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Alonso-Lopez P, Arroyas M, Beato M, Ruiz-Gonzalez S, Olabarrieta I, Garcia-Garcia ML. Respiratory, cardio-metabolic and neurodevelopmental long-term outcomes of moderate to late preterm birth: not just a near term-population. A follow-up study. Front Med (Lausanne) 2024; 11:1381118. [PMID: 39228801 PMCID: PMC11368750 DOI: 10.3389/fmed.2024.1381118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Moderate-to-late preterm infants constitute the majority within the preterm infant population. Most research on preterm infants has focused on very preterm children, often treating moderate-to-late preterm infants as similar to full-term infants. Our objective was to compare clinical, respiratory, cardio-metabolic and neurodevelopmental outcomes in adolescents aged 12-15 years born moderate and late preterm with a control group of the same age born full-term. Methods Observational cross-sectional study, comparing moderate-to-late preterm (32-36+6 weeks' gestational age) with full-term adolescents (37-41+6 weeks' gestational age; 75 each group). Perinatal and neonatal history were collected as well as data on respiratory evolution (ISAAC questionnaire for asthma symptoms for adolescents 13-14 years), anthropometric values, learning difficulties, behavioral test (screening questionnaire for high-performance autism spectrum disorder and evaluation test for attention deficit hyperactivity disorder), skin prick test, pulmonary function test, echocardiogram and blood pressure. A blood test with metabolic profile was conducted. Results Moderate-to-late preterm adolescents had more current asthma [p = 0.008, OR3 (95% CI 1.26-7.14)] and longer duration of combined treatments to control asthma (inhaled corticosteroids and anti-leukotrienes; p = 0.048). Forced vital capacity <80% was detected more often in moderate-to-late preterm patients (p = 0.013). When assessing right ventricle, moderate-to-late preterm adolescents showed better tricuspid annular plane systolic excursion z-score (p = 0.003), shortening fraction (p < 0.001) and E/A ratio z-score (p = 0.002). Regarding left ventricular assessment, moderate-to-late preterm group had smaller ventricle diastolic diameter (p = 0.04) and lower posterior wall z-score values (p = 0.037). They also showed a better S'wave z-score (p = 0.027), E wave (p = 0.005), E/A ratio (p = 0.003) and a higher septal myocardial performance index z-score (p = 0.025). Moderate-to-late preterm adolescents presented lower weight z-score (p = 0.039), body mass index z-score (p = 0.013), Waterlow weight index (p = 0.006) and higher undernutrition index [p = 0.04; OR 1.4 (95% CI 1-1.9)]. Although there were no differences in neurodevelopmental survey or behavioral tests. Conclusion Our findings underscore the importance of extended follow-up for this predominant group of premature infants to identify potential respiratory, cardiac and anthropometric issues that may emerge in the future.
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Affiliation(s)
- Patricia Alonso-Lopez
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Maria Arroyas
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Maite Beato
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Sara Ruiz-Gonzalez
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Iciar Olabarrieta
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Maria Luz Garcia-Garcia
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
- Networked Biomedical Research Center for Infectious Diseases (CIBERINFEC), Madrid, Spain
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
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Spoto G, Accetta AS, Grella M, Di Modica I, Nicotera AG, Di Rosa G. Respiratory Comorbidities and Complications of Cerebral Palsy. Dev Neurorehabil 2024; 27:194-203. [PMID: 38992903 DOI: 10.1080/17518423.2024.2374959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 04/29/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Respiratory complications are the most frequent cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP) and represent the leading cause of hospitalizations. Several factors negatively influence the respiratory status of these children: lung parenchymal alterations and factors modifying the pulmonary pump function of chest and respiratory muscles, as well as concomitant pathologies that indirectly affect the respiratory function, such as sleep disorder, malnutrition, epilepsy, and pharmacological treatments. Early management of respiratory complications can improve the global health of children with CP and enhance quality of life for them and their caregivers.
