediatr 2018; 202:56-62.e2. [PMID: 30172431 PMCID: PMC6317846 DOI: 10.1016/j.jpeds.2018.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/04/2018] [Accepted: 07/06/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the association between the presence of an atrial septal defect (ASD) and the odds of developing bronchopulmonary dysplasia (BPD) in premature infants. STUDY DESIGN We identified a cohort of infants that underwent at least one echocardiogram assessment, birth weight 501-1249 g, and gestational age 23-30 weeks discharged from the neonatal intensive care unit from 2004 to 2016. We used a BPD risk estimator to calculate the predicted risk of developing BPD at 6 postnatal ages within the first 28 days of life. We examined the association between the presence of an ASD and the development of BPD using 2 multivariable logistic regression models for each BPD risk severity on each postnatal day. The first model adjusted for predicted BPD risk and the second added therapeutic interventions for BPD. RESULTS Of 20 496 infants from 228 NICUs who met inclusion criteria, 8892 (43%) were diagnosed with BPD and 1314 (6%) had an ASD. BPD was present in 48% of infants with an ASD and 43% of infants without an ASD. In infants with an ASD, the OR of developing BPD was higher after adjusting for predicted risk of BPD plus therapeutic interventions, regardless of postnatal age or predicted BPD risk severity. CONCLUSIONS The presence of an ASD was associated with an increased odds of BPD in this cohort. Future trials should consider ASD as a potentially modifiable risk factor in this vulnerable population.
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Affiliation(s)
- Karan R Kumar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - David A Clark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Evan M Kim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Jasmine D Perry
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kaylyn Wright
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Sheikisha A Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Matthew M Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
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165
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Wang CH, Shi LP, Ma XL, DU LZ. [Clinical features and prognosis of bronchopulmonary dysplasia complicated by pulmonary hypertension in preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:893-896. [PMID: 30477618 PMCID: PMC7389022 DOI: 10.7499/j.issn.1008-8830.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the clinical features and prognosis of bronchopulmonary dysplasia (BPD) complicated by pulmonary hypertension (PH) in preterm infants. METHODS A retrospective analysis was performed on the clinical data of 191 preterm infants with BPD. RESULTS In the 191 preterm infants with BPD, 37 (19.4%), all with moderate or severe BPD, developed PH beyond 36 weeks' corrected age. The incidence rates of PH in infants with moderate and severe BPD were 5.7% (5/87) and 47.8% (32/67) respectively. Gestational age and birth weight were lower in infants with PH than in those without PH (P<0.01). Infants with PH had higher incidence rates of small for gestational age (SGA), severe BPD, surgical ligation of patent ductus arteriosus (PDA), neonatal respiratory distress syndrome, hemodynamically significant PDA, and pneumonia than those without PH (P<0.01). Durations of oxygen therapy, intubation, and positive pressure ventilation were longer in infants with PH than in those without PH (P<0.01). Infants with PH had higher incidence rates of retinopathy of prematurity and extrauterine growth retardation, a higher mortality, and a longer length of hospital stay compared with those without PH (P<0.01). In the 37 infants with PH (6 with mild PH, 14 with moderate PH, and 17 with severe PH), those with mild or moderate PH all survived; 15(88%) out of 17 infants with severe PH died. CONCLUSIONS The incidence of PH is high in preterm infants with moderate or severe BPD. Regular screening of pulmonary artery pressure is recommended for infants with BPD. Infants with low gestational age and birth weight, SGA, and severe BPD are more likely to develop PH. Infants with BPD complicated by PH have relatively high incidence rates of complications, high mortality, and poor prognosis.
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Affiliation(s)
- Chen-Hong Wang
- Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
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166
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Abreu-Pereira S, Pinto-Lopes R, Flôr-de-Lima F, Rocha G, Guimarães H. Ventilatory practices in extremely low birth weight infants in a level III neonatal intensive care unit. Pulmonology 2018; 24:337-344. [DOI: 10.1016/j.pulmoe.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 02/17/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022] Open
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167
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Cheon IS, Son YM, Jiang L, Goplen NP, Kaplan MH, Limper AH, Kita H, Paczesny S, Prakash YS, Tepper R, Ahlfeld SK, Sun J. Neonatal hyperoxia promotes asthma-like features through IL-33-dependent ILC2 responses. J Allergy Clin Immunol 2018; 142:1100-1112. [PMID: 29253513 PMCID: PMC6003836 DOI: 10.1016/j.jaci.2017.11.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Premature infants often require oxygen supplementation and, therefore, are exposed to oxidative stress. Following oxygen exposure, preterm infants frequently develop chronic lung disease and have a significantly increased risk of asthma. OBJECTIVE We sought to identify the underlying mechanisms by which neonatal hyperoxia promotes asthma development. METHODS Mice were exposed to neonatal hyperoxia followed by a period of room air recovery. A group of mice was also intranasally exposed to house dust mite antigen. Assessments were performed at various time points for evaluation of airway hyperresponsiveness, eosinophilia, mucus production, inflammatory gene expression, and TH and group 2 innate lymphoid cell (ILC2) responses. Sera from term- and preterm-born infants were also collected and levels of IL-33 and type 2 cytokines were measured. RESULTS Neonatal hyperoxia induced asthma-like features including airway hyperresponsiveness, mucus hyperplasia, airway eosinophilia, and type 2 pulmonary inflammation. In addition, neonatal hyperoxia promoted allergic TH responses to house dust mite exposure. Elevated IL-33 levels and ILC2 responses were observed in the lungs most likely due to oxidative stress caused by neonatal hyperoxia. IL-33 receptor signaling and ILC2s were vital for the induction of asthma-like features following neonatal hyperoxia. Serum IL-33 levels correlated significantly with serum levels of IL-5 and IL-13 but not IL-4 in preterm infants. CONCLUSIONS These data demonstrate that an axis involving IL-33 and ILC2s is important for the development of asthma-like features following neonatal hyperoxia and suggest therapeutic potential for targeting IL-33, ILC2s, and oxidative stress to prevent and/or treat asthma development related to prematurity.
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Affiliation(s)
- In Su Cheon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Young Min Son
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Li Jiang
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Nicholas P Goplen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Mark H Kaplan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind
| | - Andrew H Limper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Hirohito Kita
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Sophie Paczesny
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind
| | - Y S Prakash
- Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Rochester, Minn; Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Robert Tepper
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind
| | - Shawn K Ahlfeld
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Jie Sun
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minn; Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minn.
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168
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Zhong QH, Duan J, Zhang CY, Feng YL, Qi ZY, He XY, Liang K. [Effect of prone positioning on respiratory function in very preterm infants undergoing mechanical ventilation]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:608-612. [PMID: 30111467 PMCID: PMC7389764 DOI: 10.7499/j.issn.1008-8830.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the effect of prone positioning on respiratory function in very preterm infants undergoing mechanical ventilation. METHODS A total of 83 very preterm infants treated with mechanical ventilation were enrolled in the study and were randomly assigned to supine group and prone group. Four infants withdrew from the study and 79 infants completed treatment and observation (37 in the supine group and 42 in the prone group). Infants in both groups were mechanically ventilated in a volume assist-control mode. Infants in the prone group were ventilated in the supine position for 4 hours and in the prone position for 2 hours. Ventilator parameters, arterial blood gas analysis, and vital signs were recorded before grouping, every 6 hours in the supine group, and every hour after conversion into the prone position in the prone group, respectively. RESULTS Fraction of inspired oxygen (FiO2), peak inspiratory pressure, mean inspiratory pressure, and duration of ventilation were significantly lower in the prone group than in the supine group (P<0.05); there were no significant differences in tidal volume or positive end-expiratory pressure between the two groups (P>0.05). The prone group had a significantly higher PO2/FiO2 ratio but significantly lower oxygenation index and respiratory rate than the supine group (P<0.05). There were no significant differences in arterial oxygen tension, pH, base excess, heart rate, or mean blood pressure between the two groups (P>0.05). CONCLUSIONS Alternating ventilation between the prone position and supine position can improve oxygenation function, decrease the fraction of inspired oxygen, and shorten the duration of mechanical ventilation in very preterm infants undergoing mechanical ventilation.
