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Zhang Z, Jiang J, Li Z, Wan W. The Change of Cytokines and Gut Microbiome in Preterm Infants for Bronchopulmonary Dysplasia. Front Microbiol 2022; 13:804887. [PMID: 35387067 PMCID: PMC8978829 DOI: 10.3389/fmicb.2022.804887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 01/02/2023] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) is a devastating form of chronic lung disease that develops in preterm infants. BPD is speculated to arise from abnormal inflammatory responses, which is related to the composition of commensal microbiota, leading us to hypothesize that BPD susceptibility could be influenced by gut microbiota through inflammatory responses. This study is aimed to detect cytokines and the differences in fecal gut microbial composition in the BPD patients. Methods Between June 2018 and June 2020, preterm infants born at gestational age ≤30 weeks were recruited. The clinical data of infant characteristics were collected. On days 3–7 and 14–28 after birth, fresh stool samples and serum were collected. The gut microbiota composition between the BPD group and controls was detected by 16S rRNA sequencing. On days 3–7 and days 14–28, ten cytokines including IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IFN-γ, and TNF-α were detected in the serum. Results This study enrolled 38 preterm infants; the number of preterm infants in the BPD group and control group was, respectively, 18 and 20. The gestational age (27.4 ± 1.5 weeks vs. 29.5 ± 0.9 weeks, p = 0.000) and birth weight (971 ± 240 g vs. 1262 ± 335 g, p = 0.000) of the BPD group were lower than those of the control group. The present study found that the BPD group had high levels of IL-1β, IL-4, IL-6, IL-8, and TNF-α, whereas IL-10 was decreased. The Shannon diversity index of the BPD group was lower. The relative abundances of Proteobacteria in BPD group increased significantly from days 3–7 to days 14–28, while the Firmicutes was decreased. On days 14–28, the relative abundances of Proteobacteria in BPD group were significantly higher than those in the control group, while the Firmicutes was lower. Conclusion Bronchopulmonary dysplasia could be influenced by gut microbiota through inflammatory responses. More studies are needed to explore the imbalance of cytokines and microbiome in BPD infants and whether it could be reversed by probiotics. This study provided a novel perspective for treating BPD.
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Affiliation(s)
- Zhenjie Zhang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Jiang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenghong Li
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weilin Wan
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2
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Ito M, Tomotaki S, Isayama T, Hara H, Hirata K, Arai H. The status of chronic lung disease diagnosis in Japan: Secondary publication. Pediatr Int 2022; 64:e15184. [PMID: 35727868 DOI: 10.1111/ped.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Japan, the definition and classification of neonatal chronic lung disease (CLD) used for its diagnosis are a combination of those used in Japan and abroad. METHODS To clarify the current state of CLD diagnosis, a questionnaire survey was conducted. RESULTS Half of the patients of the medical centers included in the study were diagnosed with CLD in real time, while the other half were diagnosed after discharge. In addition, in approximately 70% of the facilities, diagnosis was made after discussions various among medical teams. In approximately 80% of the centers, the chest radiography used for CLD diagnosis were evaluated by multiple doctors. Furthermore, some centers used chest X-rays that were taken at approximately 28 days of age for CLD diagnosis, whereas at other facilities, diagnosis was made regardless of time at which the chest radiography were obtained. Only a small number of centers have established criteria for determining the necessity of oxygen at the corrected age of 36 weeks, and the target saturation of peripheral oxygen levels also tend to vary for each facility. Whether the conditions wherein the patient receives respiratory support for apnea or respiratory tract diseases should be considered as CLD also differed among the facilities. CONCLUSIONS It is necessary to reassess the definition and classification of CLD in Japan to accurately evaluate and improve the quality of respiratory management based on the long-term prognosis.