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D'Amico F, Lugarà C, Luppino G, Giuffrida C, Giorgianni Y, Patanè EM, Manti S, Gambadauro A, La Rocca M, Abbate T. The Influence of Neurotrophins on the Brain-Lung Axis: Conception, Pregnancy, and Neonatal Period. Curr Issues Mol Biol 2024; 46:2528-2543. [PMID: 38534776 DOI: 10.3390/cimb46030160] [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: 02/18/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
Neurotrophins (NTs) are four small proteins produced by both neuronal and non-neuronal cells; they include nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4). NTs can exert their action through both genomic and non-genomic mechanisms by interacting with specific receptors. Initial studies on NTs have identified them only as functional molecules of the nervous system. However, recent research have shown that some tissues and organs (such as the lungs, skin, and skeletal and smooth muscle) as well as some structural cells can secrete and respond to NTs. In addition, NTs perform several roles in normal and pathological conditions at different anatomical sites, in both fetal and postnatal life. During pregnancy, NTs are produced by the mother, placenta, and fetus. They play a pivotal role in the pre-implantation process and in placental and embryonic development; they are also involved in the development of the brain and respiratory system. In the postnatal period, it appears that NTs are associated with some diseases, such as sudden infant death syndrome (SIDS), asthma, congenital central hypoventilation syndrome (CCHS), and bronchopulmonary dysplasia (BPD).
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Affiliation(s)
- Federica D'Amico
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Cecilia Lugarà
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Giovanni Luppino
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Carlo Giuffrida
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Ylenia Giorgianni
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Eleonora Maria Patanè
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Sara Manti
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Antonella Gambadauro
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Mariarosaria La Rocca
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Tiziana Abbate
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
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4
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Boscarino G, Cardilli V, Conti MG, Liguori F, Repole P, Parisi P, Terrin G. Outcomes of postnatal systemic corticosteroids administration in ventilated preterm newborns: a systematic review of randomized controlled trials. Front Pediatr 2024; 12:1344337. [PMID: 38419972 PMCID: PMC10899705 DOI: 10.3389/fped.2024.1344337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Prolonged mechanical ventilation, commonly used to assist preterm newborns, increases the risk of developing bronchopulmonary dysplasia (BPD). In recent decades, studies have demonstrated that systemic corticosteroids play a significant role in the prevention and management of BPD. In this systematic review of randomized controlled trials (RCTs), we evaluated the association between the administration of systemic corticosteroids in preterm infants and its long-term outcomes, such as neurodevelopment, growth, extubation rate, and related adverse effects. Methods We conducted an electronic search in Medline, Scopus, and PubMed using the following terms: "premature infants" and "corticosteroids." We considered all RCTs published up to June 2023 as eligible. We included all studies involving preterm newborns treated with systemic corticosteroids and excluded studies on inhaled corticosteroids. Results A total of 39 RCTs were evaluated. The influence of steroids administered systemically during the neonatal period on long-term neurological outcomes remains unknown, with no influence observed for long-term growth. The postnatal administration of systemic corticosteroids has been found to reduce the timing of extubation and improve respiratory outcomes. Dexamethasone appears to be more effective than hydrocortisone, despite causing a higher rate of systemic hypertension and hyperglycemia. However, in the majority of RCTs analyzed, there were no differences in the adverse effects related to postnatal corticosteroid administration. Conclusion Dexamethasone administered during the neonatal period appears to be more effective than hydrocortisone in terms of respiratory outcomes; however, caution should be taken when administering dexamethasone. Data derived from current evidence, including meta-analyses, are inconclusive on the long-term effects of the administration of systemic steroids in preterm infants or the possibility of neurodevelopmental consequences.
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Affiliation(s)
- Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Viviana Cardilli
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federica Liguori
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Paola Repole
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Pediatrics Unit, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Collaco JM, Li Y, Rhein LM, Tracy MC, Sheils CA, Rice JL, Popova AP, Moore PE, Manimtim WM, Lai K, Kaslow JA, Hayden LP, Bansal M, Austin ED, Aoyama B, Alexiou S, Agarwal A, Villafranco N, Siddaiah R, Lagatta JM, Dawson SK, Cristea AI, Bauer SE, Baker CD, McGrath-Morrow SA. Validation of an outpatient questionnaire for bronchopulmonary dysplasia control. Pediatr Pulmonol 2023; 58:1551-1561. [PMID: 36793145 PMCID: PMC10121946 DOI: 10.1002/ppul.26358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Despite bronchopulmonary dysplasia (BPD) being a common morbidity of preterm birth, there is no validated objective tool to assess outpatient respiratory symptom control for clinical and research purposes. METHODS Data were obtained from 1049 preterm infants and children seen in outpatient BPD clinics of 13 US tertiary care centers from 2018 to 2022. A new standardized instrument was modified from an asthma control test questionnaire and administered at the time of clinic visits. External measures of acute care use were also collected. The questionnaire for BPD control was validated in the entire population and selected subgroups using standard methodology for internal reliability, construct validity, and discriminative properties. RESULTS Based on the scores from BPD control questionnaire, the majority of caregivers (86.2%) felt their child's symptoms were under control, which did not differ by BPD severity (p = 0.30) or a history of pulmonary hypertension (p = 0.42). Across the entire population and selected subgroups, the BPD control questionnaire was internally reliable, suggestive of construct validity (albeit correlation coefficients were -0.2 to -0.4.), and discriminated control well. Control categories (controlled, partially controlled, and uncontrolled) were also predictive of sick visits, emergency department visits, and hospital readmissions. CONCLUSION Our study provides a tool for assessing respiratory control in children with BPD for clinical care and research studies. Further work is needed to identify modifiable predictors of disease control and link scores from the BPD control questionnaire to other measures of respiratory health such as lung function testing.