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Affiliation(s)
- Qing-Hua Zhong
- NICU, Department of Pediatrics, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China.
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169
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The Free Radical Diseases of Prematurity: From Cellular Mechanisms to Bedside. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7483062. [PMID: 30140369 PMCID: PMC6081521 DOI: 10.1155/2018/7483062] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022]
Abstract
During the perinatal period, free radicals (FRs) are involved in several physiological roles such as the cellular responses to noxia, the defense against infectious agents, the regulation of cellular signaling function, and the induction of a mitogenic response. However, the overproduction of FRs and the insufficiency of an antioxidant mechanism result in oxidative stress (OS) which represents a deleterious process and an important mediator of damage to the placenta and the developing fetus. After birth, OS can be magnified by other predisposing conditions such as hypoxia, hyperoxia, ischemia, hypoxia ischemia-reperfusion, inflammation, and high levels of nonprotein-bound iron. Newborns are particularly susceptible to OS and oxidative damage due to the increased generation of FRs and the lack of adequate antioxidant protection. This impairment of the oxidative balance has been thought to be the common factor of the so-called “free radical related diseases of prematurity,” including retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, kidney damage, and oxidative hemolysis. In this review, we provide an update focused on the factors influencing these diseases refining the knowledge about the role of OS in their pathogenesis and the current evidences of such relationship. Mechanisms governing FR formation and subsequent OS may represent targets for counteracting tissue damage.
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170
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Higgins RD, Jobe AH, Koso-Thomas M, Bancalari E, Viscardi RM, Hartert TV, Ryan RM, Kallapur SG, Steinhorn RH, Konduri GG, Davis SD, Thebaud B, Clyman RI, Collaco JM, Martin CR, Woods JC, Finer NN, Raju TNK. Bronchopulmonary Dysplasia: Executive Summary of a Workshop. J Pediatr 2018; 197:300-308. [PMID: 29551318 PMCID: PMC5970962 DOI: 10.1016/j.jpeds.2018.01.043] [Citation(s) in RCA: 477] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/27/2017] [Accepted: 01/12/2018] [Indexed: 12/19/2022]
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
| | - Marion Koso-Thomas
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD
| | - Eduardo Bancalari
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland Baltimore, Baltimore, MD
| | - Tina V Hartert
- Department of Medicine, Division of Allergy, Pulmonology and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Rita M Ryan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Suhas G Kallapur
- Divisions of Neonatology and Developmental Biology Professor of Pediatrics David Geffen School of Medicine at UCLA Mattel Children's Hospital UCLA, Los Angeles, CA
| | - Robin H Steinhorn
- Children's National Health System, Department of Pediatrics, Washington, DC
| | - Girija G Konduri
- Department of Pediatrics, Cardiovascular Research Center and Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI
| | - Stephanie D Davis
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Bernard Thebaud
- Department of Pediatrics, Children's Hospital of Eastern Ontario and Children's Hospital of Ontario Research Institute (CHEORI), Ontario, Canada; Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute (OHRI), Ontario, Canada; Department of Cellular and Molecular Biology, University of Ottawa, Ontario, Canada
| | - Ronald I Clyman
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Camilia R Martin
- Department of Neonatology and Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason C Woods
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Neil N Finer
- Department of Pediatrics, University of California at San Diego, San Diego, CA
| | - Tonse N K Raju
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD
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171
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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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Dassios T, Dassios KG, Dassios G. Functional morphometry for the estimation of the alveolar surface area in prematurely-born infants. Respir Physiol Neurobiol 2018; 254:49-54. [PMID: 29719268 DOI: 10.1016/j.resp.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/14/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Abstract
Conventionally, the alveolar surface area (SA) has been measured by using post-mortem morphometry. Such studies have highlighted that SA in prematurely-born infants is markedly smaller when compared to term-born infants as a result of postnatal impairment or arrest of alveolar development. We herein explore how, non-invasive measurements of the ventilation/perfusion ratio (VA/Q) can be used to estimate SA in prematurely-born surviving, convalescent infants. We also compare SA in prematurely-born infants measured at term-corrected age, to term-born infants using previously published datasets of VA/Q. Fick's first law of diffusion is employed for the conversion of VA/Q measurements to SA values after correcting for differences in pulmonary perfusion, thickness of the respiratory membrane and alveolar-arterial gradient. We report that SA is fivefold smaller in prematurely-born compared to term-born infants. We conclude that non-invasive measurements of VA/Q can be used for the functional estimation of SA which could, in turn, be used as a future outcome measure in respiratory studies of prematurely-born infants.
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Affiliation(s)
- Theodore Dassios
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
| | | | - George Dassios
- Department of Chemical Engineering, University of Patras, Greece; Academy of Athens, Athens, Greece
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173
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[Clinical features and prognosis of preterm infants with varying degrees of bronchopulmonary dysplasia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20. [PMID: 29658448 PMCID: PMC7390030 DOI: 10.7499/j.issn.1008-8830.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To study the clinical features and prognosis of preterm infants with varying degrees of bronchopulmonary dysplasia (BPD). METHODS The clinical data of 144 preterm infants with a gestational age of <32 weeks who were admitted to the neonatal intensive care unit from March 2014 to March 2016 and were diagnosed with BPD were collected. According to the severity of BPD, these preterm infants were divided into mild group with 81 infants and moderate/severe group with 63 infants. The two groups were compared in terms of perinatal risk factors, treatment, comorbidities, complications, and prognosis of the respiratory system. RESULTS Compared with the mild BPD group, the moderate/severe BPD group had a significantly higher gestational age and rate of small-for-gestational-age (SGA) infants (P<0.05), as well as a significantly higher rate of severe preeclampsia and a significantly lower rate of threatened preterm labor (P<0.05). Compared with the mild BPD group, the moderate/severe BPD group had a significantly higher percentage of infants who needed mechanical ventilation at 2 weeks after birth, longer duration of mechanical ventilation, total time of oxygen therapy, and length of hospital stay, and higher incidence rates of pneumonia and cholestasis (P<0.05), as well as a significantly lower application rate of caffeine citrate (P<0.05). The multivariate logistic regression analysis showed that SGA birth (OR=5.974, P<0.05), pneumonia (OR=2.590, P<0.05), and mechanical ventilation required at 2 weeks after birth (OR=4.632, P<0.05) were risk factors for increased severity of BPD. The pulmonary function test performed at the corrected gestational age of 40 weeks showed that compared with the mild BPD group, the moderate/severe BPD group had significantly lower ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume to peak tidal expiratory flow to total expiratory volume, and tidal expiratory flow at 25% remaining expiration (P<0.05). The infants were followed up to the corrected gestational age of 1 year, and the moderate/severe BPD group had significantly higher incidence rates of recurrent hospital admission for pneumonia and recurrent wheezing (P<0.05). CONCLUSIONS SGA birth, pneumonia, and prolonged mechanical ventilation are associated with increased severity of BPD. Infants with moderate or severe BPD have poor pulmonary function and may experience recurrent infection and wheezing.