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Affiliation(s)
- Masato Ito
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Seiichi Tomotaki
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.,Neonatal Intensive Care Unit, Department of Pediatrics, Kyoto University Hospital, Kyoto, Japan
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Hiroko Hara
- Department of Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Hirokazu Arai
- Department of Neonatology, Akita Red Cross Hospital, Akita, Japan
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3
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Cuevas Guaman M, Dahm PH, Welty SE. The challenge of accurately describing the epidemiology of bronchopulmonary dysplasia (BPD) based on the various current definitions of BPD. Pediatr Pulmonol 2021; 56:3527-3532. [PMID: 33913625 DOI: 10.1002/ppul.25434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/12/2021] [Accepted: 04/08/2021] [Indexed: 02/05/2023]
Abstract
Despite marked improvements in the survival of extremely low birth weight preterm infants, bronchopulmonary dysplasia (BPD) remains a prevalent morbidity. BPD has evolved pathologically and epidemiologically but the definition has failed to keep up. The majority of the definitions of BPD still use the respiratory support provided to the infants at a single timepoint. The lack of a uniform definition of BPD presently reflects the changing BPD pathogenesis and phenotype and limits defining the epidemiology. To address the epidemiology of BPD, the definition should be clarified; even the newer definitions have not been validated entirely. The definition needs to be meaningful clinically and be predictive of long-term respiratory outcomes. We believe the definition should have a composite assessment like a score (quantitative measurement) and include the different phenotypes (qualitative measurements) so that optimally they can be applied to the different phases of BPD and at different timepoints. Furthermore, the definitions need to be easy to measure and assess so that generalizability is enhanced.
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Affiliation(s)
- Milenka Cuevas Guaman
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Paul H Dahm
- Department of Pediatrics, Division of Critical Care Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Stephen E Welty
- Department of Pediatrics, Section of Neonatology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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4
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Abstract
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in infants and is associated with increased mortality, respiratory morbidity, neurodevelopmental impairment, and increased healthcare costs. In parallel with advances made in the field of neonatal intensive care, the phenotype of BPD has evolved from a fibrocystic disease affecting late preterm infants to one of impaired parenchymal development and dysregulated vascular growth predominantly affecting infants born before 29 weeks' gestational age. BPD has been shown to have significant lifelong consequences. Adults with BPD have been found to have abnormal lung function tests, reduced exercise tolerance, and may be at increased risk for developing chronic obstructive pulmonary disease. Evidence shows that BPD occurs secondary to genetic-environmental interactions in an immature lung. In this review, we evaluate the various clinical definitions, imaging modalities, and biomarker data that are helpful in making an early diagnosis of BPD. In addition, we evaluate recent evidence about the prevention and treatment of BPD. We discuss the invasive and non-invasive ventilation strategies and pharmacological agents used in the early, evolving, and established phases of BPD.
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Affiliation(s)
- Margaret Gilfillan
- Division of Neonatology, St Christopher's Hospital for Children, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Anita Bhandari
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vineet Bhandari
- Division of Neonatology, The Children's Regional Hospital at Cooper, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
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5
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Liu X, Lv X, Jin D, Li H, Wu H. Lung ultrasound predicts the development of bronchopulmonary dysplasia: a prospective observational diagnostic accuracy study. Eur J Pediatr 2021; 180:2781-2789. [PMID: 33755776 DOI: 10.1007/s00431-021-04021-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 01/20/2023]
Abstract
This study aimed to evaluate the predictive ability of lung ultrasound (LU) in the development of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. A total of 130 VLBW infants with gestational age < 32 weeks were included; LU was performed at days 1, 2, 3, 6, 9, 12, and 15 postnatally. We calculated the LU score by 12-region, 10-region, and 6-region protocols. The incidence of BPD according to the National Institutes of Health (NIH) 2001 definition and 2019 criteria was 38.5% and 64.6%, respectively. By 12-region and 10-region protocols, LU predicted BPD from the 9th to 15th days of life (DOLs) regardless of the criteria used, with an area under the curve (AUC) ranging from 0.826 (95% confidence interval (CI): 0.750-0.887) to 0.877 (95% CI: 0.807-0.928). According to the 2019 BPD definition, the LU score incorporated gestational age, and invasive mechanical ventilation >6 days predicted BPD on the 6th DOL with an AUC of 0.862 (95% CI: 0.790-0.916). The 6-region protocol had significantly smaller AUC values on the 6th and 9th DOLs than the other two protocols.Conclusion: The 12-region and 10-region LU scoring protocols are superior to the 6-region protocol in the prediction of BPD. LU can predict the development of BPD from the 9th to 15th DOLs. With the addition of clinical variables, the earliest prediction time was the 6th DOL. What is Known: • Bronchopulmonary dysplasia is the most common and adverse complication of prematurity. Recent four studies found that lung ultrasound score or findings predicted the development of bronchopulmonary dysplasia. What is New: • We present analysis by classical 6-region and the other two lung ultrasound score (10-region and 12-region) which include an assessment of the posterior lung to allow to understand what is the best score to be used. In addition, we explore whether LU-incorporated clinical variables could improve the predictive value for BPD.
