Life-threatening bronchopulmonary dysplasia: a British Paediatric Surveillance Unit Study

Prophylactic sildenafil to prevent bronchopulmonary dysplasia: A systematic review and meta-analysis

BACKGROUND

Bronchopulmonary dysplasia (BPD) persists as one of the foremost factors contributing to mortality and morbidity in extremely preterm infants. The effectiveness of administering sildenafil early on to prevent BPD remains uncertain. The aim of this study was to investigate the efficacy and safety of prophylactically administered sildenafil during the early life stages of preterm infants to prevent mortality and BPD.

METHODS

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Ichushi were searched. Published randomized controlled trials (RCTs), non-RCTs, interrupted time series, cohort studies, case-control studies, and controlled before-and-after studies were included. Two reviewers independently screened the title, abstract, and full text, extracted data, assessed the risk of bias, and evaluated the certainty of evidence (CoE) following the Grading of Recommendations Assessment and Development and Evaluation approach. The random-effects model was used for a meta-analysis of RCTs.

RESULTS

This review included three RCTs (162 infants). There were no significant differences between the prophylactic sildenafil and placebo groups in mortality (risk ratio [RR]: 1.32; 95% confidence interval [CI]: 0.16-10.75; very low CoE), BPD (RR: 1.20; 95% CI: 0.79-1.83; very low CoE), and all other outcome assessed (all with very low CoE). The sample sizes were less than the optimal sizes for all outcomes assessed, indicating the need for further trials.

CONCLUSIONS

The prophylactic use of sildenafil in individuals at risk of BPD did not indicate any advantageous effects in terms of mortality, BPD, and other outcomes, or increased side effects.

Comparison of two novel diagnostic criteria for bronchopulmonary dysplasia in predicting adverse outcomes of preterm infants: a retrospective cohort study

BACKGROUND

This study aimed to compare the predictive value of two diagnostic criteria for bronchopulmonary dysplasia (BPD) in preterm infants with gestational age (GA) < 32 weeks for death or severe respiratory morbidity at corrected age of 18-24 months.

METHODS

In this retrospective cohort study, clinical data from July 2019 to September 2021 were classified by 2018 National Institute of Child Health and Human Development (NICHD) and 2019 Jensen definitions of BPD. Based on the follow-up results, the enrolled population was divided into adverse outcome group and normal outcome group. Logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to explore the risk factors of adverse outcomes and evaluate the predictive value of both diagnostic criteria.

RESULTS

Of 451 infants, 141 (31.3%) had adverse outcomes, which increased with increasing severity of BPD. Logistic regression analysis showed only BPD was an independent risk factor for adverse outcomes in preterm infants. ROC analysis revealed that both diagnostic criteria showed similar predictive values (2018 NICHD definition AUC = 0.771 vs. 2019 Jensen definition AUC = 0.770), with specificities of 93.5% and 96.8%, respectively; however, combining them separately with GA or birth weight did not improve their predictive values.

CONCLUSIONS

The two novel definitions of BPD demonstrate similar predictive values in predicting death or severe respiratory morbidity at corrected age of 18-24 months, with higher specificity observed in both.

Role of Postnatal Corticosteroids in the Treatment or Prevention of Bronchopulmonary Dysplasia

As the frequency of viable low birth weight preterm babies increases, bronchopulmonary dysplasia (BPD), one of the most important morbidities in these babies, also increases. Using postnatal steroids to reduce the development of BPD has not been fully enlightened. Besides all prevention strategies for reducing the development of BPD, it is known that steroid therapy used in the 1st week of life could induce negative neuromotor development according to current data. It may be recommended to administer low-dose dexamethasone between 8 and 49 days in infants dependent on mechanical ventilators in the postnatal period. It is seen that the use of hydrocortisone in the early period does not cause negative neuromotor development, but it cannot prevent the development of BPD as much as dexamethasone. All intensive care units must have their steroid protocol for BPD and use steroids in cases when the BPD development scale score is >60-65% and should have a goal of trying to keep the cumulative dose at the lowest level.

Long term outcome of babies with pulmonary hypertension

Neonatal pulmonary hypertension (PH) is associated with many severe congenital abnormalities (congenital diaphragmatic hernia) or acquired cardiorespiratory diseases such as pneumonia, meconium aspiration and bronchopulmonary dysplasia (BPD). If no cause is found it may be labelled idiopathic persistent pulmonary hypertension of the newborn. Although PH may result in life threatening hypoxia and circulatory failure, in the majority of cases, it resolves in the neonatal period following treatment of the underlying cause. However, in some cases, neonatal PH progresses into infancy and childhood where symptoms include failure to thrive and eventually right heart failure or death if left untreated. This chronic condition is termed pulmonary vascular hypertensive disease (PHVD). Although classification and diagnostic criteria have only recently been proposed for pediatric PHVD, little is known about the pathophysiology of chronic neonatal PH, or why pulmonary vascular resistance may remain elevated well beyond infancy. This review explores the many factors involved in chronic PH and what implications this may have on long term outcome when the disease progresses beyond the neonatal period.

[Expert consensus on the follow-up management of bronchopulmonary dysplasia in preterm infants after discharge]

Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in preterm infants and seriously affects the quality of life of preterm infants. BPD is a life-threatening disease to preterm infants and may lead to serious sequelae including feeding difficulties, recurrent lower respiratory tract infection, airway hyperreactive diseases, growth retardation, and neurodevelopmental delay. In order to further standardize the follow-up management of preterm infants with BPD after discharge, based on related clinical evidence in China and overseas and practice experience, the Neonatal Evidence-Based Medicine Group, Committee of Neonatal Medicine, Cross-Strait Medical and Health Exchange Association, formulated this expert consensus from the aspects of the follow-up and management of respiratory diseases, growth and development, pulmonary hypertension, nerve dysplasia, metabolic bone disease, and vaccination of preterm infants with BPD after discharge.