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Sherlock LG, Trumpie A, Hernandez-Lagunas L, McKenna S, Fisher S, Bowler R, Wright CJ, Delaney C, Nozik-Grayck E. Redistribution of Extracellular Superoxide Dismutase Causes Neonatal Pulmonary Vascular Remodeling and PH but Protects Against Experimental Bronchopulmonary Dysplasia. Antioxidants (Basel) 2018; 7:antiox7030042. [PMID: 29538340 PMCID: PMC5874528 DOI: 10.3390/antiox7030042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/03/2018] [Accepted: 03/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A naturally occurring single nucleotide polymorphism (SNP), (R213G), in extracellular superoxide dismutase (SOD3), decreases SOD3 matrix binding affinity. Humans and mature mice expressing the R213G SNP exhibit increased cardiovascular disease but decreased lung disease. The impact of this SNP on the neonatal lung at baseline or with injury is unknown. METHODS Wild type and homozygous R213G mice were injected with intraperitoneal bleomycin or phosphate buffered saline (PBS) three times weekly for three weeks and tissue harvested at 22 days of life. Vascular and alveolar development were evaluated by morphometric analysis and immunostaining of lung sections. Pulmonary hypertension (PH) was assessed by right ventricular hypertrophy (RVH). Lung protein expression for superoxide dismutase (SOD) isoforms, catalase, vascular endothelial growth factor receptor 2 (VEGFR2), endothelial nitric oxide synthase (eNOS) and guanosine triphosphate cyclohydrolase-1 (GTPCH-1) was evaluated by western blot. SOD activity and SOD3 expression were measured in serum. RESULTS In R213G mice, SOD3 lung protein expression decreased, serum SOD3 protein expression and SOD serum activity increased compared to wild type (WT) mice. Under control conditions, R213G mice developed pulmonary vascular remodeling (decreased vessel density and increased medial wall thickness) and PH; alveolar development was similar between strains. After bleomycin injury, in contrast to WT, R213G mice were protected from impaired alveolar development and their vascular abnormalities and PH did not worsen. Bleomycin decreased VEGFR2 and GTPCH-1 only in WT mice. CONCLUSION R213G neonatal mice demonstrate impaired vascular development and PH at baseline without alveolar simplification, yet are protected from bleomycin induced lung injury and worsening of pulmonary vascular remodeling and PH. These results show that vessel bound SOD3 is essential in normal pulmonary vascular development, and increased serum SOD3 expression and SOD activity prevent lung injury in experimental bronchopulmonary dysplasia (BPD) and PH.
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Affiliation(s)
- Laurie G Sherlock
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Ashley Trumpie
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Laura Hernandez-Lagunas
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Sarah McKenna
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Susan Fisher
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA.
| | - Clyde J Wright
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Cassidy Delaney
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Eva Nozik-Grayck
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
- Pediatric Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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175
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Choi YB, Lee J, Park J, Jun YH. Impact of Prolonged Mechanical Ventilation in Very Low Birth Weight Infants: Results From a National Cohort Study. J Pediatr 2018; 194:34-39.e3. [PMID: 29198532 DOI: 10.1016/j.jpeds.2017.10.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/16/2017] [Accepted: 10/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the in-hospital consequences of prolonged respiratory support with invasive mechanical ventilation in very low birth weight infants. STUDY DESIGN A cohort study was performed using prospectively collected data from 69 neonatal intensive care units participating in the Korean national registry. In total, 3508 very low birth weight infants born between January 1, 2013 and December 31, 2014 were reviewed. RESULTS The adjusted hazard ratio for death increased significantly for infants who received mechanical ventilation for more than 2 weeks compared with those were mechanically ventilated for 7 days or less. The individual mortality rate increased after 8 weeks, reaching 50% and 60% at 14 and 16 weeks of cumulative mechanical ventilation, respectively. After adjusting for potential confounders, the cumulative duration of mechanical ventilation was associated with a clinically significant increase in the odds of bronchopulmonary dysplasia and pulmonary hypertension. Mechanical ventilation exposure for longer than 2 weeks, compared with 7 days or less, was associated with retinopathy of prematurity requiring laser coagulation and periventricular leukomalacia. The odds of abnormal auditory screening test results were significantly increased in infants who needed mechanical ventilation for more than 4 weeks. A longer cumulative duration of mechanical ventilation was associated with increased lengths of hospitalization and parenteral nutrition and a higher probability of discharge with poor achievement of physical growth. CONCLUSIONS Although mechanical ventilation is a life-saving intervention for premature infants, these results indicate that it is associated with negative consequences when applied for prolonged periods.
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Affiliation(s)
- Young-Bin Choi
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea
| | - Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea; Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea.
| | - Jisun Park
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea; Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea
| | - Yong Hoon Jun
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea; Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea
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176
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Rojas P, Friaza V, García E, de la Horra C, Vargas SL, Calderón EJ, Pavón A. Early Acquisition of Pneumocystis jirovecii Colonization and Potential Association With Respiratory Distress Syndrome in Preterm Newborn Infants. Clin Infect Dis 2018; 65:976-981. [PMID: 28520902 DOI: 10.1093/cid/cix454] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/11/2017] [Indexed: 12/16/2022] Open
Abstract
Background Pneumocystis pneumonia is a well-recognized lung disease of premature and malnourished babies. Even though serologic studies have shown that children are exposed to Pneumocystis jirovecii early in life, the epidemiology of human P. jirovecii infection and the host-microorganism relationship in infancy remain poorly understood. The aim of the present study was to investigate the prevalence of P. jirovecii colonization in preterm infants and its possible association with medical complications. Methods A prospective observational study of preterm infants (birth weight <1500 g and/or gestational age <32 weeks) was carried out. Identification of P. jirovecii colonization was performed by means of molecular techniques in nasal aspirated samples at birth. Results A total of 128 preterm infants were included during the study period. Pneumocystis DNA was identified in 25.7% (95% confidence interval [CI], 17.8%-33.7%) of newborns studied. A significant increase of respiratory distress syndrome in colonized group, even after adjusting for confounding factors (odds ratio, 2.7 [95% CI, 1.0-7.5]; P = .04), was observed. No differences were observed in other medical conditions between the 2 groups. Conclusions Pneumocystis jirovecii colonization is frequent in preterm births and could be a risk factor to develop respiratory distress syndrome among preterm infants.
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Affiliation(s)
- Pilar Rojas
- Neonatology Unit, Virgen del Rocío University Children's Hospital
| | - Vicente Friaza
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Elisa García
- Neonatology Unit, Virgen del Rocío University Children's Hospital
| | - Carmen de la Horra
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Sergio L Vargas
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago
| | - Enrique J Calderón
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio Pavón
- Neonatology Unit, Virgen del Rocío University Children's Hospital
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177
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Gomez Pomar E, Concina VA, Samide A, Westgate PM, Bada HS. Bronchopulmonary Dysplasia: Comparison Between the Two Most Used Diagnostic Criteria. Front Pediatr 2018; 6:397. [PMID: 30619792 PMCID: PMC6299117 DOI: 10.3389/fped.2018.00397] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives: To compare the Shennan's and the consensus definition of Bronchopulmonary Dysplasia (BPD) from the National Institutes of Health (NIH) workshop and analyze specific risk factors associated with each definition. Study design: Retrospective analysis of records of 274 infants admitted to a level IV intensive care unit. Infants were classified as having BPD or no BPD by both definitions. Differences in incidence and risk factors were analyzed. Statistical methods included descriptive statistics, comparative tests, and marginal logistic regression modeling. Results: The estimated difference in prevalence was 32% [95% CI: (26%, 37%), (p < 0.0001)] between both criteria. The prevalence of BPD was 80% higher based on the NIH criteria [RR = 1.80; 95% CI: (1.58, 2.06)]. Infants with no BPD by the Shennan definition were breathing room air with or without positive or continuous pressure support and were most likely to be discharged home on oxygen [OR = 4.47, 95% CI: (1.20, 16.61), p = 0.03]. Gestational age, birth weight, and 1-min Apgar score predicted BPD by both definitions. Chorioamnionitis increased the risk of BPD by the Shennan definition but was associated with lower risk by the NIH criteria. IUGR was associated with BPD by the Shennan definition and with severe BPD by the NIH criteria. Conclusion: Compared to the Shennan's definition, the NIH consensus identified 80% more infants with BPD and is a better predictor of oxygen requirement at discharge. Until a new better criteria is develop, the NIH consensus definition should be used across centers.