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Affiliation(s)
- Xiaolei Liu
- Department of Neonatology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Xiaoming Lv
- Department of Neonatology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Di Jin
- Department of Neonatology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Heng Li
- Department of Neonatology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.
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6
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Cytokines and Exhaled Nitric Oxide Are Risk Factors in Preterm Infants for Bronchopulmonary Dysplasia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6648208. [PMID: 33506026 PMCID: PMC7815401 DOI: 10.1155/2021/6648208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is the most common complication of extremely preterm birth. This study was aimed at detecting cytokine and fractional exhaled nitric oxide (FeNO) levels to evaluate their mechanisms and predicted significance for BPD. Preterm infants born at gestational age ≤ 32 weeks were recruited, and clinical data were collected. We detected ten cytokines, including IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8, and TNF-α on Days 1–3, Days 7–14, and Days 21–28 after birth by using the Meso Scale Discovery (MSD) technology. The FeNO levels of infants were measured when they met the discharge criteria. A total of 46 preterm infants were enrolled, consisting of 14 infants in BPD group and 32 infants in the control group. The gestational age (27.5 ± 1.3 vs. 29.9 ± 1.3 weeks) and birth weight (1021 ± 261 g vs. 1489 ± 357 g) were lower in the BPD group. The following were high-risk factors for BPD, as determined by multivariate logistic regression analysis: gestational age < 30 weeks, birth weight < 1000 g, PDA, longer mechanical ventilation, and higher FeNO. The cytokines of IL-6 and IL-8 on Days 7–14 and IL-4, IL-6, IL-8, and TNF-α on Days 21–28 were also high-risk factors for BPD. IL-6 contributed to BPD disease severity. Conclusion. The preterm infants with PDA and prolonged mechanical ventilation tended to develop BPD. The IL-6 and IL-8 were significantly increased on Days 7–14 and were high-risk factors for BPD. Moreover, the IL-6 level was associated with BPD disease severity. We speculated that NO was related to BPD via Th2 cell-mediated inflammatory responses such as IL-4 and IL-6. Cytokines might predict the occurrence of BPD.
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7
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Toldi G, Hummler H, Pillay T. T Lymphocytes, Multi-Omic Interactions and Bronchopulmonary Dysplasia. Front Pediatr 2021; 9:694034. [PMID: 34169050 PMCID: PMC8217456 DOI: 10.3389/fped.2021.694034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) remains a significant clinical challenge in neonatal medicine. BPD is clearly a multifactorial disease with numerous antenatal and postnatal components influencing lung development. Extremely immature infants are born in the late canalicular or early saccular stage and usually receive intensive care until the early alveolar stage of lung development, resulting in varying magnitudes of impairment of alveolar septation, lung fibrosis, and abnormal vascular development. The interactions between T lymphocytes, the genome and the epigenome, the microbiome and the metabolome, as well as nutrition and therapeutic interventions such as the exposure to oxygen, volutrauma, antibiotics, corticosteroids, caffeine and omeprazole, play an important role in pathogenesis and disease progression. While our general understanding of these interactions thanks to basic research is improving, this knowledge is yet to be translated into comprehensive prevention and clinical management strategies for the benefit of preterm infants developing BPD and later during infancy and childhood suffering from the disease itself and its sequelae. In this review, we summarise existing evidence on the interplay between T lymphocytes, lung multi-omics and currently used therapeutic interventions in BPD, and highlight avenues for potential future immunology related research in the field.
