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Wang D, Huang S, Cao J, Feng Z, Jiang Q, Zhang W, Chen J, Kutty S, Liu C, Liao W, Zhang L, Zhu G, Guo W, Yang J, Liu L, Yang J, Li Q. A comprehensive study on machine learning models combining with oversampling for bronchopulmonary dysplasia-associated pulmonary hypertension in very preterm infants. Respir Res 2024; 25:199. [PMID: 38720331 PMCID: PMC11077703 DOI: 10.1186/s12931-024-02797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) remains a devastating clinical complication seriously affecting the therapeutic outcome of preterm infants. Hence, early prevention and timely diagnosis prior to pathological change is the key to reducing morbidity and improving prognosis. Our primary objective is to utilize machine learning techniques to build predictive models that could accurately identify BPD infants at risk of developing PH. METHODS The data utilized in this study were collected from neonatology departments of four tertiary-level hospitals in China. To address the issue of imbalanced data, oversampling algorithms synthetic minority over-sampling technique (SMOTE) was applied to improve the model. RESULTS Seven hundred sixty one clinical records were collected in our study. Following data pre-processing and feature selection, 5 of the 46 features were used to build models, including duration of invasive respiratory support (day), the severity of BPD, ventilator-associated pneumonia, pulmonary hemorrhage, and early-onset PH. Four machine learning models were applied to predictive learning, and after comprehensive selection a model was ultimately selected. The model achieved 93.8% sensitivity, 85.0% accuracy, and 0.933 AUC. A score of the logistic regression formula greater than 0 was identified as a warning sign of BPD-PH. CONCLUSIONS We comprehensively compared different machine learning models and ultimately obtained a good prognosis model which was sufficient to support pediatric clinicians to make early diagnosis and formulate a better treatment plan for pediatric patients with BPD-PH.
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Affiliation(s)
- Dan Wang
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Cardiology, Hunan Children's Hospital, Changsha, China
| | - Shuwei Huang
- School of Software, Tsinghua University, Beijing, China
| | - Jingke Cao
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhichun Feng
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qiannan Jiang
- Department of Neonatology, Qingdao Women and Children's Hospital, Qingdao, China
| | - Wanxian Zhang
- Department of Neonatology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Jia Chen
- Department of Neonatology, Guangdong Women and Children Hospital, Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Shelby Kutty
- Pediatric and Congenital Cardiology, Taussig Heart Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Changgen Liu
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wenyu Liao
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Le Zhang
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Guli Zhu
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Wenhao Guo
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Jie Yang
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lin Liu
- School of Software, Tsinghua University, Beijing, China.
| | - Jingwei Yang
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China.
| | - Qiuping Li
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Nawaytou H, Hills NK, Clyman RI. Patent ductus arteriosus and the risk of bronchopulmonary dysplasia-associated pulmonary hypertension. Pediatr Res 2023; 94:547-554. [PMID: 36804505 PMCID: PMC10403370 DOI: 10.1038/s41390-023-02522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/13/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND The aim of the study was to determine whether prolonged exposure to a moderate/large patent ductus arteriosus left-to-right shunt (PDA) increases the risk of late (beyond 36 weeks) pulmonary hypertension (BPD-PH) and pulmonary vascular disease (BPD-PVD) during the neonatal hospitalization in preterm infants (<28 weeks' gestation) with bronchopulmonary dysplasia (BPD). METHODS All infants requiring respiratory support ≥36 weeks had systematic echocardiographic evaluations for BPD-PH at planned intervals. Infants were classified as having either flow-associated BPD-PH (BPD-flow-PH) or BPD-PVD. RESULTS 256 infants survived ≥36 weeks: 105 had NO BPD (were off respiratory support by 36 weeks); 151 had BPD. 22/151 had BPD-PH (12/22 had BPD-flow-PH from a PDA that persisted beyond 36 weeks; 10/22 had BPD-PVD). Moderate/large PDA shunts that persisted beyond 36 weeks were significantly associated with an increased incidence of BPD-PH due to BPD-flow-PH. We found no association between the duration of PDA exposure and the incidence of BPD-PVD. CONCLUSIONS Moderate/large PDA shunts increase the risk of flow-associated BPD-PH when present beyond 36 weeks. Although term infants with PDA-congenital heart disease can develop pulmonary vascular remodeling and PVD after months of PDA exposure, we found no echocardiographic evidence in preterm infants that prolonged PDA exposure increases the incidence of BPD-PVD during the neonatal hospitalization. IMPACT In our study, preterm infants (<28 weeks' gestation) with bronchopulmonary dysplasia (BPD) had a 15% incidence of pulmonary hypertension (PH) beyond 36 weeks' postmenstrual age as a comorbidity. Moderate/large patent ductus arteriosus (PDA) shunts increased the risk of flow-associated PH when present beyond 36 weeks. Although months of prolonged PDA exposure can cause pulmonary vascular remodeling and pulmonary vascular disease (PVD) in term infants with PDA-congenital heart disease, we found no echocardiographic evidence for an association between the duration of PDA exposure and the incidence of late PVD during the neonatal hospitalization in preterm infants with BPD.
