Bronchopulmonary Dysplasia: Definitions and Epidemiology. In: Bhandari V, editor. Bronchopulmonary Dysplasia. Cham: Springer International Publishing; 2016. pp. 167-82. [DOI: 10.1007/978-3-319-28486-6_9]

Bubbly and cystic appearance on chest radiograph of extremely preterm infants with bronchopulmonary dysplasia is associated with wheezing disorder

AIM

Bubbly/cystic appearance on chest X-ray (CXR) is an important factor in cases of severe bronchopulmonary dysplasia (BPD). We aimed to determine whether CXR -based BPD classifications obtained in extremely preterm infants with oxygen dependency at 28 days after birth (BPD28) is associated with wheezing disorders.

METHODS

This was a multicentre retrospective cohort study of population data from infants (body weight, <1500 g) enrolled in the Neonatal Research Network of Japan. Of the 15 480 infants born at <28 weeks of gestation between 2003 and 2012, 8979 met the BPD28 criteria, and 4007 were classified as the no BPD28 group. BPD28 infants were classified according to the bubbly/cystic or no bubbly/cystic appearance on CXR at postnatal ≧28 days. The effects on wheezing disorder at 3 years of age were analysed.

RESULTS

Bubbly/cystic BPD28 infants showed higher rates of wheezing disorders compared with no BPD28 infants. Bubbly/cystic BPD28 (odds ratio 1.7; 95% confidence interval, 1.3-2.2) was a significant independent factor for wheezing disorders.

CONCLUSION

A bubbly/cystic appearance on CXR with BPD28 was a potential risk factor of wheezing disorders at 3 years of age. This may be a useful early diagnostic tool at ≧28 postnatal days in extremely preterm infants.

Impact of chest radiography-based definition of bronchopulmonary dysplasia

BACKGROUND

Bubbly/cystic appearance on chest radiograph is an important factor in severe-type bronchopulmonary dysplasia (BPD) in Japan. The aim of this study was to determine the perinatal characteristics and neonatal complications of the bubbly/cystic(+) group in extremely preterm infants with BPD, that is, oxygen dependency at day 28 after birth (BPD28).

METHODS

This was a multicenter retrospective cohort study of population data from infants (birthweight, <1,500 g) enrolled in the Neonatal Research Network of Japan. Of the 15 480 infants born at <28 weeks' gestational age (GA) between 2003 and 2012, 8,979 met the BPD28 criteria. The BPD28 infants were classified according to bubbly/cystic appearance on radiograph (±) at >28 postnatal days.

RESULTS

The bubbly/cystic(+) group had lower GA and birthweight and required longer mechanical ventilation and oxygen dependency than the bubbly/cystic(-) group. After adjustment for confounding factors, bubbly/cystic appearance was an independent risk factor for home oxygen therapy at discharge.

CONCLUSION

Bubbly/cystic appearance on chest radiograph was a predictor of short-term respiratory outcomes in infants with BPD28, which is diagnosed much earlier (≥28 postnatal days), and has a potentially different etiology to BPD36 (oxygen and/or positive pressure respiratory support dependency at 36 weeks' postmenstrual age).

Chorioamnionitis: Is a major player in the development of bronchopulmonary dysplasia?

Chorioamnionitis is an inflammation in the fetal membranes or placenta. When chorioamnionitis develops, fetal lungs are exposed to inflammatory cytokines and mediators via amniotic fluid. Because inflammation plays a pivotal role in the development of bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity, fetal lung inflammation induced by chorioamnionitis has been considered to be one of the major pathogenetic factors for BPD. Although there have been a number of studies that demonstrated the relationship between chorioamnionitis and BPD, there are still controversies on this issue. The controversies on the relationship between chorioamnionitis and BPD arise from not-unified definitions of chorioamnionitis and BPD, different study populations, and the proportion of contribution between inflammation and infectious microorganisms. The publication bias also contributes to the controversies. Clinical trials targeting chorioamnionitis or microorganisms that cause chorioamnionitis will answer on the actual relationship between chorioamnionitis and BPD and provide a novel prophylactic strategy against BPD based on that relationship.

How to decrease bronchopulmonary dysplasia in your neonatal intensive care unit today and "tomorrow"

Bronchopulmonary dysplasia, or BPD, is the most common chronic lung disease in infants. Genetic predisposition and developmental vulnerability secondary to antenatal and postnatal infections, compounded with exposure to hyperoxia and invasive mechanical ventilation to an immature lung, result in persistent inflammation, culminating in the characteristic pulmonary phenotype of BPD of impaired alveolarization and dysregulated vascularization. In this article, we highlight specific areas in current management, and speculate on therapeutic strategies that are on the horizon, that we believe will make an impact in decreasing the incidence of BPD in your neonatal intensive care units.