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Affiliation(s)
- Gergely Toldi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Helmut Hummler
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Thillagavathie Pillay
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom.,Department of Neonatology, University Hospitals Leicester NHS Foundation Trust, Leicester, United Kingdom.,College of Life Sciences, University of Leicester, Leicester, United Kingdom
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8
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Addis DR, Molyvdas A, Ambalavanan N, Matalon S, Jilling T. Halogen exposure injury in the developing lung. Ann N Y Acad Sci 2020; 1480:30-43. [PMID: 32738176 DOI: 10.1111/nyas.14445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/19/2020] [Accepted: 07/30/2020] [Indexed: 12/27/2022]
Abstract
Owing to a high-volume industrial usage of the halogens chlorine (Cl2 ) and bromine (Br2 ), they are stored and transported in abundance, creating a risk for accidental or malicious release to human populations. Despite extensive efforts to understand the mechanisms of toxicity upon halogen exposure and to develop specific treatments that could be used to treat exposed individuals or large populations, until recently, there has been little to no effort to determine whether there are specific features and or the mechanisms of halogen exposure injury in newborns or children. We established a model of neonatal halogen exposure and published our initial findings. In this review, we aim to contrast and compare the findings in neonatal mice exposed to Br2 with the findings published on adult mice exposed to Br2 and the neonatal murine models of bronchopulmonary dysplasia. Despite remarkable similarities across these models in overall alveolar architecture, there are distinct functional and apparent mechanistic differences that are characteristic of each model. Understanding the mechanistic and functional features that are characteristic of the injury process in neonatal mice exposed to halogens will allow us to develop countermeasures that are appropriate for, and effective in, this unique population.
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Affiliation(s)
- Dylan R Addis
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,Division of Molecular and Translational Biomedicine, Pulmonary Injury and Repair Center, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,UAB Comprehensive Cardiovascular Center, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Adam Molyvdas
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,Division of Molecular and Translational Biomedicine, Pulmonary Injury and Repair Center, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Namasivayam Ambalavanan
- Division of Neonatology, Department of Pediatrics, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Sadis Matalon
- Department of Anesthesiology and Perioperative Medicine, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,Division of Molecular and Translational Biomedicine, Pulmonary Injury and Repair Center, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Tamas Jilling
- Division of Neonatology, Department of Pediatrics, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,Department of Pediatrics, the University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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9
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Chen JL, Zhang CL. [Changes of serum interleukin-33 in preterm infants with bronchopulmonary dysplasia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:716-720. [PMID: 32669167 PMCID: PMC7389611 DOI: 10.7499/j.issn.1008-8830.2001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the role of interleukin-33 (IL-33) in the development and progression of bronchopulmonary dysplasia (BPD) in preterm infants. METHODS A prospective cohort study was performed on 128 preterm infants with a gestational age of ≤32 weeks and/or a birth weight of ≤1 500 g. They were classified to a non-BPD group with 50 infants, a mild BPD group with 32 infants, a moderate BPD group with 30 infants, and a severe BPD group with 16 infants. Related data were collected, including antepartum factors of mothers (antepartum hormone and chorioamnionitis), intrapartum factors of preterm infants (sex, gestational age, birth weight, mode of birth, and birth asphyxia), treatment after birth (pulmonary surfactant, duration of invasive ventilation, duration of noninvasive ventilation, duration of parenteral nutrition, and length of hospital stay). The high-risk factors for BPD were analyzed. ELISA was used to measure the serum level of IL-33 in preterm infants on days 1, 14, and 28 after birth. The serum level of IL-33 was compared between groups at different time points after birth. The preterm infants with moderate or severe BPD were treated with conventional corticosteroid therapy (DART regimen), and the serum level of IL-33 was measured before and after treatment. RESULTS There were significant differences between the preterm infants with BPD and those without BPD in the incidence of maternal chorioamnionitis, gestational age, birth weight, the incidence of birth asphyxia, duration of invasive ventilation, duration of noninvasive ventilation, duration of parenteral nutrition, and total length of hospital stay (P<0.05). There were significant differences in the above indices among the preterm infants with different severities of BPD (P<0.05). On days 1, 14, and 28 after birth, the infants with BPD had a significantly higher serum level of IL-33 than those without BPD, and the serum level of IL-33 tended to increase with the severity of BPD and over the time after birth (P<0.05). The preterm infants with moderate or severe BPD had a significant reduction in the serum level of IL-33 after the treatment with DART regimen (P<0.05). CONCLUSIONS Serum IL-33 is closely associated with the development and severity of BPD. Anti-inflammatory therapy with DART regimen can decrease the serum level of IL-33.