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Affiliation(s)
- Hythem Nawaytou
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Ronald I Clyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
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Qu S, Shan L, Chen X, Zhang Z, Wu Y, Chen Y, Zhuo F, Wang Y, Dong H. The role of rhIGF-1/BP3 in the prevention of pulmonary hypertension in bronchopulmonary dysplasia and its underlying mechanism. BMC Pulm Med 2023; 23:209. [PMID: 37322452 DOI: 10.1186/s12890-023-02498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND This study aimed to determine whether postnatal treatment with recombinant human IGF-1 (rhIGF-1)/binding peptide 3 (BP3) ameliorates lung injury and prevents pulmonary hypertension (PH) in bronchopulmonary dysplasia (BPD) models. METHODS We used two models of BPD in this study: one model that was associated with chorioamnionitis (CA), stimulated by intra-amniotic fluid and exposure to lipopolysaccharide (LPS), whereas the other was exposed to postnatal hyperoxia. Newborn rats were treated with rhIGF-1/BP3 (0.2 mg/Kg/d) or saline via intraperitoneal injection. The study endpoints included the wet/dry weight (W/D) ratio of lung tissues, radial alveolar counts (RACs), vessel density, right ventricular hypertrophy (RVH), lung resistance, and lung compliance. Hematoxylin and eosin (H&E) and Masson staining were used to evaluate the degree of lung injury and pulmonary fibrosis. IGF-1 and eNOS expression were detected using western blotting or quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). The levels of SP-C, E-cadherin, N-cadherin, FSP1, and Vimentin in the lung tissues were detected by immunofluorescence. RESULTS LPS and hyperoxia treatment increased lung injury and pulmonary fibrosis, enhanced RVH and total respiratory resistance, and decreased RAC, pulmonary vascular density and pulmonary compliance in young mice (all p < 0.01). Simultaneously, LPS and hyperoxia induced an increase in epithelial-mesenchymal transition (EMT) in airway epithelial cells. However, rhIGF-1/BP3 treatment reduced lung injury and pulmonary fibrosis, decreased RVH and total respiratory resistance, and enhanced RAC, pulmonary vascular density and pulmonary compliance, as well as inhibited EMT in airway epithelial cells in LPS and hyperoxia treated mice. CONCLUSION Postnatal rhIGF-1/BP3 treatment relieved the effects of LPS or hyperoxia on lung injury and prevented RVH, providing a promising strategy for the treatment of BPD.
