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Teper A, Colom AJ, Schubert R, Jerkic PS. Update in postinfectious bronchiolitis obliterans. Pediatr Pulmonol 2024; 59:2338-2348. [PMID: 37378463 DOI: 10.1002/ppul.26570] [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: 12/15/2022] [Revised: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
Postinfectious bronchiolitis obliterans (PiBO) is a rare and severe form of chronic obstructive lung disease caused by an infectious injury to the lower respiratory tract. The most commonly recognized inciting stimuli leading to PiBO are airway pathogens, such as adenovirus and Mycoplasma. PiBO is characterized by persistent and nonreversible airway obstruction, with functional and radiological evidence of small airway involvement. The literature has limited information on the aetiology, clinical profile, treatment, and outcome of PiBO.
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Affiliation(s)
- Alejandro Teper
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Alejandro J Colom
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ralf Schubert
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Pera-Silvija Jerkic
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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2
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Shin JE, Lee SM, Lee MJ, Han J, Lim J, Jang H, Eun HS, Park MS, Kim SY, Sohn MH, Jung JY, Kim KW. Oligohydramnios affects pulmonary functional/structural abnormalities in school-aged children with bronchopulmonary dysplasia. Clin Exp Pediatr 2024; 67:257-266. [PMID: 38623024 PMCID: PMC11065638 DOI: 10.3345/cep.2023.01053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/09/2023] [Accepted: 02/01/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The relationship between early life factors and childhood pulmonary function and structure in preterm infants remains unclear. PURPOSE This study investigated the impact of bronchopulmonary dysplasia (BPD) and perinatal factors on childhood pulmonary function and structure. METHODS This longitudinal cohort study included preterm participants aged ≥5 years born between 2005 and 2015. The children were grouped by BPD severity according to National Institutes of Health criteria. Pulmonary function tests (PFTs) were performed using spirometry. Chest computed tomography (CT) scans were obtained and scored for hyperaeration or parenchymal lesions. PFT results and chest CT scores were analyzed with perinatal factors. RESULTS A total 150 children (66 females) aged 7.7 years (6.4-9.9 years) were categorized into non/mild BPD (n=68), moderate BPD (n=39), and severe BPD (n=43) groups. The median z score for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and forced midexpiratory flow (FEF25%-75%) were significantly lower in the severe versus non/mild BPD group (-1.24 vs. -0.18, -0.22 vs. 0.41, -1.80 vs. -1.12, and -1.88 vs. -1.00, respectively; all P<0.05). The median z scores of FEV1, FEV1/ FVC, and FEF25%-75% among asymptomatic patients were also significantly lower in the severe versus non/mild BPD group (-0.82 vs. 0.09, -1.68 vs. -0.87, -1.59 vs. -0.61, respectively; all P<0.05). The severe BPD group had a higher median (range) CT score than the non/mild BPD group (6 [0-12] vs. 1 [0-10], P<0.001). Prenatal oligohydramnios was strongly associated with both low pulmonary function (FEV1/FVC CONCLUSION School-aged children with severe BPD showed airflow limitations and structural abnormalities despite no subjective respiratory symptoms. These results suggest that patients with a history of prenatal oligohydramnios or prolonged mechanical ventilation require extended follow-up.
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Affiliation(s)
- Jeong Eun Shin
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Gangnam Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jungho Han
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joohee Lim
- Department of Pediatrics, Gangnam Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Haerin Jang
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea
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3
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Doyle LW, Ranganathan S, Mainzer RM, Cheong JL. Relationships of Severity of Bronchopulmonary Dysplasia with Adverse Neurodevelopmental Outcomes and Poor respiratory Function at 7-8 Years of Age. J Pediatr 2024:114005. [PMID: 38453001 DOI: 10.1016/j.jpeds.2024.114005] [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: 11/14/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To clarify the relationships of three definitions of severity of bronchopulmonary dysplasia (BPD) with adverse neurodevelopmental and respiratory outcomes at early school-age. STUDY DESIGN Participants comprised 218 consecutive survivors to 7-8 years of age born either <28 weeks' gestation or weighing <1000 g in Victoria, Australia, in 2005. BPD was classified as none, Grade 1 (mild), Grade 2 (moderate), or Grade 3 (severe), using two commonly accepted definitions: 1) Jobe2001, and 2) Higgins2018, and our own 3) VICS2005, adapted from Jensen2019. Outcomes included major neurodevelopmental disability, low intelligence quotient and academic achievement, poor motor function, and poor respiratory function as assessed by spirometry. Outcomes for children with each grade of BPD were compared with children with no BPD. RESULTS Of the 218 survivors, 132 (61%) had BPD on Jobe2001 criteria, and 113 (52%) had BPD on both Higgins2018 and VICS2005 criteria. Grade 1 on any criteria was not associated with any adverse neurodevelopmental outcomes. Grade 1 on both Higgins2018 and VICS2005 was associated with reduced spirometry. Grade 2 on both Higgins2018 and VICS2005, and Grade 3 on all criteria were associated with increased risk for both adverse neurodevelopmental and respiratory outcomes. CONCLUSIONS Compared with no BPD, receiving additional oxygen up to 29% but no positive pressure support at 36 weeks' postmenstrual age increased the risk of abnormal respiratory function but not adverse neurodevelopment. Receiving ≥30% oxygen or any positive pressure support at 36 weeks increased the risk of both adverse outcomes.