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Affiliation(s)
- Joseph M. Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD
| | - Yun Li
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Pulmonary Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Lawrence M Rhein
- Neonatal-Perinatal Medicine/Pediatric Pulmonology, University of Massachusetts, Worcester, MA
| | - Michael C. Tracy
- Division of Pediatric Pulmonary, Asthma and Sleep Medicine, Stanford University, Stanford, CA
| | - Catherine A. Sheils
- Division of Pulmonary Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Jessica L. Rice
- Division of Pulmonary Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | | | - Paul E. Moore
- Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN
| | - Winston M. Manimtim
- Division of Neonatology, Children’s Mercy-Kansas City and University of Missouri Kansas City School of Medicine
| | - Khanh Lai
- Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, UT
| | - Jacob A. Kaslow
- Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN
| | - Lystra P. Hayden
- Division of Pulmonary Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Manvi Bansal
- Pulmonology and Sleep Medicine, Children’s Hospital of Los Angeles, Los Angeles, CA
| | - Eric D. Austin
- Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, TN
| | - Brianna Aoyama
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD
| | - Stamatia Alexiou
- Division of Pulmonary Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Amit Agarwal
- Division of Pulmonary Medicine, Arkansas Children’s Hospital and University of Arkansas for Medical Sciences, Little Rock, AR
| | - Natalie Villafranco
- Pulmonary Medicine, Texas Children’s Hospital and Baylor University, Houston, TX
| | | | - Joanne M. Lagatta
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee, Wisconsin
| | - Sara K. Dawson
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee, Wisconsin
| | - A. Ioana Cristea
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children’s Hospital and Indiana University, Indianapolis, IN
| | - Sarah E. Bauer
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children’s Hospital and Indiana University, Indianapolis, IN
| | - Christopher D. Baker
- Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Sharon A. McGrath-Morrow
- Division of Pulmonary Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
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Manti S, Xerra F, Spoto G, Butera A, Gitto E, Di Rosa G, Nicotera AG. Neurotrophins: Expression of Brain-Lung Axis Development. Int J Mol Sci 2023; 24:ijms24087089. [PMID: 37108250 PMCID: PMC10138985 DOI: 10.3390/ijms24087089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Neurotrophins (NTs) are a group of soluble growth factors with analogous structures and functions, identified initially as critical mediators of neuronal survival during development. Recently, the relevance of NTs has been confirmed by emerging clinical data showing that impaired NTs levels and functions are involved in the onset of neurological and pulmonary diseases. The alteration in NTs expression at the central and peripheral nervous system has been linked to neurodevelopmental disorders with an early onset and severe clinical manifestations, often named "synaptopathies" because of structural and functional synaptic plasticity abnormalities. NTs appear to be also involved in the physiology and pathophysiology of several airway diseases, neonatal lung diseases, allergic and inflammatory diseases, lung fibrosis, and even lung cancer. Moreover, they have also been detected in other peripheral tissues, including immune cells, epithelium, smooth muscle, fibroblasts, and vascular endothelium. This review aims to provide a comprehensive description of the NTs as important physiological and pathophysiological players in brain and lung development.