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Affiliation(s)
- Enrique Gomez Pomar
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Vanessa A Concina
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Aaron Samide
- Department of Pediatrics, Johns Hopkins All Children's Hospital in Florida, St. Petersburg, FL, United States
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Henrietta S Bada
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
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178
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Postnatal steroids in extreme preterm infants: Intra-tracheal instillation using surfactant as a vehicle. Paediatr Respir Rev 2018; 25:78-84. [PMID: 28651937 DOI: 10.1016/j.prrv.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/23/2017] [Indexed: 01/07/2023]
Abstract
Chronic Lung Disease (CLD) is a common respiratory morbidity in survivors following extreme preterm birth, and is associated with adverse neurodevelopment in the long term. Besides demographics, multiple risk factors are implicated in the pathogenesis of CLD. However, early lung inflammation appears to be the common pathway that leads to the pathological and clinical changes observed in CLD. Postnatal use of systemic steroids has been successful in reducing the incidence of CLD but resulted in unacceptable adverse neurodevelopmental outcomes. The efficacy of inhaled steroids is not yet established. We review the evidence of tracheal instillation of steroids using surfactant as a lipid vehicle, including published data on drug distribution, in vitro physical studies, and clinical trials in animals and human infants.
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179
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McKenna S, Butler B, Jatana L, Ghosh S, Wright CJ. Inhibition of IκBβ/NFκB signaling prevents LPS-induced IL1β expression without increasing apoptosis in the developing mouse lung. Pediatr Res 2017; 82:1064-1072. [PMID: 28753596 PMCID: PMC5761659 DOI: 10.1038/pr.2017.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 07/05/2017] [Indexed: 01/09/2023]
Abstract
BackgroundThe pro-inflammatory consequences of IL1β expression contribute to the pathogenesis of bronchopulmonary dysplasia. Selectively targeting Lipopolysaccharide (LPS)-induced IκBβ/NFκB signaling attenuates IL1β mRNA expression in macrophages. Whether targeting IκBβ/NFκB signaling affects the anti-apoptotic gene expression, a known consequence of global LPS-induced NFκB inhibition, is unknown.MethodsMacrophages (RAW 264.7, bone marrow-derived macrophage) were assessed for LPS-induced IL1β mRNA/protein expression, anti-apoptotic gene expression, cell viability (trypan blue exclusion), and activation of apoptosis (caspase-3 and PARP cleavage) following pharmacologic and genetic attenuation of IκBβ/NFκB signaling. Expressions of IL1β and anti-apoptotic genes were assessed in endotoxemic newborn mice (P0) with intact (WT), absent (IκBβ KO), and attenuated (IκBβ overexpressing) IκBβ/NFκB signaling.ResultsIn cultured macrophages, pharmacologic and genetic inhibition of LPS-induced IκBβ/NFκB signaling significantly attenuated IL1β mRNA and protein expression. Importantly, targeting IκBβ/NFκB signaling did not attenuate LPS-induced expression of anti-apoptotic genes or result in cell death. In endotoxemic neonatal mice, targeting LPS-induced IκBβ/NFκB signaling significantly attenuated pulmonary IL1β expression without affecting the anti-apoptotic gene expression.ConclusionTargeting IκBβ/NFκB signaling prevents LPS-induced IL1β expression without inducing apoptosis in cultured macrophages and in the lungs of endotoxemic newborn mice. Inhibiting this pathway may prevent inflammatory injury without affecting the protective role of NFκB activity in the developing lung.
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Affiliation(s)
- Sarah McKenna
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Brittany Butler
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Laurie Jatana
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Sankar Ghosh
- Department of Microbiology & Immunology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Clyde J. Wright
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045
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180
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Ortiz LE, McGrath-Morrow SA, Sterni LM, Collaco JM. Sleep disordered breathing in bronchopulmonary dysplasia. Pediatr Pulmonol 2017; 52:1583-1591. [PMID: 29064170 PMCID: PMC5693767 DOI: 10.1002/ppul.23769] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are limited data on the effect of bronchopulmonary dysplasia (BPD) on sleep disordered breathing (SDB). We hypothesized that both the severity of prematurity and BPD would increase the likelihood of SDB in early childhood. Our secondary aim was to evaluate the association of demographic factors on the development of SDB. METHODS This is a retrospective study of patient factors and overnight polysomnogram (PSG) data of children enrolled in our BPD registry between 2008 and 2015. Association between PSG results and studied variables was assessed using multiple linear regression analysis. RESULTS One-hundred-forty children underwent at least one sleep study on room air. The mean respiratory disturbance index (RDI) was elevated at 9.9 events/hr (SD: 10.1). The mean obstructive apnea-hypopnea index (OAHI) was 6.5 (9.1) events/hr and the mean central event rate of 3.0 (3.7) events/hr. RDI had decreased by 22% or 1.5 events/hour (95%CI: 0.6, 1.9) with each year of age (P = 0.005). Subjects with more severe respiratory disease had 38% more central events (P = 0.02). Infants exposed to secondhand smoke had 2.4% lower (P = 0.04) oxygen saturation nadirs and a pattern for more desaturation events. Non-white subjects were found to have 33% higher OAHI (P = 0.05), while white subjects had a 61% higher rate of central events (P < 0.001). CONCLUSIONS RDI was elevated in a selected BPD population compared to norms for non-preterm children. BPD severity, smoke exposure, and race may augment the severity of SDB. RDI improved with age but was still elevated by age 4, suggesting that this population is at risk for the sequelae of SDB.
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Affiliation(s)
- Luis E Ortiz
- Johns Hopkins Medical Institutions, Baltimore, Maryland
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181
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Ricci F, Catozzi C, Ravanetti F, Murgia X, D'Aló F, Macchidani N, Sgarbi E, Di Lallo V, Saccani F, Pertile M, Cacchioli A, Catinella S, Villetti G, Civelli M, Amadei F, Stellari FF, Pioselli B, Salomone F. In vitro and in vivo characterization of poractant alfa supplemented with budesonide for safe and effective intratracheal administration. Pediatr Res 2017; 82:1056-1063. [PMID: 28723887 DOI: 10.1038/pr.2017.171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/18/2017] [Indexed: 12/29/2022]
Abstract
BackgroundThe intratracheal (IT) administration of budesonide using surfactant as a vehicle has been shown to reduce the incidence of bronchopulmonary dysplasia (BPD) in preterm infants. The objective of this study was to characterize the in vitro characteristics and in vivo safety and efficacy of the extemporaneous combination of budesonide and poractant alfa.MethodsThe stability, minimum surface tension, and viscosity of the preparation were evaluated by means of high-performance liquid chromatography (HPLC), Wilhelmy balance, and Rheometer, respectively. The safety and efficacy of the IT administration of the mixture were tested in two respiratory distress syndrome (RDS) animal models: twenty-seventh day gestational age premature rabbits and surfactant-depleted adult rabbits.ResultsA pre-formulation trial identified a suitable procedure to ensure the homogeneity and stability of the formulation. Wilhelmy Balance tests clarified that budesonide supplementation has no detrimental effect on poractant alfa surface tension activity. The addition of budesonide to poractant alfa did not affect the physiological response to surfactant treatment in both RDS animal models, and was associated to a significant reduction of lung inflammation in surfactant-depleted rabbits.ConclusionOur in vitro and in vivo analysis suggests that the IT administration of a characterized extemporaneous combination of poractant alfa and budesonide is a safe and efficacious procedure in the context of RDS.