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Affiliation(s)
- Lex W Doyle
- Department of Obstetrics, Gynaecology and Newborn Health, The Royal Women's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Rheanna M Mainzer
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie Ly Cheong
- Department of Obstetrics, Gynaecology and Newborn Health, The Royal Women's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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4
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Hagman C, Björklund LJ, Bjermer L, Hansen-Pupp I, Tufvesson E. Lung function deficits and bronchodilator responsiveness at 12 years of age in children born very preterm compared with controls born at term. Pediatr Pulmonol 2023; 58:3156-3170. [PMID: 37594159 DOI: 10.1002/ppul.26636] [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: 12/14/2022] [Revised: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Very preterm birth is associated with lung function impairment later in life, but several aspects have not been studied. We aimed to comprehensively assess lung function at school age in very preterm infants and term controls, with special emphasis on bronchopulmonary dysplasia (BPD), sex, and bronchodilator response. METHODS At 12 years of age, 136 children born very preterm (85 with and 51 without BPD) and 56 children born at term performed spirometry, body plethysmography, impulse oscillometry, measurement of diffusion capacity, and multiple breath washout, before and after bronchodilator inhalation. RESULTS Airway symptoms and a diagnosis of asthma were more common in children born very preterm. These children had more airflow limitation, seen as lower forced expiratory volume in 1 s (FEV1 ) (p < .001), FEV1 /forced vital capacity (FVC) (p = .011), and mean forced expiratory flow between 25% and 75% of FVC (p < .001), and a higher total and peripheral airway resistance compared with term-born controls. There was no difference in total lung capacity but air trapping and lung clearance index were higher in children born very preterm. Diffusion capacity was lower in children born very preterm, especially in those with a diagnosis of BPD. In most other tests, the differences between preterm-born children with or without BPD were smaller than between children born preterm versus at term. Boys born preterm had more lung function deficits than preterm-born girls. In children born very preterm, airway obstruction was to a large extent reversible. CONCLUSION At 12 years of age, children born very preterm had lower lung function than children born at term in most aspects and there was only little difference between children with or without BPD. Airway obstruction improved markedly after bronchodilator inhalation.
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Affiliation(s)
- Cecilia Hagman
- Department of Clinical Sciences, Lund, Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Lars J Björklund
- Department of Clinical Sciences, Lund, Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Leif Bjermer
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Ingrid Hansen-Pupp
- Department of Clinical Sciences, Lund, Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ellen Tufvesson
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
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5
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Hillman NH, Jobe AH. Preterm lung and brain responses to mechanical ventilation and corticosteroids. J Perinatol 2023; 43:1222-1229. [PMID: 37169913 DOI: 10.1038/s41372-023-01692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
Mechanical ventilation is necessary to maintain oxygenation and ventilation in many preterm infants. Unfortunately, even short periods of mechanical ventilation can cause lung and airway injury, and initiate the lung inflammation that contributes to the development of bronchopulmonary dysplasia (BPD). The mechanical stretch leads to airway cell differentiation and simplification of the alveoli, and releases cytokines that cause systemic response in other organs. Mechanical ventilation also leads to brain injury (IVH, white and gray matter) and neuronal inflammation that can affect the neurodevelopment of preterm infants. In efforts to decrease BPD, corticosteroids have been used for both prevention and treatment of lung inflammation. Corticosteroids have also been demonstrated to cause neuronal injury, so the clinician must balance the negative effects of both mechanical ventilation and steroids on the brain and lungs. Predictive models for BPD can help assess the infants who will benefit most from corticosteroid exposure. This review describes the lung and brain injury from mechanical ventilation in the delivery room and chronic mechanical ventilation in animal models. It provides updates on the current guidelines for use of postnatal corticosteroids (dexamethasone, hydrocortisone, budesonide, budesonide with surfactant) for the prevention and treatment of BPD, and the effects the timing of each steroid regimen has on neurodevelopment.
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Affiliation(s)
- Noah H Hillman
- Division of Neonatology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA.
| | - Alan H Jobe
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, 45229, USA
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Shah J, Shadid ILC, Carey VJ, Laranjo N, O'Connor GT, Zeiger RS, Bacharier L, Litonjua AA, Weiss ST, Mirzakhani H. Early-Life Weight Status and Risk of Childhood Asthma or Recurrent Wheeze in Preterm and Term Offspring. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2125-2132.e1. [PMID: 37088369 PMCID: PMC10330365 DOI: 10.1016/j.jaip.2023.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Excessive weight is associated with the development of childhood asthma. However, trends among preterm and term offspring may differ. OBJECTIVE To assess whether the association of longitudinal weight for age (WFA) and odds of asthma/recurrent wheeze in early life differs between children born preterm and those born at term. METHODS This study used prospectively collected data from the Vitamin D Antenatal Asthma Reduction Trial. Children (n = 804) were followed-up and anthropometric measurements, including WFA, were taken at birth and annually until the age of 6 years. The primary outcome was asthma/recurrent wheeze by age 3 and 6 years. RESULTS Among the offspring, 71 (8.8%) were premature. In all the children, the odds of asthma/recurrent wheeze increased by 15% (adjusted odds ratio [aOR], 1.15; 95% CI, 1.10-1.20; P < .001) by age 3 years and 9% (aOR, 1.09; 95% CI, 1.07-1.11; P < .001) by age 6 years for each unit increase in WFA z score. Odds were different between term and preterm offspring (Pinteraction < .001). In term offspring, the odds of having asthma/recurrent wheeze by age 3 and 6 years increased by 22% and 15%, respectively (aOR, 1.22, 95% CI, 1.16-1.27, P < .001, and aOR, 1.15, 95% CI, 1.11-1.18, P < .001). In preterm offspring, by age 3 years, odds of asthma/recurrent wheeze decreased by 10% for each unit increase in WFA z score (aOR, 0.90; 95% CI, 0.81-0.99; P = .030) and decreased by 27% by age 6 years (aOR, .73; 95% CI, 0.61-0.86; P < .001). CONCLUSIONS During early life, increasing standardized WFA is associated with higher odds of asthma/recurrent wheeze in term children. In contrast, in preterm children, a higher standardized WFA during catch-up growth may decrease the odds of asthma/recurrent wheeze associated with prematurity.