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Affiliation(s)
- Jun-Long Chen
- Department of Neonatology, Inner Mongolia People's Hospital, Huhhot 010017, China.
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10
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Bonadies L, Zaramella P, Porzionato A, Perilongo G, Muraca M, Baraldi E. Present and Future of Bronchopulmonary Dysplasia. J Clin Med 2020; 9:jcm9051539. [PMID: 32443685 PMCID: PMC7290764 DOI: 10.3390/jcm9051539] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder among infants born extremely preterm. The pathogenesis of BPD involves multiple prenatal and postnatal mechanisms affecting the development of a very immature lung. Their combined effects alter the lung's morphogenesis, disrupt capillary gas exchange in the alveoli, and lead to the pathological and clinical features of BPD. The disorder is ultimately the result of an aberrant repair response to antenatal and postnatal injuries to the developing lungs. Neonatology has made huge advances in dealing with conditions related to prematurity, but efforts to prevent and treat BPD have so far been only partially effective. Seeing that BPD appears to have a role in the early origin of chronic obstructive pulmonary disease, its prevention is pivotal also in long-term respiratory outcome of these patients. There is currently some evidence to support the use of antenatal glucocorticoids, surfactant therapy, protective noninvasive ventilation, targeted saturations, early caffeine treatment, vitamin A, and fluid restriction, but none of the existing strategies have had any significant impact in reducing the burden of BPD. New areas of research are raising novel therapeutic prospects, however. For instance, early topical (intratracheal or nebulized) steroids seem promising: they might help to limit BPD development without the side effects of systemic steroids. Evidence in favor of stem cell therapy has emerged from several preclinical trials, and from a couple of studies in humans. Mesenchymal stromal/stem cells (MSCs) have revealed a reparatory capability, preventing the progression of BPD in animal models. Administering MSC-conditioned media containing extracellular vesicles (EVs) have also demonstrated a preventive action, without the potential risks associated with unwanted engraftment or the adverse effects of administering cells. In this paper, we explore these emerging treatments and take a look at the revolutionary changes in BPD and neonatology on the horizon.
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Affiliation(s)
- Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.B.); (P.Z.)
| | - Patrizia Zaramella
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.B.); (P.Z.)
| | - Andrea Porzionato
- Human Anatomy Section, Department of Neurosciences, University of Padova, 35128 Padova, Italy;
| | - Giorgio Perilongo
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy;
| | - Maurizio Muraca
- Institute of Pediatric Research “Città della Speranza”, Stem Cell and Regenerative Medicine Laboratory, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy;
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.B.); (P.Z.)
- Correspondence: ; Tel.: +39-049-821-3560; Fax: +39-049-821-3502
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11
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Cheng H, Wu B, Wang L, Hu T, Deng Z, Li D. Insights into the expression profiles and functions of circRNAs in a newborn hyperoxia-induced rat bronchopulmonary dysplasia model. J Gene Med 2020; 22:e3163. [PMID: 31961470 DOI: 10.1002/jgm.3163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/03/2020] [Accepted: 01/04/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a severe chronic lung disease in preterm infants. Circular RNAs (circRNAs) are key regulators of various biological processes. The present study aimed to explore the biological roles of circRNAs in BPD pathogenesis. METHODS A newborn BPD rat model was developed to construct a circRNA library; Illumina deep sequencing (Illumina, San Diego, CA, USA) was used to reveal differential expression of circRNAs in the hyperoxia-induced BPD rat models. Sanger sequencing and a reverse transcription-polymerase chain reaction were performed to confirm circRNAs that may be related to BPD. After miRNA binding-site prediction, we constructed a network diagram of circRNA-competing endogenous RNAs (ceRNAs) related to transforming growth factor (TGF)-β and p53 pathways using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. RESULTS In total, 256 differentially expressed circRNAs were detected between the hyperoxia group and the normoxia group. Of these circRNAs, 195 were up-regulated and 61 were down-regulated. The differences of circRNA distribution between the two groups were analyzed and six circRNAs were validated in the tissue samples. GO analysis indicated that 6519 target genes were enriched in cell location and biological processes. KEGG pathway enrichment analysis showed that circRNAs involved in 242 KEGG pathways. A network diagram of circRNA-ceRNA related to TGF-β and p53 pathways was constructed. CONCLUSIONS CircRNAs are differentially expressed between the BPD model and control group. Many target genes of circRNAs are involved in the developmental process, which suggests that BPD may be associated with pathways including extracellular matrix-receptor interaction, vascular endothelial growth factor signaling and vascular smooth muscle contraction.