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Affiliation(s)
- Sehua Qu
- Department of Neonatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Lianqiang Shan
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Xin Chen
- Department of Neonatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Zhen Zhang
- Department of Neonatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Yumeng Wu
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Yun Chen
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Feixiang Zhuo
- Department of Neonatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Yitong Wang
- Bengbu Medical College, Bengbu, 233000, China
| | - Huaifu Dong
- Department of Neonatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
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Jia M, Li J, Zhang J, Wei N, Yin Y, Chen H, Yan S, Wang Y. Identification and validation of cuproptosis related genes and signature markers in bronchopulmonary dysplasia disease using bioinformatics analysis and machine learning. BMC Med Inform Decis Mak 2023; 23:69. [PMID: 37060021 PMCID: PMC10105406 DOI: 10.1186/s12911-023-02163-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Bronchopulmonary Dysplasia (BPD) has a high incidence and affects the health of preterm infants. Cuproptosis is a novel form of cell death, but its mechanism of action in the disease is not yet clear. Machine learning, the latest tool for the analysis of biological samples, is still relatively rarely used for in-depth analysis and prediction of diseases. METHODS AND RESULTS First, the differential expression of cuproptosis-related genes (CRGs) in the GSE108754 dataset was extracted and the heat map showed that the expression of NFE2L2 gene was significantly higher in the control group whereas the expression of GLS gene was significantly higher in the treatment group. Chromosome location analysis showed that both the genes were positively correlated and associated with chromosome 2. The results of immune infiltration and immune cell differential analysis showed differences in the four immune cells, significantly in Monocytes cells. Five new pathways were analyzed through two subgroups based on consistent clustering of CRG expression. Weighted correlation network analysis (WGCNA) set the screening condition to the top 25% to obtain the disease signature genes. Four machine learning algorithms: Generalized Linear Models (GLM), Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGB) were used to screen the disease signature genes, and the final five marker genes for disease prediction. The models constructed by GLM method were proved to be more accurate in the validation of two datasets, GSE190215 and GSE188944. CONCLUSION We eventually identified two copper death-associated genes, NFE2L2 and GLS. A machine learning model-GLM was constructed to predict the prevalence of BPD disease, and five disease signature genes NFATC3, ERMN, PLA2G4A, MTMR9LP and LOC440700 were identified. These genes that were bioinformatics analyzed could be potential targets for identifying BPD disease and treatment.
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Affiliation(s)
| | - Jieyi Li
- Shanghai Literature Institute of Traditional Chinese Medicine, Shanghai, 200000, China
| | - Jingying Zhang
- Shanghai Literature Institute of Traditional Chinese Medicine, Shanghai, 200000, China
| | - Ningjing Wei
- ChengZheng Wisdom (Shanghai) Health Sciences and Technology Co., Ltd, Shanghai, 200000, China
| | - Yating Yin
- ChengZheng Wisdom (Shanghai) Health Sciences and Technology Co., Ltd, Shanghai, 200000, China
| | - Hui Chen
- Shanghai Literature Institute of Traditional Chinese Medicine, Shanghai, 200000, China
| | - Shixing Yan
- Shanghai Daosh Medical Technology Co., Ltd, Shanghai, 200000, China
| | - Yong Wang
- Shanghai Literature Institute of Traditional Chinese Medicine, Shanghai, 200000, China.
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Levy PT, Levin J, Leeman KT, Mullen MP, Hansmann G, Kourembanas S. Diagnosis and management of pulmonary hypertension in infants with bronchopulmonary dysplasia. Semin Fetal Neonatal Med 2022; 27:101351. [PMID: 35641413 DOI: 10.1016/j.siny.2022.101351] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic pulmonary hypertension of infancy (cPHi) is a heterogeneous disease process that contributes to morbidity and mortality in preterm infants. cPHi is most commonly associated with chronic lung disease of prematurity and represents a unique phenotype of bronchopulmonary dysplasia. It is characterized by persistently elevated or newly rising pulmonary vascular resistance and pulmonary artery pressure beyond the first weeks of age. The high-pressure afterload on the right ventricle may or may not be tolerated, depending upon additional cardiovascular shunting and co-morbidities. A comprehensive clinical evaluation combined with advanced hemodynamic assessment by echocardiography and other cardiac imaging modalities help decipher the etiopathologies of disease, identify cardiopulmonary compromise earlier and guide individualized therapeutic intervention tailored by the phenotype. This review summarizes the underlying etiologies, risk factors for development, hemodynamic assessment, management, and follow-up of cPHi in preterm infants. We offer an algorithm for early detection of cPHi and outline research priorities.