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Affiliation(s)
- Jhill Shah
- Division of Paediatric Pulmonary Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Iskander L C Shadid
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - George T O'Connor
- Pulmonary Centre, Department of Medicine, Boston Medical Centre, Boston University, Boston, Mass
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - Leonard Bacharier
- Division of Paediatric Allergy, Immunology and Pulmonary Medicine, Department of Paediatrics, Washington University, St Louis, Mo
| | - Augusto A Litonjua
- Division of Paediatric Pulmonary Medicine, Golisano Children's Hospital at University of Rochester Medical Centre, Rochester, NY
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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Gibbons JT, Course CW, Evans EE, Kotecha S, Kotecha SJ, Simpson SJ. Increasing airway obstruction through life following bronchopulmonary dysplasia: a meta-analysis. ERJ Open Res 2023; 9:00046-2023. [PMID: 37342090 PMCID: PMC10277871 DOI: 10.1183/23120541.00046-2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Background Few studies exist investigating lung function trajectories of those born preterm; however growing evidence suggests some individuals experience increasing airway obstruction throughout life. Here we use the studies identified in a recent systematic review to provide the first meta-analysis investigating the impact of preterm birth on airway obstruction measured by the forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. Methods Cohorts were included for analysis if they reported FEV1/FVC in survivors of preterm birth (<37 weeks' gestation) and control populations born at term. Meta-analysis was performed using a random effect model, expressed as standardised mean difference (SMD). Meta-regression was conducted using age and birth year as moderators. Results 55 cohorts were eligible, 35 of which defined groups with bronchopulmonary dysplasia (BPD). Compared to control populations born at term, lower values of FEV1/FVC were seen in all individuals born preterm (SMD -0.56), with greater differences seen in those with BPD (SMD -0.87) than those without BPD (SMD -0.45). Meta-regression identified age as a significant predictor of FEV1/FVC in those with BPD with the FEV1/FVC ratio moving -0.04 sds away from the term control population for every year of increased age. Conclusions Survivors of preterm birth have significantly increased airway obstruction compared to those born at term with larger differences in those with BPD. Increased age is associated with a decline in FEV1/FVC values suggesting increased airway obstruction over the life course.
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Affiliation(s)
- James T.D. Gibbons
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | | | - Emily E. Evans
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | - Sarah J. Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | - Shannon J. Simpson
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Carregã M, Sousa P, Rocha G, Ferreira-Magalhães M, Azevedo I. Respiratory and non-respiratory outcomes of bronchopulmonary dysplasia in adolescents: A systematic review. Early Hum Dev 2023; 180:105756. [PMID: 36965348 DOI: 10.1016/j.earlhumdev.2023.105756] [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: 02/02/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND There is lack of evidence synthesis on the global consequences of bronchopulmonary dysplasia (BPD) in adolescence. AIM Assess the impact of bronchopulmonary dysplasia on respiratory and non-respiratory outcomes in adolescents. METHODS A systematic review of studies assessing the outcomes of adolescents aged 10 to 19 years-old with BPD was conducted. We independently screened studies published until 6th March 2023 in PubMed® and Scopus® databases. Data on methodologic design, sample descriptive and findings were extracted from each study. Risk of bias was assessed using quality assessment tools. RESULTS Thirty-one studies were included. Adolescents with a history of BPD present with more respiratory symptoms (wheezing, respiratory exacerbations, need for respiratory medication) and twenty-five studies showed a reduction in pulmonary function, with varying impact according to BPD severity and no differences before and after the surfactant era. Spirometry evaluation throughout the years is not consensual, but methacholine and salbutamol response in BPD groups is increased compared to non-BPD groups. Markers of eosinophilic airway inflammation are not increased as in asthma patients. Exercise potential is identical, but data regarding physical capacity and activity are inconsistent. More frequent radiologic abnormalities translate into higher high-resolution computed tomography scores, with linear (72.2 %) and triangular subpleural opacities (58.3 %) as the most common findings. There is a higher risk for special needs in education, but quality of life seems to be equal to non-BPD adolescents. CONCLUSIONS BPD negatively impacts both pulmonary and non-pulmonary outcomes in adolescents.
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Affiliation(s)
- Mariana Carregã
- Unidade Local de Saúde de Matosinhos, Portugal; Medicine Faculty, University of Porto, Portugal.