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Affiliation(s)
- Hanrong Cheng
- Institute of Respiratory Diseases, Shenzhen People's Hospital; The First Affiliated Hospital of Southern University of Science and Technology; The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Benqing Wu
- Children's Medical Center of Guangming New District Medical Group, Shenzhen, China
| | - Lingwei Wang
- Institute of Respiratory Diseases, Shenzhen People's Hospital; The First Affiliated Hospital of Southern University of Science and Technology; The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Tianyong Hu
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
| | - Zhuhui Deng
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
| | - Dongcai Li
- Institute of ENT and Shenzhen Key Laboratory of ENT, Longgang ENT Hospital, Shenzhen, China
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12
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Bhandari V. Designing a better definition of bronchopulmonary dysplasia. Pediatr Pulmonol 2019; 54:678-679. [PMID: 30864236 DOI: 10.1002/ppul.24305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Vineet Bhandari
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Cakir U, Tayman C, Yucel C. A Novel Diagnostic Marker for the Severity of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: Interleukin-33. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:12-17. [PMID: 31508250 DOI: 10.1089/ped.2019.0994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
Background: Bronchopulmonary dysplasia (BPD) is an important clinical problem for premature infants. Previously, some biomarkers associated with severity of BPD have been studied. In our study, we aimed to investigate the value of interleukin-33 (IL-33) levels as a new biomarker in the follow-up of BPD severity and response to treatment. Materials and Methods: Premature infants of <32 weeks of gestational age and birth weight <1,500 g were included in the study. Infants with BPD were divided into moderate and severe BPD groups. Infants without BPD were assigned as the control group. Cord blood samples were taken from both groups immediately after birth. In addition, blood samples were obtained at the time of diagnosis of BPD and after the end of hydrocortisone (HC) treatment to measure IL-33 values in the serum. Results: During the study period, a total of 192 infants were eligible: 96 infants in the BPD group and 96 in the control group. Cord IL-33 values were similar between control (1.29 ± 0.68 pg/mL) and BPD (moderate/severe) (1.31 ± 0.84 pg/mL) groups (P = 0.813). The levels of IL-33 were higher in BPD group (3.43 ± 0.98 pg/mL) than in the control group (0.98 ± 0.51 pg/mL) (P < 0.001). IL-33 values decreased significantly after HC treatment (pretreatment: 3.43 ± 0.98 pg/mL versus post-treatment: 2.97 ± 0.28 pg/mL) (P < 0.001). In addition, IL-33 levels were significantly higher in severe BPD (3.91 ± 1.22 pg/mL) than in moderate BPD (2.82 ± 0.74) group (P < 0.001). Conclusions: Although the IL-33 level was not predictive of the development of BPD immediately after birth, it may be used as a new biomarker to diagnose, monitor, and follow the response to treatment of BPD.
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Affiliation(s)
- Ufuk Cakir
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Cuneyt Tayman
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Cigdem Yucel
- Department of Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Tayman C, Cakir U, Yucel C, Bekmez BO. Is Endocan a Novel Diagnostic Marker for the Severity of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants? Arch Bronconeumol 2019; 55:465-471. [PMID: 30833192 DOI: 10.1016/j.arbres.2019.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/09/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Endocan levels were found to be associated with severity and mortality of the respiratory system diseases. OBJECTIVE We aimed to figure out whether endocan was an important marker for the diagnosis, severity and follow-up of bronchopulmonary dysplasia (BPD). MATERIALS AND METHODS Infants with moderate/severe BPD, and who required hydrocortisone treatment were included in the study group. Infants without BPD were allocated in the control group. Endocan levels were compared between the control group and the study group, and before and after the treatment in the study group. RESULTS A total of 148 infants, 74 infants in the control group and 74 infants in the BPD group, were included. The endocan level was higher in the BPD group than in the control group (P = .001). Endocan levels before treatment in the BPD group was found to be higher than endocan level after treatment (P = .021). CONCLUSION Our study found that endocan levels increased in moderate/severe BPD. Serum endocan levels may be a safe and novel indicator for the follow-up of response to treatment and the prognosis of the severity of the disease.