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Affiliation(s)
- Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Jonathan Levin
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Kristen T Leeman
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Mary P Mullen
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hanover, Germany.
| | - Stella Kourembanas
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Neonatal pulmonary hypertension after severe early-onset fetal growth restriction: post hoc reflections on the Dutch STRIDER study. Eur J Pediatr 2022; 181:1709-1718. [PMID: 35018508 PMCID: PMC8964651 DOI: 10.1007/s00431-021-04355-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/08/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED The aim was to reflect on the unexpected finding of persistent pulmonary hypertension of the neonate (PPHN) and pulmonary hypertension in infants born within the Dutch STRIDER trial, its definition and possible pathophysiological mechanisms. The trial randomly assigned pregnant women with severe early-onset fetal growth restriction to sildenafil 25 mg three times a day versus placebo. Sildenafil use did not reduce perinatal mortality and morbidity, but did result in a higher rate of neonatal pulmonary hypertension (PH). The current paper reflects on the used definition, prevalence, and possible pathophysiology of the data on pulmonary hypertension. Twenty infants were diagnosed with pulmonary hypertension (12% of 163 live born infants). Of these, 16 infants had PPHN shortly after birth, and four had pulmonary hypertension associated with sepsis or bronchopulmonary dysplasia. Four infants with PPHN in the early neonatal period subsequently developed pulmonary hypertension associated with bronchopulmonary dysplasia in later life. Infants with pulmonary hypertension were at lower gestational age at delivery, had a lower birth weight and a higher rate of neonatal co-morbidity. The infants in the sildenafil group showed a significant increase in pulmonary hypertension compared to the placebo group (relative risk 3.67; 95% confidence interval 1.28 to 10.51, P = 0.02). CONCLUSION Pulmonary hypertension occurred more frequent among infants of mothers allocated to antenatal sildenafil compared with placebo. A possible pathophysiological mechanism could be a "rebound" vasoconstriction after cessation of sildenafil. Additional studies and data are necessary to understand the mechanism of action. WHAT IS KNOWN • In the Dutch STRIDER trial, persistent pulmonary hypertension in the neonate (PPHN) was more frequent among infants after antenatal sildenafil exposure versus placebo. WHAT IS NEW • The current analysis focuses on the distinction between PPHN and pulmonary hypertension associated with sepsis or bronchopulmonary dysplasia and on timing of diagnosis and aims to identify the infants at risk for developing pulmonary hypertension. • The diagnosis pulmonary hypertension is complex, especially in infants born after severe early-onset fetal growth restriction. The research field could benefit from an unambiguous consensus definition and standardized screening in infants at risk is proposed.
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Tong Y, Zhang S, Riddle S, Zhang L, Song R, Yue D. Intrauterine Hypoxia and Epigenetic Programming in Lung Development and Disease. Biomedicines 2021; 9:944. [PMID: 34440150 PMCID: PMC8394854 DOI: 10.3390/biomedicines9080944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Clinically, intrauterine hypoxia is the foremost cause of perinatal morbidity and developmental plasticity in the fetus and newborn infant. Under hypoxia, deviations occur in the lung cell epigenome. Epigenetic mechanisms (e.g., DNA methylation, histone modification, and miRNA expression) control phenotypic programming and are associated with physiological responses and the risk of developmental disorders, such as bronchopulmonary dysplasia. This developmental disorder is the most frequent chronic pulmonary complication in preterm labor. The pathogenesis of this disease involves many factors, including aberrant oxygen conditions and mechanical ventilation-mediated lung injury, infection/inflammation, and epigenetic/genetic risk factors. This review is focused on various aspects related to intrauterine hypoxia and epigenetic programming in lung development and disease, summarizes our current knowledge of hypoxia-induced epigenetic programming and discusses potential therapeutic interventions for lung disease.
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Affiliation(s)
- Yajie Tong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China;
| | - Shuqing Zhang
- School of Pharmacy, China Medical University, Shenyang 110122, China;
| | - Suzette Riddle
- Cardiovascular Pulmonary Research Laboratories, Departments of Pediatrics and Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Lubo Zhang
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA;
| | - Rui Song
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA;
| | - Dongmei Yue
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China;
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