| | - Patrícia Sousa
- Department of Pediatrics, Centro Hospitalar Universitário do São João, Porto, Portugal
| | - Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- Department of Pediatric Pulmonology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Child and Adolescent Medicine, Abel Salazar Biomedical Sciences Institute, Porto, Portugal; Department of Medicine of Community, Information and Health Decision (MEDCIDS), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Inês Azevedo
- Department of Pediatrics, Centro Hospitalar Universitário do São João, Portugal; Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
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9
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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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10
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Prematurity and BPD: what general pediatricians should know. Eur J Pediatr 2023; 182:1505-1516. [PMID: 36763190 PMCID: PMC10167192 DOI: 10.1007/s00431-022-04797-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 02/11/2023]
Abstract
More and more very low birth weight (VLBW) infants around the world survive nowadays, with consequently larger numbers of children developing prematurity-related morbidities, especially bronchopulmonary dysplasia (BPD). BPD is a multifactorial disease and its rising incidence in recent years means that general pediatricians are much more likely to encounter a child born extremely preterm, possibly with BPD, in their clinical practice. Short- and long-term sequelae in VLBW patients may affect not only pulmonary function (principally characterized by an obstructive pattern), but also other aspect including the neurological (neurodevelopmental and neuropsychiatric disorders), the sensorial (earing and visual impairment), the cardiological (systemic and pulmonary hypertension, reduced exercise tolerance and ischemic heart disease in adult age), nutritional (feeding difficulties and nutritional deficits), and auxological (extrauterine growth restriction). For the most premature infants at least, a multidisciplinary follow-up is warranted after discharge from the neonatal intensive care unit in order to optimize their respiratory and neurocognitive potential, and prevent respiratory infections, nutritional deficiencies or cardiovascular impairments. Conclusion: The aim of this review is to summarize the main characteristics of preterm and BPD infants, providing the general pediatrician with practical information regarding these patients' multidisciplinary complex follow-up. We explore the current evidence on respiratory outcomes and their management that actually does not have a definitive available option. We also discuss the available investigations, treatments, and strategies for prevention and prophylaxis to improve the non-respiratory outcomes and the quality of life for these children and their families, a critical aspect not always considered. This comprehensive approach, added to the increased needs of a VLBW subjects, is obviously related to very high health-related costs that should be beared in mind. What is Known: • Every day, a general pediatrician is more likely to encounter a former very low birth weight infant. • Very low birth weight and prematurity are frequently related not only with worse respiratory outcomes, but also with neurological, sensorial, cardiovascular, renal, and nutritional issues. What is New: • This review provides to the general pediatrician a comprehensive approach for the follow-up of former premature very low birth weight children, with information to improve the quality of life of this special population.
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11
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Chan HF, Smith LJ, Biancardi AM, Bray J, Marshall H, Hughes PJC, Collier GJ, Rao M, Norquay G, Swift AJ, Hart K, Cousins M, Watkins WJ, Wild JM, Kotecha S. Image Phenotyping of Preterm-Born Children Using Hyperpolarized 129Xe Lung Magnetic Resonance Imaging and Multiple-Breath Washout. Am J Respir Crit Care Med 2023; 207:89-100. [PMID: 35972833 PMCID: PMC9952860 DOI: 10.1164/rccm.202203-0606oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/16/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: Preterm birth is associated with low lung function in childhood, but little is known about the lung microstructure in childhood. Objectives: We assessed the differential associations between the historical diagnosis of bronchopulmonary dysplasia (BPD) and current lung function phenotypes on lung ventilation and microstructure in preterm-born children using hyperpolarized 129Xe ventilation and diffusion-weighted magnetic resonance imaging (MRI) and multiple-breath washout (MBW). Methods: Data were available from 63 children (aged 9-13 yr), including 44 born preterm (⩽34 weeks' gestation) and 19 term-born control subjects (⩾37 weeks' gestation). Preterm-born children were classified, using spirometry, as prematurity-associated obstructive lung disease (POLD; FEV1 < lower limit of normal [LLN] and FEV1/FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (FEV1 < LLN and FEV1/FVC ⩾ LLN), preterm-(FEV1 ⩾ LLN) and term-born control subjects, and those with and without BPD. Ventilation heterogeneity metrics were derived from 129Xe ventilation MRI and SF6 MBW. Alveolar microstructural dimensions were derived from 129Xe diffusion-weighted MRI. Measurements and Main Results: 129Xe ventilation defect percentage and ventilation heterogeneity index were significantly increased in preterm-born children with POLD. In contrast, mean 129Xe apparent diffusion coefficient, 129Xe apparent diffusion coefficient interquartile range, and 129Xe mean alveolar dimension interquartile range were significantly increased in preterm-born children with BPD, suggesting changes of alveolar dimensions. MBW metrics were all significantly increased in the POLD group compared with preterm- and term-born control subjects. Linear regression confirmed the differential effects of obstructive disease on ventilation defects and BPD on lung microstructure. Conclusion: We show that ventilation abnormalities are associated with POLD, and BPD in infancy is associated with abnormal lung microstructure.
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Affiliation(s)
- Ho-Fung Chan
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Laurie J. Smith
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Alberto M. Biancardi
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Jody Bray
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Helen Marshall
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Paul J. C. Hughes
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Guilhem J. Collier
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Madhwesha Rao
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Graham Norquay
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Andrew J. Swift
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Kylie Hart
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Michael Cousins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - W. John Watkins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jim M. Wild
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
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12
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Hysinger EB, Woods JC. Seeing Premature Lung Disease: Hyperpolarized Xe Magnetic Resonance Imaging. Am J Respir Crit Care Med 2023; 207:15-16. [PMID: 36067056 PMCID: PMC9952862 DOI: 10.1164/rccm.202208-1612ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Erik B. Hysinger