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Affiliation(s)
- Sara Manti
- Pediatric Unit, Department of Human and Pediatric Pathology "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Federica Xerra
- Pediatric Unit, Department of Human and Pediatric Pathology "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Giulia Spoto
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Ambra Butera
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Eloisa Gitto
- Intensive Pediatric Unit, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Gabriella Di Rosa
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Antonio Gennaro Nicotera
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
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Perrone S, Manti S, Petrolini C, Dell'Orto VG, Boscarino G, Ceccotti C, Bertini M, Buonocore G, Esposito SMR, Gitto E. Oxygen for the Newborn: Friend or Foe? CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030579. [PMID: 36980137 PMCID: PMC10047080 DOI: 10.3390/children10030579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Oxygen supplementation is widely used in neonatal care, however, it can also cause toxic effects if not used properly. Therefore, it appears crucial to find a balance in oxygen administration to avoid damage as a consequence of its insufficient or excessive use. Oxygen toxicity is mainly due to the production of oxygen radicals, molecules normally produced in humans and involved in a myriad of physiological reactions. In the neonatal period, an imbalance between oxidants and antioxidant defenses, the so-called oxidative stress, might occur, causing severe pathological consequences. In this review, we focus on the mechanisms of the production of oxygen radicals and their physiological functions in determining a set of diseases grouped together as "free radical diseases in the neonate". In addition, we describe the evolution of the oxygenation target recommendations during neonatal resuscitation and post-stabilization phases with the aim to define the best oxygen administration according to the newest evidence.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Sara Manti
- Pediatric Unit, Department of Human Pathology "Gaetano Barresi", University of Messina, 98122 Messina, Italy
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Valentina Giovanna Dell'Orto
- Neonatology Unit, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Giovanni Boscarino
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Ceccotti
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Mattia Bertini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | | | - Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Human Pathology "Gaetano Barresi", University of Messina, 98122 Messina, Italy
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Peralta GP, Piatti R, Haile SR, Adams M, Bassler D, Moeller A, Natalucci G, Kriemler S. Respiratory morbidity in preschool and school-age children born very preterm and its association with parents' health-related quality of life and family functioning. Eur J Pediatr 2023; 182:1201-1210. [PMID: 36607410 PMCID: PMC9817445 DOI: 10.1007/s00431-022-04783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
The purpose of this study is to describe the prevalence and severity of respiratory symptoms in children born very preterm and to assess their association with parents' health-related quality of life (HRQoL) and family functioning. We conducted a cross-sectional study and recruited children born less than 32 weeks' gestation between January 2006 and December 2019, in the greater Zurich area, Switzerland. Between May and December 2021, parents were invited to complete an online survey for their preterm child and for a control term born (≥ 37 weeks' gestation) sibling aged 1 to 18 years. We used a validated questionnaire to assess respiratory symptoms and the Pediatrics Quality of Life Family Impact Module (PedsQL FIM) to assess parents' HRQoL and family functioning. The survey was completed for 616 very preterm children (99 with bronchopulmonary dysplasia (BPD)) and 180 controls. Girls made up 45% (46% in controls) of the sample, and 63% (60% in controls) of participants were aged 6 to 18 years (school-age). Very preterm children reported a higher risk of respiratory symptoms than controls, especially preschoolers and those with moderate-to-severe BPD. Parents of children with "mild" and "moderate-severe" respiratory symptoms had on average -3.9 (95%CI: -6.6 to -1.1) and -8.2 (-11.2 to -5.2) lower PedsQL FIM total score, respectively, than parents of children with no symptoms. The same pattern was observed after stratifying by age categories. Conclusions: Our study suggests that respiratory morbidity in very preterm children has a negative impact on parents' HRQoL and family functioning, even beyond the first years of life. What is Known: • The burden of respiratory morbidity associated with very premature birth is high and last far beyond the neonatal period. • Respiratory morbidity contributes to lower health-related quality of life (HRQoL) in parents of very preterm children in early infancy. What is New: • Respiratory morbidity in very preterm children has a negative impact on parents' HRQoL and family functioning beyond the first years of life. • Parents of very preterm children with moderate and severe respiratory symptoms are the ones who report lower scores, both for preschool and school-age children.