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Affiliation(s)
- Cuneyt Tayman
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Ufuk Cakir
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
| | - Cigdem Yucel
- Department of Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Buse Ozer Bekmez
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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15
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The definition of bronchopulmonary dysplasia: an evolving dilemma. Pediatr Res 2018; 84:586-588. [PMID: 30188504 DOI: 10.1038/s41390-018-0167-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 12/11/2022]
Abstract
The definition of bronchopulmonary dysplasia (BPD) continues to be a challenging one. The evolution of the disease as well as its definition are discussed. Limitations of the current as well as newer suggested definitions of BPD are summarized. Recognition of the variability of the pulmonary phenotype is a critical aspect of the disease that needs to identified, utilizing biomarkers that will potentially better inform the next iteration of the definition of BPD.
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16
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Lal CV, Olave N, Travers C, Rezonzew G, Dolma K, Simpson A, Halloran B, Aghai Z, Das P, Sharma N, Xu X, Genschmer K, Russell D, Szul T, Yi N, Blalock JE, Gaggar A, Bhandari V, Ambalavanan N. Exosomal microRNA predicts and protects against severe bronchopulmonary dysplasia in extremely premature infants. JCI Insight 2018. [PMID: 29515035 DOI: 10.1172/jci.insight.93994] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Premature infants are at high risk for developing bronchopulmonary dysplasia (BPD), characterized by chronic inflammation and inhibition of lung development, which we have recently identified as being modulated by microRNAs (miRNAs) and alterations in the airway microbiome. Exosomes and exosomal miRNAs may regulate cell differentiation and tissue and organ development. We discovered that tracheal aspirates from infants with severe BPD had increased numbers of, but smaller, exosomes compared with term controls. Similarly, bronchoalveolar lavage fluid from hyperoxia-exposed mice (an animal model of BPD) and supernatants from hyperoxia-exposed human bronchial epithelial cells (in vitro model of BPD) had increased exosomes compared with air controls. Next, in a prospective cohort study of tracheal aspirates obtained at birth from extremely preterm infants, utilizing independent discovery and validation cohorts, we identified unbiased exosomal miRNA signatures predictive of severe BPD. The strongest signal of reduced miR-876-3p in BPD-susceptible compared with BPD-resistant infants was confirmed in the animal model and in vitro models of BPD. In addition, based on our recent discovery of increased Proteobacteria in the airway microbiome being associated with BPD, we developed potentially novel in vivo and in vitro models for BPD combining Proteobacterial LPS and hyperoxia exposure. Addition of LPS led to a larger reduction in exosomal miR 876-3p in both hyperoxia and normoxia compared with hyperoxia alone, thus indicating a potential mechanism by which alterations in microbiota can suppress miR 876-3p. Gain of function of miR 876-3p improved the alveolar architecture in the in vivo BPD model, demonstrating a causal link between miR 876-3p and BPD. In summary, we provide evidence for the strong predictive biomarker potential of miR 876-3p in severe BPD. We also provide insights on the pathogenesis of neonatal lung disease, as modulated by hyperoxia and microbial product-induced changes in exosomal miRNA 876-3p, which could be targeted for future therapeutic development.