- Division of Pulmonary MedicineCincinnati Children’s Hospital Medical CenterCincinnati, Ohio
| | - Jason C. Woods
- Division of Pulmonary MedicineCincinnati Children’s Hospital Medical CenterCincinnati, Ohio
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13
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Du Berry C, Nesci C, Cheong JL, FitzGerald T, Mainzer R, Ranganathan S, Doyle LW, Vrijlandt EJ, Welsh L. Long-term expiratory airflow of infants born moderate-late preterm: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101597. [PMID: 35923430 PMCID: PMC9340512 DOI: 10.1016/j.eclinm.2022.101597] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Moderate-late preterm (MLP; 32 to <37 weeks' gestation) birth is associated with reduced expiratory airflow during child, adolescent and adult years. However, some studies have reported only minimal airflow limitation and hence it is unclear if clinical assessment in later life is warranted. Our aim was to compare maximal expiratory airflow in children and adults born MLP with term-born controls, and with expected norms. METHODS We systematically reviewed studies reporting z-scores for spirometric indices (forced expired volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC ratio and forced expiratory flow at 25-75% of FVC [FEF25-75%]) from participants born MLP aged five years or older, with or without a term-born control group from 4 databases (MEDLINE, CINAHL, Embase, Emcare). Publications were searched for between the 22nd of September 2021 to the 29th of September 2021. A meta-analysis of eligible studies was conducted using a random effects model. The study protocol was published in PROSPERO (CRD #42021281518). FINDINGS We screened 4970 articles and identified 18 relevant studies, 15 of which were eligible for meta-analysis (8 with term-born controls and 7 without). Compared with controls, MLP participants had lower z-scores (mean difference [95% confidence interval] I2) for FEV1: -0.22 [-0.35, -0.09] 49.3%, FVC: -0.23 [-0.4, -0.06] 71.8%, FEV1/FVC: -0.11 [-0.20 to -0.03] 9.3% and FEF25-75%: -0.27 [-0.41 to -0.12] 21.9%. Participants born MLP also had lower z-scores, on average, when compared with a z-score of 0 (mean [95% CI] I2) for FEV1: -0.26 [-0.40 to -0.11] 85.2%, FVC: -0.18 [-0.34 to -0.02] 88.3%, FEV1/FVC: -0.24 [-0.43 to -0.05] 90.5% and FEF25-75%: -0.33 [-0.54 to -0.20] 94.7%. INTERPRETATION Those born MLP had worse expiratory airflows than those born at term, and compared with norms, although reductions were modest. Clinicians should be aware that children and adults born MLP may be at higher risk of obstructive lung disease compared with term-born peers. FUNDING This work is supported by grants from the National Health and Medical Research Council (Centre of Research Excellence #1153176, Project grant #1161304); Medical Research Future Fund (Career Development Fellowship to J.L.Y Cheong #1141354) and from the Victorian Government's Operational Infrastructure Support Programme. C. Du Berry's PhD candidature is supported by the Melbourne Research Scholarship and the Centre of Research Excellence in Newborn Medicine.
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Affiliation(s)
- Cassidy Du Berry
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
- Corresponding author at: Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Christopher Nesci
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
| | - Jeanie L.Y. Cheong
- Department of Obstetrics and Gynaecology, The University of Melbourne, Australia
- Victorian Infant Brain Studies Group, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- Newborn Research, The Royal Women's Hospital Melbourne, Australia
| | - Tara FitzGerald
- Department of Physiotherapy, The University of Melbourne, Australia
- Victorian Infant Brain Studies Group, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
| | - Rheanna Mainzer
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Clinical Epidemiology and Biostatistics Unit, Population Health, Murdoch Children's Research Institute, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
| | - Lex W. Doyle
- Department of Paediatrics, The University of Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Australia
- Victorian Infant Brain Studies Group, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- Newborn Research, The Royal Women's Hospital Melbourne, Australia
| | - Elianne J.L.E. Vrijlandt
- Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, and the Groningen Research Institute for Asthma and COPD, the Netherlands
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Liam Welsh
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
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14
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Kotecha SJ, Gibbons JTD, Course CW, Evans EE, Simpson SJ, Watkins WJ, Kotecha S. Geographical Differences and Temporal Improvements in Forced Expiratory Volume in 1 Second of Preterm-Born Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:867-877. [PMID: 35759258 PMCID: PMC9237805 DOI: 10.1001/jamapediatrics.2022.1990] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Although preterm birth is associated with later deficits in lung function, there is a paucity of information on geographical differences and whether improvements occur over time, especially after surfactant was introduced. Objective To determine deficits in percentage predicted forced expiratory volume in 1 second (%FEV1) in preterm-born study participants, including those with bronchopulmonary dysplasia (BPD) in infancy, when compared with term-born control groups. Data Sources Eight databases searched up to December 2021. Study Selection Studies reporting spirometry for preterm-born participants with or without a term-born control group were identified. Data Extraction and Synthesis Data were extracted and quality assessed by 1 reviewer and checked by another. Data were pooled using random-effects models and analyzed using Review Manager and the R metafor package. Main Outcomes and Measures Deficits in %FEV1 between preterm-born and term groups. Associations between deficits in %FEV1 and year of birth, age, introduction of surfactant therapy, and geographical region of birth and residence were also assessed. Results From 16 856 titles, 685 full articles were screened: 86 with and without term-born control groups were included. Fifty studies with term controls were combined with the 36 studies from our previous systematic review, including 7094 preterm-born and 17 700 term-born participants. Of these studies, 45 included preterm-born children without BPD, 29 reported on BPD28 (supplemental oxygen dependency at 28 days), 26 reported on BPD36 (supplemental oxygen dependency at 36 weeks' postmenstrual age), and 86 included preterm-born participants. Compared with the term-born group, the group of all preterm-born participants (all preterm) had deficits of %FEV1 of -9.2%; those without BPD had deficits of -5.8%, and those with BPD had deficits of approximately -16% regardless of whether they had BPD28 or BPD36. As year of birth increased, there was a statistically significant narrowing of the difference in mean %FEV1 between the preterm- and term-born groups for the all preterm group and the 3 BPD groups but not for the preterm-born group without BPD. For the all BPD group, when compared with Scandinavia, North America and western Europe had deficits of -5.5% (95% CI, -10.7 to -0.3; P = .04) and -4.1% (95% CI, -8.8 to 0.5; P = .08), respectively. Conclusions and Relevance Values for the measure %FEV1 were reduced in preterm-born survivors. There were improvements in %FEV1 over recent years, but geographical region had an association with later %FEV1 for the BPD groups.