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Affiliation(s)
| | | | | | - Xabier Murgia
- Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | | | | | - Elisa Sgarbi
- R&D Department, Chiesi Farmaceutici, Parma, Italy
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182
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Dietz RM, Wright CJ. Oxidative stress diseases unique to the perinatal period: A window into the developing innate immune response. Am J Reprod Immunol 2017; 79:e12787. [PMID: 29194835 DOI: 10.1111/aji.12787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/31/2017] [Indexed: 12/15/2022] Open
Abstract
The innate immune system has evolved to play an integral role in the normally developing lung and brain. However, in response to oxidative stress, innate immunity, mediated by specific cellular and molecular programs and signaling, contributes to pathology in these same organ systems. Despite opposing drivers of oxidative stress, namely hyperoxia in neonatal lung injury and hypoxia/ischemia in neonatal brain injury, similar pathways-including toll-like receptors, NFκB and MAPK cascades-have been implicated in tissue damage. In this review, we consider recent insights into the innate immune response to oxidative stress in both neonatal and adult models to better understand hyperoxic lung injury and hypoxic-ischemic brain injury across development and aging. These insights support the development of targeted immunotherapeutic strategies to address the challenge of harnessing the innate immune system in oxidative stress diseases of the neonate.
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Affiliation(s)
- Robert M Dietz
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Clyde J Wright
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
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183
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Rodriguez-Martinez CE, Acuña-Cordero R, Sossa-Briceño MP. Predictors of prolonged length of hospital stay or readmissions for acute viral lower respiratory tract infections among infants with a history of bronchopulmonary dysplasia. J Med Virol 2017; 90:405-411. [PMID: 28975628 DOI: 10.1002/jmv.24962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/07/2017] [Indexed: 11/08/2022]
Abstract
Length of hospital stay and readmissions are outcome measures that have been largely overlooked in many studies that have evaluated the clinical evolution of pediatric patients with bronchopulmonary dysplasia (BPD). The aim of the present study was to identify predictors of prolonged hospitalizations or readmissions for acute lower respiratory infections (ALRIs) in infants with BPD. In a prospective cohort study, we determined independent predictors of prolonged hospitalizations or readmissions for ALRIs during the first 2 years of life in a population of infants with BPD living in Bogota, Colombia. Of a total of 138 patients included in the study, 83 (60.1%) had at least one hospitalization for ALRI during the follow-up period. After controlling for potential confounders, we found that independent predictors of prolonged hospitalizations or readmissions for ALRIs included male gender (OR = 3.09; CI 95% 1.27-7.52; P = 0.013), ambulatory oxygen therapy between 90 and 119 days (OR = 3.21; CI 95% 1.00-10.24; P = 0.049), ambulatory oxygen therapy equal to or greater than 120 days (OR = 5.73; CI 95% 2.01-16.32; P = 0.001), gestational age at birth (OR = 1.35; CI 95% 1.03-1.76; P = 0.026), birth weight (OR = 0.997; CI 95% 0.996-0.999; P = 0.010), and duration of breastfeeding equal to or greater than 6 months (OR = 0.39; CI 95% 0.16-0.96; P = 0.039). The factors identified can be taken into account when planning policies to reduce duration of hospital stay and readmissions in infants with BPD.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Ranniery Acuña-Cordero
- Department of Pediatric Pulmonology, Hospital Militar Central, Department of Pediatrics, School of Medicine, Universidad Militar Nueva Granada, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
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184
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Kalikkot Thekkeveedu R, Guaman MC, Shivanna B. Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology. Respir Med 2017; 132:170-177. [PMID: 29229093 PMCID: PMC5729938 DOI: 10.1016/j.rmed.2017.10.014] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/23/2017] [Accepted: 10/20/2017] [Indexed: 12/31/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease of primarily premature infants that results from an imbalance between lung injury and repair in the developing lung. BPD is the most common respiratory morbidity in preterm infants, which affects nearly 10, 000 neonates each year in the United States. Over the last two decades, the incidence of BPD has largely been unchanged; however, the pathophysiology has changed with the substantial improvement in the respiratory management of extremely low birth weight (ELBW) infants. Here we have attempted to comprehensively review and summarize the current literature on the pathogenesis and pathophysiology of BPD. Our goal is to provide insight to help further progress in preventing and managing severe BPD in the ELBW infants.
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Affiliation(s)
| | - Milenka Cuevas Guaman
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Binoy Shivanna
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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185
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Lehtinen A, Korhonen P, Hyödynmaa E, Koivisto AM, Peltola T, Hämäläinen M, Moilanen E, Tammela O. Adipokines played a limited role in predicting temporary growth differences between very low birthweight infants with and without bronchopulmonary dysplasia. Acta Paediatr 2017. [PMID: 28639282 DOI: 10.1111/apa.13942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study explored whether growth was poorer among very low birthweight (VLBW) infants with bronchopulmonary dysplasia (BPD) and assessed adipokine levels as predictors of early growth. METHODS We studied 53 VLBW infants born in Tampere University Hospital up to 12 months of corrected age (CA). The median gestational age of the 21 infants with BPD and 32 infants without BPD was 29 weeks, and the median birthweights were 930 (635-1470) and 1185 (650-1470) grams. Growth parameters, macronutrients intake and plasma levels of adipokines were measured. RESULTS Bronchopulmonary dysplasia infants were lighter than controls until 36 weeks of CA, with catch-up growth achieved by three months of CA. Adipsin levels were lower in BPD infants at 28 days of postnatal age. High leptin levels seemed protective for low weight for height at nine months of CA. The duration of ventilator therapy predicted low weight for height, length for age and body mass index and BPD predicted low length for age at 12 months of CA. CONCLUSIONS Catch-up growth in VLBW infants with BPD was achieved by three months of CA, but adipokines played a limited role in predicting growth. Shortening ventilator therapy could help growth in VLBW infants.
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Affiliation(s)
- A Lehtinen
- Faculty of Medicine; University of Tampere; Tampere Finland
| | - P Korhonen
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - E Hyödynmaa
- Department of Paediatrics; Central Finland Central Hospital; Jyväskylä Finland
| | - AM Koivisto
- School of Health Sciences; University of Tampere; Tampere Finland
| | - T Peltola
- Medical Nutrition Unit; Tampere University Hospital; Tampere Finland
| | - M Hämäläinen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - E Moilanen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - O Tammela
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
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Mortality among infants with evolving bronchopulmonary dysplasia increases with major surgery and with pulmonary hypertension. J Perinatol 2017; 37:1043-1046. [PMID: 28617427 DOI: 10.1038/jp.2017.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/31/2017] [Accepted: 05/15/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess whether mortality in patients with evolving bronchopulmonary dysplasia (BPD, defined as ⩾28 days of oxygen exposure with lung disease) is independently associated with pulmonary arterial hypertension (PAH) and surgery. STUDY DESIGN Single institution retrospective birth cohort of preterm infants with gestational age (GA) 230/7 to 366/7 weeks, and evolving BPD delivered between 2001 and 2014. Surgery was classified as minor or major using published criteria. Mortality was analyzed by stepwise logistic regression analysis. RESULTS Among 577 patients with evolving BPD, 33 (6%) died prior to discharge. Mortality decreased with GA (adjusted odds ratio (aOR): 0.69; 95% confidence interval (CI): 0.55, 0.87), birth weight Z-score (aOR: 0.69, 95% CI: 0.47, 0.996) and increased with PAH (aOR: 30, 95% CI: 2.1, 415), major surgery (aOR; 2.8, 95% CI: 1.3, 6.3), and PAH and surgery (aOR: 10.3, 95% CI: 2.5, 42.1). CONCLUSION Among preterm patients with evolving BPD, PAH and surgery are independently associated with mortality.