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Affiliation(s)
- Gabriela P Peralta
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
| | | | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Mark Adams
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine and Childhood Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Giancarlo Natalucci
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Larsson-Rosenquist Centre for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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9
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Gunawardana S, Harris C, Greenough A. Use of impulse oscillometry to assess lung function in prematurely born children and young people: Comparisons with spirometry. Paediatr Respir Rev 2023; 45:52-57. [PMID: 36270894 DOI: 10.1016/j.prrv.2022.07.003] [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: 04/29/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
Premature birth is a risk factor for bronchopulmonary dysplasia (BPD); both of which are associated with obstructive airway disease throughout childhood. Impulse oscillometry (IOS) is an effort-independent, passive measure of tidal breathing, which could have benefits in assessing lung function amongst younger patients unable to perform valid spirometry. A literature search was conducted to investigate the use of IOS in prematurely born children and young people. IOS results correlate with those of spirometry. Reversibility of airway obstruction in children with BPD is variable. IOS could have benefits in assessing individual patient response and suitability for bronchodilator therapy. More work, however, is required to establish multi-ethnic reference ranges and standardise commercially available devices prior to its routine incorporation into clinical practice.
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Affiliation(s)
- Shannon Gunawardana
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK.
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, UK.
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Perrone S, Manti S, Buttarelli L, Petrolini C, Boscarino G, Filonzi L, Gitto E, Esposito SMR, Nonnis Marzano F. Vascular Endothelial Growth Factor as Molecular Target for Bronchopulmonary Dysplasia Prevention in Very Low Birth Weight Infants. Int J Mol Sci 2023; 24:ijms24032729. [PMID: 36769049 PMCID: PMC9916882 DOI: 10.3390/ijms24032729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) still represents an important burden of neonatal care. The definition of the disease is currently undergoing several revisions, and, to date, BPD is actually defined by its treatment rather than diagnostic or clinic criteria. BPD is associated with many prenatal and postnatal risk factors, such as maternal smoking, chorioamnionitis, intrauterine growth restriction (IUGR), patent ductus arteriosus (PDA), parenteral nutrition, sepsis, and mechanical ventilation. Various experimental models have shown how these factors cause distorted alveolar and vascular growth, as well as alterations in the composition and differentiation of the mesenchymal cells of a newborn's lungs, demonstrating a multifactorial pathogenesis of the disease. In addition, inflammation and oxidative stress are the common denominators of the mechanisms that contribute to BPD development. Vascular endothelial growth factor-A (VEGFA) constitutes the most prominent and best studied candidate for vascular development. Animal models have confirmed the important regulatory roles of epithelial-expressed VEGF in lung development and function. This educational review aims to discuss the inflammatory pathways in BPD onset for preterm newborns, focusing on the role of VEGFA and providing a summary of current and emerging evidence.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Correspondence:
| | - Sara Manti
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Unirsity of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Luca Buttarelli
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giovanni Boscarino
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Laura Filonzi
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Viale delle Scienze 11, 43125 Parma, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Unirsity of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Susanna Maria Roberta Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Francesco Nonnis Marzano
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Viale delle Scienze 11, 43125 Parma, Italy
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11
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Zhang X, Liu J, Wu B, He F. Factors influencing pulmonary function during tidal breathing in neonates. Asian J Surg 2022; 45:1705-1706. [DOI: 10.1016/j.asjsur.2022.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/26/2022] [Indexed: 11/02/2022] Open
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12
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Kalikkot Thekkeveedu R, El-Saie A, Prakash V, Katakam L, Shivanna B. Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies. J Clin Med 2022; 11:jcm11030557. [PMID: 35160009 PMCID: PMC8836835 DOI: 10.3390/jcm11030557] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Supportive care with mechanical ventilation continues to be an essential strategy for managing severe neonatal respiratory failure; however, it is well known to cause and accentuate neonatal lung injury. The pathogenesis of ventilator-induced lung injury (VILI) is multifactorial and complex, resulting predominantly from interactions between ventilator-related factors and patient-related factors. Importantly, VILI is a significant risk factor for developing bronchopulmonary dysplasia (BPD), the most common chronic respiratory morbidity of preterm infants that lacks specific therapies, causes life-long morbidities, and imposes psychosocial and economic burdens. Studies of older children and adults suggest that understanding how and why VILI occurs is essential to developing strategies for mitigating VILI and its consequences. This article reviews the preclinical and clinical evidence on the pathogenesis and pathophysiology of VILI in neonates. We also highlight the evidence behind various lung-protective strategies to guide clinicians in preventing and attenuating VILI and, by extension, BPD in neonates. Further, we provide a snapshot of future directions that may help minimize neonatal VILI.