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Affiliation(s)
- Sarah J Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - James T D Gibbons
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kid's Institute, Perth, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Australia.,School of Allied Health, Curtin University, Perth, Australia
| | - Christopher W Course
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Emily E Evans
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Shannon J Simpson
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kid's Institute, Perth, Australia.,School of Allied Health, Curtin University, Perth, Australia
| | - W John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
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15
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Di Filippo P, Dodi G, Ciarelli F, Di Pillo S, Chiarelli F, Attanasi M. Lifelong Lung Sequelae of Prematurity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5273. [PMID: 35564667 PMCID: PMC9104309 DOI: 10.3390/ijerph19095273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
The clinical, functional, and structural pattern of chronic lung disease of prematurity has changed enormously in last years, mirroring a better perinatal management and an increasing lung immaturity with the survival of increasingly premature infants. Respiratory symptoms and lung function impairment related to prematurity seem to improve over time, but premature birth increases the likelihood of lung function impairment in late childhood, predisposing to chronic obstructive pulmonary disease (COPD). It is mandatory to identify those individuals born premature who are at risk for developing long-term lung disease through a better awareness of physicians, the use of standardized CT imaging scores, and a more comprehensive periodic lung function evaluation. The aim of this narrative review was to provide a systematic approach to lifelong respiratory symptoms, lung function impairment, and lung structural anomalies in order to better understand the specific role of prematurity on lung health.
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Affiliation(s)
- Paola Di Filippo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (F.C.); (S.D.P.); (F.C.); (M.A.)
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16
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Time-Specific Factors Influencing the Development of Asthma in Children. Biomedicines 2022; 10:biomedicines10040758. [PMID: 35453508 PMCID: PMC9025817 DOI: 10.3390/biomedicines10040758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023] Open
Abstract
Susceptibility to asthma is complex and heterogeneous, as it involves both genetic and environmental insults (pre- and post-birth) acting in a critical window of development in early life. According to the Developmental Origins of Health and Disease, several factors, both harmful and protective, such as nutrition, diseases, drugs, microbiome, and stressors, interact with genotypic variation to change the capacity of the organism to successfully adapt and grow in later life. In this review, we aim to provide the latest evidence about predictive risk and protective factors for developing asthma in different stages of life, from the fetal period to adolescence, in order to develop strategic preventive and therapeutic interventions to predict and improve health later in life. Our study shows that for some risk factors, such as exposure to cigarette smoke, environmental pollutants, and family history of asthma, the evidence in favor of a strong association of those factors with the development of asthma is solid and widely shared. Similarly, the clear benefits of some protective factors were shown, providing new insights into primary prevention. On the contrary, further longitudinal studies are required, as some points in the literature remain controversial and a source of debate.
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17
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Collaco JM, McGrath-Morrow SA. Bronchopulmonary dysplasia as a determinant of respiratory outcomes in adult life. Pediatr Pulmonol 2021; 56:3464-3471. [PMID: 33730436 PMCID: PMC8446084 DOI: 10.1002/ppul.25301] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
Respiratory disease is unfortunately common in preterm infants with the archetype being bronchopulmonary dysplasia (BPD). BPD affects approximately 50,000 preterm infants in the U.S. annually with substantial morbidity and mortality related to its pathology (alveolar, airway, and pulmonary vasculature maldevelopment). Predicting the likelihood and severity of chronic respiratory disease in these children as they age is difficult and compounded by the lack of consistent phenotyping. Barriers to understanding the actual scope of this problem include few longitudinal studies, information limited by small retrospective studies and the ever-changing landscape of therapies in the NICU that affect long-term respiratory outcomes. Thus, the true burden of adult respiratory disease caused by premature birth is currently unknown. Nevertheless, limited data suggest that a substantial percentage of children with a history of BPD have long-term respiratory symptoms and persistent airflow obstruction associated with altered lung function trajectories into adult life. Small airway disease with variable bronchodilator responsiveness, is the most common manifestation of lung dysfunction in adults with a history of BPD. The etiology of this is unclear however, developmental dysanapsis may underlie the airflow obstruction in some adults with a history of BPD. This type of flow limitation resembles that of aging adults with chronic obstructive lung disease with no history of smoking. It is also unclear whether lung function abnormalities in people with a history of BPD are static or if these individuals with BPD have a more accelerated decline in lung function as they age compared to controls. While some of the more significant mediators of lung function, such as tobacco smoke and respiratory infections have been identified, more work is necessary to identify the best means of preserving lung function for individuals born prematurely throughout their lifespan.
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Affiliation(s)
- Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sharon A McGrath-Morrow
- Division of Pulmonary and Sleep, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Moschino L, Bonadies L, Baraldi E. Lung growth and pulmonary function after prematurity and bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3499-3508. [PMID: 33729686 PMCID: PMC8597033 DOI: 10.1002/ppul.25380] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022]
Abstract
Bronchopulmonary dysplasia (BPD) still carries a heavy burden of morbidity and mortality in survivors of extreme prematurity. The disease is characterized by simplification of the alveolar structure, involving a smaller number of enlarged alveoli due to decreased septation and a dysmorphic pulmonary microvessel growth. These changes lead to persistent abnormalities mainly affecting the smaller airways, lung parenchyma, and pulmonary vasculature, which can be assessed with lung function tests and imaging techniques. Several longitudinal lung function studies have demonstrated that most preterm-born subjects with BPD embark on a low lung function trajectory, never achieving their full airway growth potential. They are consequently at higher risk of developing a chronic obstructive pulmonary disease-like phenotype later in life. Studies based on computer tomography and magnetic resonance imaging, have also shown that in these patients there is a persistence of lung abnormalities like emphysematous areas, bronchial wall thickening, interstitial opacities, and mosaic lung attenuation also in adult age. This review aims to outline the current knowledge of pulmonary and vascular growth in survivors of BPD and the evidence of their lung function and imaging up to adulthood.