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Affiliation(s)
- Charitharth Vivek Lal
- Department of Pediatrics.,Translational Research in Disordered and Normal Development Program, and.,Program in Protease and Matrix Biology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Nelida Olave
- Department of Pediatrics.,Translational Research in Disordered and Normal Development Program, and
| | | | - Gabriel Rezonzew
- Department of Pediatrics.,Translational Research in Disordered and Normal Development Program, and
| | | | | | - Brian Halloran
- Department of Pediatrics.,Translational Research in Disordered and Normal Development Program, and
| | - Zubair Aghai
- Department of Pediatrics, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania, USA
| | - Pragnya Das
- Department of Pediatrics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nirmal Sharma
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Xin Xu
- Program in Protease and Matrix Biology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Kristopher Genschmer
- Program in Protease and Matrix Biology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Derek Russell
- Program in Protease and Matrix Biology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Tomasz Szul
- Program in Protease and Matrix Biology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, UAB, Alabama, USA
| | - J Edwin Blalock
- Program in Protease and Matrix Biology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Amit Gaggar
- Program in Protease and Matrix Biology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Vineet Bhandari
- Department of Pediatrics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Namasivayam Ambalavanan
- Department of Pediatrics.,Translational Research in Disordered and Normal Development Program, and
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17
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Mahlman M, Karjalainen MK, Huusko JM, Andersson S, Kari MA, Tammela OKT, Sankilampi U, Lehtonen L, Marttila RH, Bassler D, Poets CF, Lacaze-Masmonteil T, Danan C, Delacourt C, Palotie A, Muglia LJ, Lavoie PM, Hadchouel A, Rämet M, Hallman M. Genome-wide association study of bronchopulmonary dysplasia: a potential role for variants near the CRP gene. Sci Rep 2017; 7:9271. [PMID: 28839172 PMCID: PMC5571168 DOI: 10.1038/s41598-017-08977-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/20/2017] [Indexed: 11/28/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD), the main consequence of prematurity, has a significant heritability, but little is known about predisposing genes. The aim of this study was to identify gene loci predisposing infants to BPD. The initial genome-wide association study (GWAS) included 174 Finnish preterm infants of gestational age 24–30 weeks. Thereafter, the most promising single-nucleotide polymorphisms (SNPs) associated with BPD were genotyped in both Finnish (n = 555) and non-Finnish (n = 388) replication cohorts. Finally, plasma CRP levels from the first week of life and the risk of BPD were assessed. SNP rs11265269, flanking the CRP gene, showed the strongest signal in GWAS (odds ratio [OR] 3.2, p = 3.4 × 10−6). This association was nominally replicated in Finnish and French African populations. A number of other SNPs in the CRP region, including rs3093059, had nominal associations with BPD. During the first week of life the elevated plasma levels of CRP predicted the risk of BPD (OR 3.4, p = 2.9 × 10–4) and the SNP rs3093059 associated nominally with plasma CRP levels. Finally, SNP rs11265269 was identified as a risk factor of BPD (OR 1.8, p = 5.3 × 10−5), independently of the robust antenatal risk factors. As such, in BPD, a potential role for variants near CRP gene is proposed.
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Affiliation(s)
- Mari Mahlman
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
| | - Minna K Karjalainen
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Johanna M Huusko
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.,Perinatal Institute, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sture Andersson
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - M Anneli Kari
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Outi K T Tammela
- Tampere University Hospital, Tampere University, and Center of Pediatric Child Health, Tampere, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Liisa Lehtonen
- Turku University Hospital, and the University of Turku, Turku, Finland
| | - Riitta H Marttila
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany
| | | | - Claude Danan
- Inserm, U955, Créteil, France.,CRB, CHI-Creteil, France.,Department of neonatology, CHI-Creteil, Creteil, France
| | - Christophe Delacourt
- Inserm, U955, Créteil, France.,AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Paris, France.,Université Paris-Descartes, Paris, France
| | - Aarno Palotie
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,The Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Psychiatric & Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Louis J Muglia
- Perinatal Institute, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver Canada, Vancouver, Canada
| | - Alice Hadchouel
- Inserm, U955, Créteil, France.,AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Paris, France.,Université Paris-Descartes, Paris, France
| | - Mika Rämet
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.,BioMediTech Institute and Faculty of Medical and Life Sciences, University of Tampere, Tampere, Finland
| | - Mikko Hallman
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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18
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Affiliation(s)
- Sascha Meyer
- University Children's Hospital of Saarland, Department of General Pediatrics and Neonatology, Neonatal Intensive Care Unit, Homburg, Germany.
| | - Michael Zemlin
- University Children's Hospital of Saarland, Department of General Pediatrics and Neonatology, Neonatal Intensive Care Unit, Homburg, Germany
| | - Martin Poryo
- University Children's Hospital of Saarland, Department of Pediatric Cardiology, Homburg, Germany
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