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Affiliation(s)
| | - Ahmed El-Saie
- Section of Neonatology, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64106, USA;
- Department of Pediatrics, Cairo University, Cairo 11956, Egypt
| | - Varsha Prakash
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Lakshmi Katakam
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Binoy Shivanna
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +832-824-6474; Fax: +832-825-3204
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13
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Hart K, Cousins M, Watkins WJ, Kotecha SJ, Henderson AJ, Kotecha S. Association of Early Life Factors with Prematurity-Associated Lung Disease: Prospective Cohort Study. Eur Respir J 2021; 59:13993003.01766-2021. [PMID: 34588197 PMCID: PMC9095942 DOI: 10.1183/13993003.01766-2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022]
Abstract
Background Although bronchopulmonary dysplasia (BPD) is associated with lung function deficits in childhood, many who develop BPD have normal lung function in childhood and many without BPD, including those born at 33–34 weeks of gestation, have lung dysfunction in childhood. Since the predictability of BPD for future lung deficits is increasingly doubted, we prospectively recruited preterm-born children to identify early-life factors associated with lung function deficits after preterm birth. Methods From 767 children aged 7–12 years who had their respiratory symptoms assessed, and had spirometry before and after a bronchodilator in our Respiratory Health Outcomes in Neonates (RHiNO) study, 739 (544 preterm-born at ≤34 weeks of gestation and 195 term-born) had satisfactory lung function. Data were analysed using multivariable logistic regression and mediation. Results When preterm-born children were classified according to their lung function, low lung function (prematurity-associated lung disease (PLD)) was associated with BPD, gestation and intra-uterine growth restriction (IUGR) on univariable logistic regression analyses. However, on multivariable logistic regression analyses, gestation (β= –0.153, se 0.051; p=0.003) and IUGR (OR 1.783, 95% CI 1.06–3.00; p=0.029) remained significantly associated with later deficits of lung function, but BPD (OR 0.99, 95% CI 0.52–1.89; p=0.974) did not. Mediation analyses confirmed these results. Conclusions Although traditionally BPD has been associated with low lung function in later life, the data show that gestation and IUGR are significantly associated with PLD in childhood, but BPD is not. By identifying children with PLD, we can better understand the underlying mechanisms and develop optimal therapies. Although traditionally bronchopulmonary dysplasia is thought to be associated with longer term lung function deficits, this study shows that gestation and fetal growth restriction are better predictors of lung function deficits in prematurely born childrenhttps://bit.ly/3obSdSz
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Affiliation(s)
- Kylie Hart
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.,Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Michael Cousins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.,Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - W John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sarah J Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - A John Henderson
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,This publication is dedicated to our expert collaborator, valued mentor, and very dear late friend
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom .,Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
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14
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Murata T, Kyozuka H, Yasuda S, Fukuda T, Yamaguchi A, Maeda H, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Association between maternal ritodrine hydrochloride administration during pregnancy and childhood wheezing up to three years of age: The Japan environment and children's study. Pediatr Allergy Immunol 2021; 32:1455-1463. [PMID: 34013624 DOI: 10.1111/pai.13545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/25/2021] [Accepted: 05/13/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The effects of maternal ritodrine hydrochloride administration (MRA) during pregnancy on fetuses and offspring are not entirely clear. The present study aimed to evaluate the association between MRA and childhood wheezing using data from a nationwide Japanese birth cohort study. METHODS This study analyzed the data of the participants enrolled in the Japan Environment and Children's Study, a nationwide prospective birth cohort study, between 2011 and 2014. Data of women with singleton live births after 22 weeks of gestation were analyzed. The participants were divided according to MRA status. Considering childhood factors affecting the incidence of wheezing, including smoking environment and childhood viral infections, a logistic regression model was used to calculate odds ratios for "wheezing ever," diagnosis of asthma in the last 12 months, and "asthma ever" in women with MRA, with women who did not receive MRA as the reference. Additionally, participants were stratified by term births, and odds ratios for outcomes were calculated using a logistic regression model. RESULTS A total of 68,123 participants were analyzed. The adjusted odds ratio for wheezing was 1.17 (95% confidence interval, 1.12-1.22). The adjusted odds ratios for the other outcomes did not significantly increase after adjusting for childhood factors. The same tendency was confirmed after excluding women with preterm births. CONCLUSION MRA was associated with a slightly increased incidence of childhood wheezing up to three years, irrespective of term or preterm birth status. It is important that perinatal physicians consider the potential effects of MRA on the offspring's childhood health.
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Affiliation(s)
- Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hajime Maeda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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