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Mueller M, Kramer BW. Stem cells and Bronchopulmonary Dysplasia - The five questions: Which cells, when, in which dose, to which patients via which route? Paediatr Respir Rev 2017; 24:54-59. [PMID: 28162941 DOI: 10.1016/j.prrv.2016.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/06/2016] [Indexed: 12/14/2022]
Abstract
Preterm birth is the leading cause of death in newborns and children. Despite advances in perinatology, immature infants continue to face serious risks such chronic respiratory impairment from bronchopulmonary dysplasia (BPD). Current treatment options are insufficient and novel approaches are desperately needed. In recent years stem cells have emerged as potential candidates to treat BPD with mesenchymal stem/stromal cells (MSCs) being particularly promising. MSCs originate from several stem cell niches including bone marrow, skin, or adipose, umbilical cord, and placental tissues. Although the first MSCs clinical trials in BPD are ongoing, multiple questions remain open. In this review, we discuss the question of the optimal cell source (live cells or cell products), route and timing of the transplantation. Furthermore, we discuss MSCs possible capacities including migration, homing, pro-angiogenesis, anti-inflammatory, and tissue-regenerative potential as well.
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Affiliation(s)
- Martin Mueller
- Department of Obstetrics and Gynecology, University Hospital Bern, Bern, Switzerland; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA; Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Boris W Kramer
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; School of Oncology and Developmental Biology (GROW), Maastricht, The Netherlands.
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Cassiano RGM, Gaspardo CM, Faciroli RADD, Martinez FE, Linhares MBM. Temperament and behavior in toddlers born preterm with related clinical problems. Early Hum Dev 2017. [PMID: 28628773 DOI: 10.1016/j.earlhumdev.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare temperament and behavior profiles among groups of preterm toddlers differentiated by level of prematurity and the presence of bronchopulmonary dysplasia (BPD) or retinopathy of prematurity (ROP), controlling for neonatal clinical conditions and chronological age. METHOD The sample comprised 100 preterm toddlers segregated according to level of prematurity (75 very preterm and 25 moderate/late preterm) and presence of BPD (n=36) and ROP (n=63). Temperament was assessed by the Early Childhood Behavior Questionnaire and behavior by the Child Behavior Checklist. The MANOVA was performed with a post-hoc univariate test. RESULTS The level of prematurity and the presence of BPD and ROP did not affect temperament and behavioral problems in toddlers born preterm. However, the covariates age and length of stay in NICU (Neonatal Intensive Care Unit) affected temperament and behavioral problems, respectively. The older toddlers showed higher inhibitory control and lower activity levels than younger toddlers (range of 18-36months-old). Additionally, toddlers who stayed in the NICU longer showed more pervasive development and emotionally reactive problems than toddlers who stayed in NICU for less time. CONCLUSION The level of prematurity and the presence of bronchopulmonary dysplasia and retinopathy of prematurity did not affect temperament and behavioral problems in toddlers born preterm. However, a longer stay in the NICU increased the risk for behavioral problems, and age enhanced the regulation of temperament at toddlerhood.
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Affiliation(s)
- Rafaela Guilherme Monte Cassiano
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Claudia Maria Gaspardo
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Augusto de Deus Faciroli
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Eulógio Martinez
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Beatriz Martins Linhares
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Wang X, Fu JH, Xue XD. Expression dynamics of caveolin-1 in fibroblasts of newborn rats with chronic lung disease and its impact on lung fibroblast proliferation. Acta Cir Bras 2017; 32:359-368. [PMID: 28591365 DOI: 10.1590/s0102-865020170050000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/19/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate the changes of caveolin-1 in lung fibroblasts in newborn Wistar rats when exposed to hyperoxic conditions, as well as lung fibroblasts cell cycle. Methods: One hundred newborn Wistar rats were randomly divided (50 rats/group) into experimental and control groups, exposed to hyperoxic conditions or normal air, respectively. The fraction of inspired oxygen (FiO2) in the experimental group was 90%, whereas this value was 21% in the control group. Lung fibroblasts were collected on days 3, 7, and 14 of the experiment. Caveolin-1 expression dynamics in lung fibroblasts was assayed in each group by immunofluorescence and Western blot analyses. Flow cytometry (FCM) was used to assess the proportions of lung fibroblasts at different stages of the cell cycle. Results: On day 3, no significant difference in caveolin-1 expression was observed between the hyperoxic and control groups; however, on days 7 and 14, caveolin-1 expression was significantly lower in the hyperoxic group than in the control (P<0.05). No apparent differences were observed in caveolin-1 expression in the control group at the different time points. Using FCM analysis, we showed that the proportion of lung fibroblasts in G0/G1 phase in the hyperoxic group decreased compared to that of the control group on day 7, while the proportion of S-phase cells increased (P<0.05). These differences were more significant when the groups were compared on day 14 (P<0.01). Conclusion: After seven days the exposure to hyperoxic conditions, lung fibroblasts proliferated and caveolin-1 expression decreased.
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Affiliation(s)
- Xin Wang
- MD, Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China. Conception and design of the study, technical procedures, acquisition and analysis of data, manuscript writing
| | - Jian-Hua Fu
- MD, Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China. Analysis and interpretation of data, manuscript writing
| | - Xin-Dong Xue
- Professor, Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China. Conception, design, intellectual and scientific content of the study; critical revision; final approval the manuscript
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190
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Kelly EN, Shah VS, Levenbach J, Vincer M, DaSilva O, Shah PS. Inhaled and systemic steroid exposure and neurodevelopmental outcome of preterm neonates. J Matern Fetal Neonatal Med 2017; 31:2665-2672. [DOI: 10.1080/14767058.2017.1350644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Edmond N. Kelly
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Vibhuti S. Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Jody Levenbach
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Michael Vincer
- Department of Paediatrics, IWK Health Centre, Halifax, Canada
| | - Orlando DaSilva
- Department of Paediatrics, Western University, London, Canada
| | - Prakesh S. Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
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Abstract
RATIONALE Tracheobronchomalacia is a common comorbidity in neonates with bronchopulmonary dysplasia. However, the effect of tracheobronchomalacia on the clinical course of bronchopulmonary dysplasia is not well-understood. OBJECTIVE We sought to assess the impact of tracheobronchomalacia on outcomes in neonates with bronchopulmonary dysplasia in a large, multi-center cohort. METHODS We preformed a cohort study of 974 neonates with bronchopulmonary dysplasia admitted to 27 neonatal intensive care units participating in the Children's Hospital Neonatal Database who had undergone bronchoscopy. In hospital morbidity for neonates with bronchopulmonary dysplasia and tracheobronchomalacia (N=353, 36.2%) was compared to those without tracheobronchomalacia (N=621, 63.8%) using mixed-effects multivariate regression. RESULTS Neonates with tracheobronchomalacia and bronchopulmonary dysplasia had more comorbidities, such as gastroesophageal reflux (OR=1.65, 95%CI 1.23- 2.29, P=0.001) and pneumonia (OR=1.68, 95%CI 1.21-2.33, P=0.002) and more commonly required surgeries such as tracheostomy (OR=1.55, 95%CI 1.15-2.11, P=0.005) and gastrostomy (OR=1.38, 95%CI 1.03-1.85, P=0.03) compared with those without tracheobronchomalacia. Neonates with tracheobronchomalacia were hospitalitized (118 ± 93 vs 105 ± 83 days, P=0.02) and ventilated (83.1 ± 91.1 vs 67.2 ± 71.9 days, P=0.003) longer than those without tracheobronchomalacia. Upon discharge, neonates with tracheobronchomalacia and BPD were more likely to be mechanically ventilated (OR=1.37, 95CI 1.01-1.87 P=0.045) and possibly less likely to receive oral nutrition (OR=0.69, 95%CI 0.47-1.01, P=0.058). CONCLUSIONS Tracheobronchomalacia is common in neonates with bronchopulmonary dysplasia who undergo bronchoscopy and is associated with longer and more complicated hospitalizations.
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192
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The significance of IL-1β +3953C>T, IL-6 -174G>C and -596G>A, TNF-α -308G>A gene polymorphisms and 86 bp variable number tandem repeat polymorphism of IL-1RN in bronchopulmonary dysplasia in infants born before 32 weeks of gestation. Cent Eur J Immunol 2017; 42:287-293. [PMID: 29204094 PMCID: PMC5708201 DOI: 10.5114/ceji.2017.67000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/20/2017] [Indexed: 01/26/2023] Open
Abstract
Introduction Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects primarily preterm infants. Genetic factors are also taken into consideration in the pathogenesis of BPD. Genetic predispositions to higher production of inflammation mediators seem to be crucial.
