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Patel J, Weinberger B, Pulju M, Galanti SG, Kasniya G, Gupta V, Kurepa D. Lung Ultrasound Assessment of Regional Distribution of Pulmonary Edema and Atelectasis in Infants with Evolving Bronchopulmonary Dysplasia. Diagnostics (Basel) 2024; 14:2341. [PMID: 39451663 PMCID: PMC11506572 DOI: 10.3390/diagnostics14202341] [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: 08/29/2024] [Revised: 10/08/2024] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Preterm infants are at risk for bronchopulmonary dysplasia (BPD) due to prolonged respiratory support. Studies have described differences in the regional distribution of lung ventilation (non-dependent (NDL) vs. dependent (DL)). The aim of this study was to use LUS to compare regional distribution of pulmonary edema and atelectasis in infants with evolving BPD. Methods: We prospectively performed LUS in premature infants with evolving BPD. On each side, three lung areas (NDL/anterior, lateral, and DL/posterior) were examined for the presence of pulmonary edema and atelectasis. Pulmonary edema scores were assigned based on the number of B-lines, and atelectasis scores were assigned based on the presence/absence of atelectasis. Results: 38 premature infants were enrolled. The NDL showed more pulmonary edema and atelectasis compared to the DL (p = 0.003, p = 0.049, respectively) and compared to the lateral lung (p =< 0.001, p = 0.004, respectively). There was no difference between the lateral and DL (p = 0.188, p = 0.156, respectively). There was no difference between the right and the left lung (p = 0.223, p = 0.656, respectively). Conclusions: In this cohort of preterm infants with evolving BPD, lung disease was unevenly distributed, with more pulmonary edema and atelectasis in the NDL regions compared to the DL or lateral regions.
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Affiliation(s)
- Jimikumar Patel
- Division of Newborn Medicine, Department of Pediatrics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA;
| | - Barry Weinberger
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Margaret Pulju
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Stephanie G. Galanti
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Gangajal Kasniya
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Venkata Gupta
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
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He LLH, Foo G, Kenna KR, Douglas E, Fatmous M, Sutton RJ, Perkins EJ, Sourial M, Pereira-Fantini PM, Tingay DG, Sett A. Lung ultrasound detects regional aeration inhomogeneity in ventilated preterm lambs. Pediatr Res 2024; 95:129-134. [PMID: 37591926 PMCID: PMC10798896 DOI: 10.1038/s41390-023-02781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Inhomogeneous lung aeration is a significant contributor to preterm lung injury. EIT detects inhomogeneous aeration in the research setting. Whether LUS detects inhomogeneous aeration is unknown. The aim was to determine whether LUS detects regional inhomogeneity identified by EIT in preterm lambs. METHODS LUS and EIT were simultaneously performed on mechanically ventilated preterm lambs. LUS images from non-dependent and dependent regions were acquired and reported using a validated scoring system and computer-assisted quantitative LUS greyscale analysis (Q-LUSMGV). Regional inhomogeneity was calculated by observed over predicted aeration ratio from the EIT reconstructive model. LUS scores and Q-LUSMGV were compared with EIT aeration ratios using one-way ANOVA. RESULTS LUS was performed in 32 lambs (~125d gestation, 128 images). LUS scores were greater in upper anterior (non-dependent) compared to lower lateral (dependent) regions of the left (3.4 vs 2.9, p = 0.1) and right (3.4 vs 2.7, p < 0.0087). The left and right upper regions also had greater LUS scores compared to right lower (3.4 vs 2.7, p < 0.0087) and left lower (3.7 vs 2.9, p = 0.1). Q-LUSMGV yielded similar results. All LUS findings corresponded with EIT regional differences. CONCLUSION LUS may have potential in measuring regional aeration, which should be further explored in human studies. IMPACT Inhomogeneous lung aeration is an important contributor to preterm lung injury, however, tools detecting inhomogeneous aeration at the bedside are limited. Currently, the only tool clinically available to detect this is electrical impedance tomography (EIT), however, its use is largely limited to research. Lung ultrasound (LUS) may play a role in monitoring lung aeration in preterm infants, however, whether it detects inhomogeneous lung aeration is unknown. Visual LUS scores and mean greyscale image analysis using computer assisted quantitative LUS (Q-LUSMGV) detects regional lung aeration differences when compared to EIT. This suggests LUS reliably detects aeration inhomogeneity warranting further investigation in human trials.