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Affiliation(s)
- Laura Moschino
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Luca Bonadies
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy.,Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
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19
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Martin RJ, Jobe AH, Bancalari E. What is BPD today and in the next 50 years? Am J Physiol Lung Cell Mol Physiol 2021; 321:L974-L977. [PMID: 34643100 PMCID: PMC8616614 DOI: 10.1152/ajplung.00415.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Richard J Martin
- Case Western Reserve University School of Medicine, University Hospitals/Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Alan H Jobe
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eduardo Bancalari
- Division of Neonatology, University of Miami Miller School of Medicine, Miami, Florida
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20
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Satrell E, Clemm H, Røksund O, Hufthammer KO, Thorsen E, Halvorsen T, Vollsæter M. Development of lung diffusion to adulthood following extremely preterm birth. Eur Respir J 2021; 59:13993003.04103-2020. [PMID: 34625479 PMCID: PMC9117733 DOI: 10.1183/13993003.04103-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
Background Gas exchange in extremely preterm (EP) infants must take place in fetal lungs. Childhood lung diffusing capacity of the lung for carbon monoxide (DLCO) is reduced; however, longitudinal development has not been investigated. We describe the growth of DLCO and its subcomponents to adulthood in EP compared with term-born subjects. Methods Two area-based cohorts born at gestational age ≤28 weeks or birthweight ≤1000 g in 1982–1985 (n=48) and 1991–1992 (n=35) were examined twice, at ages 18 and 25 years and 10 and 18 years, respectively, and compared with matched term-born controls. Single-breath DLCO was measured at two oxygen pressures, with subcomponents (membrane diffusion (DM) and pulmonary capillary blood volume (VC)) calculated using the Roughton–Forster equation. Results Age-, sex- and height-standardised transfer coefficients for carbon monoxide (KCO) and DLCO were reduced in EP compared with term-born subjects, and remained so during puberty and early adulthood (p-values for all time-points and both cohorts ≤0.04), whereas alveolar volume (VA) was similar. Development occurred in parallel to term-born controls, with no signs of pubertal catch-up growth nor decline at age 25 years (p-values for lack of parallelism within cohorts 0.99, 0.65, 0.71, 0.94 and 0.44 for z-DLCO, z-VA, z-KCO, DM and VC, respectively). Split by membrane and blood volume components, findings were less clear; however, membrane diffusion seemed most affected. Conclusions Pulmonary diffusing capacity was reduced in EP compared with term-born subjects, and development from childhood to adulthood tracked in parallel to term-born subjects, with no signs of catch-up growth nor decline at age 25 years. Pulmonary diffusing capacity following extremely preterm (EP) birth was reduced compared with term-born subjects. From mid-childhood to adulthood, development tracked in parallel in the EP and term-born groups, with preterms following lower trajectories.https://bit.ly/3ARPD7D
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Affiliation(s)
- Emma Satrell
- Department of Clinical Science, University of Bergen, Bergen, Norway .,Department of Pediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Hege Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola Røksund
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Einar Thorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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21
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Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in preterm infants of low birthweight who required postnatal respiratory support. Although overall incidence rates have not changed, recent advancements in medical care have resulted in lower mortality rates, and those affected are beginning to live longer. As a result, the long-term repercussions of BPD are becoming more apparent. Whereas BPD has been thought of as a disease of just the lungs, resulting in abnormalities such as increased susceptibility to pulmonary infections, impaired exercise tolerance, and pulmonary hypertension, the enduring complications of BPD have been found to extend much further. This includes an increased risk for cerebral palsy and developmental delays, lower intelligence quotient (IQ) scores, impaired executive functioning, behavioral challenges, delays in expressive and receptive language development, and an increased risk of growth failure. In addition, the deficits of BPD have been found to influence much more than just physical health; BPD survivors have been noted to have higher rates of health care use, starting with the initial hospitalization and continuing with therapy and specialist follow-up, as well as impairments in quality of life, both physical and psychological, that continue into adulthood. The long-term consequences of BPD may best be addressed through future research, including better understanding of the pathophysiologic mechanisms leading to BPD, further comparisons between newborns with BPD and those without, and long-term assessment and management of BPD patients as adults.
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Affiliation(s)
- Travis D Homan
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ravi P Nayak
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
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22
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Jobe AH, Bancalari E. An All-Inclusive Perspective on Bronchopulmonary Dysplasia. J Pediatr 2021; 234:257-259. [PMID: 33811871 DOI: 10.1016/j.jpeds.2021.03.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/05/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Alan H Jobe
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Eduardo Bancalari
- University of Miami Miller School of Medicine Division of Neonatology, Miami, FL
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23
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Littner Y, Volinsky C, Kuint J, Yekutiel N, Borenstein-Levin L, Dinur G, Hochwald O, Kugelman A. Respiratory morbidity in very low birth weight infants through childhood and adolescence. Pediatr Pulmonol 2021; 56:1609-1616. [PMID: 33657277 DOI: 10.1002/ppul.25329] [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: 01/02/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the long-term (up to 18 years of age) respiratory outcomes of children and adolescents born at very low birth weight (VLBW; ≤1500 g) in comparison with that of children born >1500 g. METHODS An observational, longitudinal, retrospective study comparing VLBW infants with matched controls, registered at a large health maintenance organization in Israel. Pulmonary outcomes collected anonymously from the electronic medical files included respiratory illness diagnoses, purchased medications for respiratory problems, office visits with either a pediatric pulmonologist or cardiologist and composite respiratory morbidity combining all these parameters. RESULTS Our study included 5793 VLBW infants and 11,590 matched controls born between 1998 and 2012. The majority (99%) of VLBW infants were premature (born < 37 weeks' gestation), while 93% of controls were born at term. The composite respiratory morbidity was significantly higher in VLBW infants compared with controls in all age groups (relative risk [95% confidence interval]: 1 year: 1.22 [1.19-1.26], <2 years: 1.30 [1.27-1.34], 2-6 years: 1.29 [1.27-1.32], 6-12 years: 1.53 [1.47-1.59], 12-18 years: 1.46 [1.35-1.56]; respectively). Both VLBW infants and controls demonstrated a steady decline in the composite respiratory morbidity with aging. In VLBW infants, lower gestational age was associated with higher respiratory morbidity only until 2 years of age and the morbidity declined in each gestational age group until adolescence. CONCLUSION Our study confirmed a strong association between VLBW and pulmonary morbidity. The higher prevalence of respiratory composite morbidity in VLBW infants persists over the years until adolescence. The respiratory morbidity is most evident in the first year of life and declines afterward.