Material and methods The aim of this study was to evaluate the possible relationship between polymorphisms: interleukin-1β +3953 C>T, interleukin-6 -174 G>C and -596 G>A, tumour necrosis factor -308 G>A and interleukin-1RN VNTR 86bp and the occurrence of BPD in a population of 100 preterm infants born from singleton pregnancy, before 32+0 weeks of gestation, exposed to antenatal steroids therapy, and without congenital abnormalities.
Results In the study population BPD was diagnosed in 36 (36%) newborns. Among the studied polymorphisms we found the higher prevalence for BPD developing of the following genotypes: 1/2 (OR 1.842 [0.673-5.025] and 2/2 IL-1RN (OR 1.75 [0.418-6.908] 86bpVNTR; GC (2.222 [0.658-8.706]) and CC IL-6 -174G>C (1.6 [0.315-8.314]) and GA (2.753 [0.828-10.64]) and AA (1.5 [0.275-8.067] IL-6 -596G>A), GA 1.509 (0.515-4.301) TNF-α -308G>A. However, these finding were not statistically significant. Conclusions Genetic factors are undeniably involved in the pathogenesis of BPD. In the times of individualised therapy finding genes responsible for BPD might allow the development of new treatment strategies. A new way of specific therapy could ensure the reduction of complications connected with BPD and treatment costs.
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193
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Collins JJP, Tibboel D, de Kleer IM, Reiss IKM, Rottier RJ. The Future of Bronchopulmonary Dysplasia: Emerging Pathophysiological Concepts and Potential New Avenues of Treatment. Front Med (Lausanne) 2017; 4:61. [PMID: 28589122 PMCID: PMC5439211 DOI: 10.3389/fmed.2017.00061] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/02/2017] [Indexed: 12/13/2022] Open
Abstract
Yearly more than 15 million babies are born premature (<37 weeks gestational age), accounting for more than 1 in 10 births worldwide. Lung injury caused by maternal chorioamnionitis or preeclampsia, postnatal ventilation, hyperoxia, or inflammation can lead to the development of bronchopulmonary dysplasia (BPD), one of the most common adverse outcomes in these preterm neonates. BPD patients have an arrest in alveolar and microvascular development and more frequently develop asthma and early-onset emphysema as they age. Understanding how the alveoli develop, and repair, and regenerate after injury is critical for the development of therapies, as unfortunately there is still no cure for BPD. In this review, we aim to provide an overview of emerging new concepts in the understanding of perinatal lung development and injury from a molecular and cellular point of view and how this is paving the way for new therapeutic options to prevent or treat BPD, as well as a reflection on current treatment procedures.
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Affiliation(s)
- Jennifer J P Collins
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ismé M de Kleer
- Division of Pediatric Pulmonology, Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Robbert J Rottier
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
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Lesage F, Jimenez J, Toelen J, Deprest J. Preclinical evaluation of cell-based strategies to prevent or treat bronchopulmonary dysplasia in animal models: a systematic review. J Matern Fetal Neonatal Med 2017; 31:958-966. [PMID: 28277906 DOI: 10.1080/14767058.2017.1301927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common complication of extreme prematurity as no effective treatment is available to date. This calls for the exploration of new therapeutic options like cell therapy, which is already effective for various human (lung) disorders. We systematically searched the MEDLINE, Embase, and Web of Science databases from the earliest date till January 2017 and included original studies on the perinatal use of cell-based therapies (i.e. cells and/or cell-derivatives) to treat BDP in animal models. Fourth publications describing 47 interventions were retrieved. Newborn mice/rats raised in a hyperoxic environment were studied in most interventions. Different cell types - either intact cells or their conditioned medium - were administered, but bone marrow and umbilical cord blood derived mesenchymal stem cells were most prevalent. All studies reported positive effects on outcome parameters including alveolar and vascular morphometry, lung function, and inflammation. Cell homing to the lungs was demonstrated in some studies, but the therapeutic effects seemed to be mostly mediated via paracrine modulation of inflammation, fibrosis and angiogenesis. CONCLUSION Multiple rat/mouse studies show promise for cell therapy for BPD. Yet careful study of action mechanisms and side effects in large animal models is imperative before clinical translation can be achieved.
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Affiliation(s)
- Flore Lesage
- a Department of Development and Regeneration, Group Biomedical Sciences , KU Leuven , Leuven , Belgium
| | - Julio Jimenez
- a Department of Development and Regeneration, Group Biomedical Sciences , KU Leuven , Leuven , Belgium.,b Department of Obstetrics and Gynaecology , Clínica Alemana Universidad del Desarrollo , Santiago , Chile
| | - Jaan Toelen
- a Department of Development and Regeneration, Group Biomedical Sciences , KU Leuven , Leuven , Belgium.,c Department of Pediatrics , University Hospitals Leuven , Leuven , Belgium
| | - Jan Deprest
- a Department of Development and Regeneration, Group Biomedical Sciences , KU Leuven , Leuven , Belgium.,d Research Department of Maternal Fetal Medicine , UCL Institute for Women's Health (IWH), University College London , London , United Kingdom
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195
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Davidson LM, Berkelhamer SK. Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes. J Clin Med 2017; 6:E4. [PMID: 28067830 PMCID: PMC5294957 DOI: 10.3390/jcm6010004] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/28/2016] [Accepted: 12/28/2016] [Indexed: 12/16/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in premature infants who required mechanical ventilation and oxygen therapy for acute respiratory distress. While advances in neonatal care have resulted in improved survival rates of premature infants, limited progress has been made in reducing rates of BPD. Lack of progress may in part be attributed to the limited therapeutic options available for prevention and treatment of BPD. Several lung-protective strategies have been shown to reduce risks, including use of non-invasive support, as well as early extubation and volume ventilation when intubation is required. These approaches, along with optimal nutrition and medical therapy, decrease risk of BPD; however, impacts on long-term outcomes are poorly defined. Characterization of late outcomes remain a challenge as rapid advances in medical management result in current adult BPD survivors representing outdated neonatal care. While pulmonary disease improves with growth, long-term follow-up studies raise concerns for persistent pulmonary dysfunction; asthma-like symptoms and exercise intolerance in young adults after BPD. Abnormal ventilatory responses and pulmonary hypertension can further complicate disease. These pulmonary morbidities, combined with environmental and infectious exposures, may result in significant long-term pulmonary sequalae and represent a growing burden on health systems. Additional longitudinal studies are needed to determine outcomes beyond the second decade, and define risk factors and optimal treatment for late sequalae of disease.
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Affiliation(s)
- Lauren M Davidson
- Department of Pediatrics, University at Buffalo SUNY, Buffalo, NY 14228, USA.
| | - Sara K Berkelhamer
- Department of Pediatrics, University at Buffalo SUNY, Buffalo, NY 14228, USA.
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Trends and variation in management and outcomes of very low-birth-weight infants with patent ductus arteriosus. Pediatr Res 2016; 80:785-792. [PMID: 27509008 DOI: 10.1038/pr.2016.166] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/23/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND We examined recent trends and interhospital variation in use of indomethacin, ibuprofen, and surgical ligation for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants. METHODS Included in this retrospective study of the Pediatric Hospital Information System database were 13,853 VLBW infants from 19 US children's hospitals, admitted at age < 3 d between 1 January 2005 and 31 December 2014. PDA management and in-hospital outcomes were examined for trends and variation. RESULTS PDA was diagnosed in 5,719 (42%) VLBW infants. Cyclooxygenase inhibitors and/or ligation were used in 74% of infants with PDA overall, however studied hospitals varied greatly in PDA management. Odds of any cyclooxygenase inhibitor or surgical treatment for PDA decreased 11% per year during the study period. This was temporally associated with improved survival but also with increasing bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, and acute renal failure in unadjusted analyses. There was no detectable correlation between hospital-specific changes in PDA management and hospital-specific changes in outcomes of preterm birth during the study period. CONCLUSION Use of cyclooxygenase inhibitors and ligation for PDA in VLBW infants decreased over a 10-y period at the studied hospitals. Further evidence is needed to assess the impact of this change in PDA management.