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Affiliation(s)
- Laura L H He
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia.
| | - Gillian Foo
- Joan Kirner Women's and Children's Hospital, Western Health, Victoria, VIC, Australia
| | - Kelly R Kenna
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Ellen Douglas
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Monique Fatmous
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Rebecca J Sutton
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Translational Research Unit, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Magdy Sourial
- Translational Research Unit, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia
| | - Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia
- Joan Kirner Women's and Children's Hospital, Western Health, Victoria, VIC, Australia
- Newborn Research Centre, The Royal Women's Hospital, Victoria, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, VIC, Australia
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Barrett JS, Nicholas T, Azer K, Corrigan BW. Role of Disease Progression Models in Drug Development. Pharm Res 2022; 39:1803-1815. [PMID: 35411507 PMCID: PMC9000925 DOI: 10.1007/s11095-022-03257-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 12/11/2022]
Abstract
The use of Disease progression models (DPMs) in Drug Development has been widely adopted across therapeutic areas as a method for integrating previously obtained disease knowledge to elucidate the impact of novel therapeutics or vaccines on disease course, thus quantifying the potential clinical benefit at different stages of drug development programs. This paper provides a brief overview of DPMs and the evolution in data types, analytic methods, and applications that have occurred in their use by Quantitive Clinical Pharmacologists. It also provides examples of how these models have informed decisions and clinical trial design across several therapeutic areas and at various stages of development. It briefly describes potential new applications of DPMs utilizing emerging data sources, and utilizing new analytic techniques, and discuss new challenges faced such as requiring description of multiple endpoints, rapid model development, application of machine learning-based analytics, and use of high dimensional and real-world data. Considerations for the continued evolution future of DPMs to serve as community-maintained expert systems are also provided.
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Affiliation(s)
- Jeffrey S. Barrett
- Rare Disease Cures Accelerator Data Analytics Platform, Critical Path Institute, Tuscon, AZ 85718 USA
| | - Tim Nicholas
- Global Product Development, Pfizer Inc, 445 Eastern Point Rd, Groton, CT 06340 USA
| | - Karim Azer
- Axcella Therapeutics, 840 Memorial Drive, Cambridge, MA 02139 USA
| | - Brian W. Corrigan
- Global Product Development, Pfizer Inc, 445 Eastern Point Rd, Groton, CT 06340 USA
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Corsini I, Ficial B, Ciarcià M, Capasso L, Migliaro F, Rodriguez-Fanjul J, Clemente M, Raimondi F, Dani C. Lung ultrasound scores in neonatal clinical practice: A narrative review of the literature. Pediatr Pulmonol 2022; 57:1157-1166. [PMID: 35229487 DOI: 10.1002/ppul.25875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 11/10/2022]
Abstract
Lung ultrasound (LU) has in recent years increasingly been used as a point-of-care method. Initially, LU was used as a so-called descriptive diagnostic method for neonatal respiratory diseases. Instead, this review article focuses on the use of LU as a "functional" tool using classification of findings in patterns or using semiquantitative scores. We review and describe the evidence that led to the implementation of LU in predicting the need for surfactant replacement therapy in preterm infants and in the identification of newborns at risk of developing bronchopulmonary dysplasia. LU appears to be a very promising method for the future of clinical management of newborns in both acute and chronic phases of pulmonary pathologies related to prematurity. However, further studies are needed to define its role before full implementation.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology and NICU, Federico II University Hospital, Naples, Italy
| | - Fiorella Migliaro
- Division of Neonatology and NICU, Federico II University Hospital, Naples, Italy
| | - Javier Rodriguez-Fanjul
- Neonatal Intensive Care Unit, Department of Paediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - Maria Clemente
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Raimondi
- Division of Neonatology and NICU, Federico II University Hospital, Naples, Italy
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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Impact of patient positions in lung ultrasound protocol: author's reply. J Perinatol 2022; 42:290. [PMID: 34845296 DOI: 10.1038/s41372-021-01281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/08/2022]
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Alonso-Ojembarrena A, Raimondi F. The meaning of gravity-induced lung ultrasound score variations. J Perinatol 2022; 42:289. [PMID: 34845297 DOI: 10.1038/s41372-021-01280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022]
Affiliation(s)
- A Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain. .,Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain.
| | - F Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II", Naples, Italy
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