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197
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Mueller M, Wolfs TGA, Schoeberlein A, Gavilanes AWD, Surbek D, Kramer BW. Mesenchymal stem/stromal cells-a key mediator for regeneration after perinatal morbidity? Mol Cell Pediatr 2016; 3:6. [PMID: 26869264 PMCID: PMC4751100 DOI: 10.1186/s40348-016-0034-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/19/2016] [Indexed: 02/07/2023] Open
Abstract
Perinatal complications in both term- and preterm-born infants are a leading cause of neonatal morbidities and mortality. Infants face different challenges in the neonatal intensive care unit with long-term morbidities such as perinatal brain injury and bronchopulmonary dysplasia being particularly devastating. While advances in perinatal medicine have improved our understanding of the pathogenesis, effective therapies to prevent and/or reduce the severity of these disorders are still lacking. The potential of mesenchymal stem/stromal cell (MSC) therapy has emerged during the last two decades, and an increasing effort is conducted to address brain- and lung-related morbidities in neonates at risk. Various studies support the notion that MSCs have protective effects. MSCs are an easy source and may be readily available after birth in a clinical setting. MSCs' mechanisms of action are diverse, including migration and homing, release of growth factors and immunomodulation, and the potential to replace injured cells. Here, we review the pathophysiology of perinatally acquired brain and lung injuries and focus on MSCs as potential candidates for therapeutic strategies summarizing preclinical and clinical evidence.
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Affiliation(s)
- Martin Mueller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
- Department of Obstetrics and Gynecology, University Hospital Bern and Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Tim G A Wolfs
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.
| | - Andreina Schoeberlein
- Department of Obstetrics and Gynecology, University Hospital Bern and Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Antonio W D Gavilanes
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
- Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
- Department of Neuropsychology, Division Neuroscience, School of Mental Health and neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University Hospital Bern and Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - Boris W Kramer
- Department of Pediatrics, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.
- Department of Neuropsychology, Division Neuroscience, School of Mental Health and neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.
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198
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Paes B, Fauroux B, Figueras-Aloy J, Bont L, Checchia PA, Simões EAF, Manzoni P, Carbonell-Estrany X. Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Infants with Chronic Lung Disease. Infect Dis Ther 2016; 5:453-471. [PMID: 27864751 PMCID: PMC5125140 DOI: 10.1007/s40121-016-0137-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The REGAL (RSV evidence-a geographical archive of the literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This third publication covers the risk and burden of RSV infection in infants with chronic lung disease (CLD), formerly called bronchopulmonary dysplasia (BPD). METHODS A systematic review was undertaken of publications between January 1, 1995 and December 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov. Studies reporting data for hospital visits/admissions for RSV infection among infants with CLD/BPD who were not prophylaxed, as well as studies reporting RSV-associated morbidity, mortality, and healthcare costs, were included. Burdens of disease data were compared with preterm infants without CLD/BPD, other high-risk groups and term infants. Study quality and strength of evidence (SOE) were graded using recognized criteria. RESULTS A total of 1837 studies were identified and 39 were included. CLD/BPD is a significant independent risk factor for RSV hospitalization [RSVH (odds ratio 2.2-7.2); high SOE]. Infants and young children with CLD/BPD had high RSVH rates which were generally similar in Europe, the United States, and Canada, mostly varying between 12 and 21%. Infants with CLD also had a longer length of hospital stay than other high-risk groups and term infants (high SOE). On average, infants spent 4-11 days in hospital (moderate SOE). Once hospitalized for RSV, affected children were at risk for a more severe course of disease than children with no RSVH (moderate SOE). CONCLUSION Severe RSV infection in infants and young children with CLD/BPD poses a significant health burden in Western countries. Further studies focussing on the burden of RSV infection in this well-recognized population at high risk for severe disease are needed to help improve outcomes and plan allocation of healthcare resources. FUNDING AbbVie.
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Affiliation(s)
- Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Houston, TX, USA
| | - Eric A F Simões
- Center for Global Health, Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paolo Manzoni
- Neonatology and NICU, Sant'Anna Hospital, Turin, Italy
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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199
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Jensen EA, Panitch H, Feng R, Moore PE, Schmidt B. Interobserver Reliability of the Respiratory Physical Examination in Premature Infants: A Multicenter Study. J Pediatr 2016; 178:87-92. [PMID: 27567413 PMCID: PMC5613665 DOI: 10.1016/j.jpeds.2016.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To measure the inter-rater reliability of 7 visual and 3 auscultatory respiratory physical examination findings at 36-40 weeks' postmenstrual age in infants born less than 29 weeks' gestation. Physicians also estimated the probability that each infant would remain hospitalized for 3 months after the examination or be readmitted for a respiratory illness during that time. STUDY DESIGN Prospective, multicenter, inter-rater reliability study using standardized audio-video recordings of respiratory physical examinations. RESULTS We recorded the respiratory physical examination of 30 infants at 2 centers and invited 32 physicians from 9 centers to review the examinations. The intraclass correlation values for physician agreement ranged from 0.73 (95% CI 0.57-0.85) for subcostal retractions to 0.22 (95% CI 0.11-0.41) for expiratory abdominal muscle use. Eight (27%) infants remained hospitalized or were readmitted within 3 months after the examination. The area under the receiver operating characteristic curve for prediction of this outcome was 0.82 (95% CI 0.78-0.86). Physician predictive accuracy was greater for infants receiving supplemental oxygen (0.90, 95% CI 0.86-0.95) compared with those breathing in room air (0.71, 95% CI 0.66-0.75). CONCLUSIONS Physicians often do not agree on respiratory physical examination findings in premature infants. Physician prediction of short-term respiratory morbidity was more accurate for infants receiving supplemental oxygen compared with those breathing in room air.
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Affiliation(s)
- Erik A Jensen
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Howard Panitch
- Department of Pediatrics, Division of Pulmonology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Rui Feng
- Department of Biostatistics and Epidemiology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Paul E Moore
- Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Barbara Schmidt
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Tamoxifen dosing for Cre-mediated recombination in experimental bronchopulmonary dysplasia. Transgenic Res 2016; 26:165-170. [PMID: 27730498 DOI: 10.1007/s11248-016-9987-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth characterized by blunted post-natal lung development. BPD can be modelled in mice by exposure of newborn mouse pups to elevated oxygen levels. Little is known about the mechanisms of perturbed lung development associated with BPD. The advent of transgenic mice, where genetic rearrangements can be induced in particular cell-types at particular time-points during organogenesis, have great potential to explore the pathogenic mechanisms at play during arrested lung development. Many inducible, conditional transgenic technologies available rely on the application of the estrogen-receptor modulator, tamoxifen. While tamoxifen is well-tolerated and has been widely employed in adult mice, or in healthy developing mice; tamoxifen is not well-tolerated in combination with hyperoxia, in the most widely-used mouse model of BPD. To address this, we set out to establish a safe and effective tamoxifen dosing regimen that can be used in newborn mouse pups subjected to injurious stimuli, such as exposure to elevated levels of environmental oxygen. Our data reveal that a single intraperitoneal dose of tamoxifen of 0.2 mg applied to newborn mouse pups in 10 μl Miglyol vehicle was adequate to successfully drive Cre recombinase-mediated genome rearrangements by the fifth day of life, in a murine model of BPD. The number of recombined cells was comparable to that observed in regular tamoxifen administration protocols. These findings will be useful to investigators where tamoxifen dosing is problematic in the background of injurious stimuli and mouse models of human and veterinary disease.
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