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Affiliation(s)
- Yoav Littner
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chen Volinsky
- Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Kuint
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,K.S.M Research & Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Naama Yekutiel
- K.S.M Research & Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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24
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Pérez-Tarazona S, Rueda Esteban S, García-García ML, Arroyas Sanchez M, de Mir Messa I, Acevedo Valarezo T, Mesa Medina O, Callejón Callejón A, Canino Calderín EM, Albi Rodriguez S, Ayats Vidal R, Salcedo Posadas A, Costa Colomer J, Domingo Miró X, Berrocal Castañeda M, Villares Porto-Dominguez A. Respiratory outcomes of "new" bronchopulmonary dysplasia in adolescents: A multicenter study. Pediatr Pulmonol 2021; 56:1205-1214. [PMID: 33314679 PMCID: PMC8246560 DOI: 10.1002/ppul.25226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Long-term respiratory consequences of bronchopulmonary dysplasia (BPD) in preterm infants born in the post-surfactant era ("new" BPD) remain partially unknown. The present study aimed to evaluate the respiratory outcomes of "new" BPD in adolescents who were born preterm. METHODS This multicenter, cross-sectional study included 286 adolescents born between 2003 and 2005 (mean age: 14.2 years); among them, 184 and 102 were born extremely preterm (EP; <28 weeks' gestation) and moderate-late preterm (32 to <37 weeks' gestation), respectively. Among EP adolescents, 92 had BPD, and 92 did not. All participants underwent lung function tests, skin prick testing, and questionnaires on asthma symptoms and quality of life. RESULTS EP adolescents with BPD had significantly lower forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), FEV1 /FVC ratio, and forced expiratory flow between 25% and 75% of FVC than other included adolescents. FEV1 /FVC ratios were below the lower limit of normal (z-score <-1.645) in 30.4% of EP adolescents with BPD, 13.0% of EP adolescents without BPD, and 11.8% of adolescents who were born moderate-late preterm. Bronchodilator response and air-trapping were significantly higher in BPD adolescents than in other adolescents. Diffusion capacity was significantly lower in EP adolescents than in moderate-late preterm adolescents. Asthma symptoms and quality-of-life scores were similar among groups. CONCLUSION EP adolescents with "new" BPD had poorer pulmonary function than EP adolescents without BPD or moderate-late preterm adolescents. Further studies are needed to determine whether "new" BPD is associated with early-onset chronic obstructive pulmonary disease in adulthood.
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Affiliation(s)
| | | | - Maria L García-García
- Pediatric Pulmonology Unit, Severo Ochoa University Hospital, Leganés, Madrid, Spain
| | - Maria Arroyas Sanchez
- Pediatric Pulmonology Unit, Severo Ochoa University Hospital, Leganés, Madrid, Spain
| | - Inés de Mir Messa
- Pediatric Pulmonology and Cystic Fibrosis Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Orlando Mesa Medina
- Pediatric Pulmonology Unit, Nuestra Señora de la Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Alicia Callejón Callejón
- Pediatric Pulmonology Unit, Nuestra Señora de la Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Elisa M Canino Calderín
- Pediatric Pulmonology Unit, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Salome Albi Rodriguez
- Pediatric Pulmonology and Allergy Unit, 12th of October University Hospital, Madrid, Spain
| | - Roser Ayats Vidal
- Pediatric Pulmonology, Allergology and Immunology Unit, Cystic Fibrosis Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Jordi Costa Colomer
- Pediatric Pulmonology Unit, Sant Joan de Deu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Domingo Miró
- Pediatric Pulmonology, Allergology and Immunology Unit, Cystic Fibrosis Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
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25
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Yu X, Wei J, Li Y, Zhang L, Che H, Liu L. Longitudinal Assessment of Pulmonary Function and Bronchodilator Response in Pediatric Patients With Post-infectious Bronchiolitis Obliterans. Front Pediatr 2021; 9:674310. [PMID: 34095034 PMCID: PMC8169978 DOI: 10.3389/fped.2021.674310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
Backgroud: Postinfectious bronchiolitis obliterans (PIBO) is a rare respiratory disease. In recent years, the disease has been recognized and diagnosed increasingly in children. Pulmonary function is important for diagnosis, identifying the severity of the PIBO and monitoring progression. But there have been only a few studies that followed the evolution of PIBO on the basis of pulmonary function tests (PFTs). Objective: The study targeted the evolution of pulmonary function and bronchodilator response in a case series of Chinese children with PIBO. Methods: Twelve children between the ages of 6-99 months with PIBO were studied retrospectively from 2009 to 2019. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the FEV1/FVC ratio, and maximal midexpiratory flow velocity 25-75% (MMEF25-75%) were collected at each PFT, and bronchodilator responses were evaluated. Spirometric parameters were monitored over time, and generalized linear mixed models were used to analyze longitudinal panel data. Results: The median baseline PFT values for FVC, FEV1, the FEV1/FVC ratio, and MMEF25-75% were 41.6, 39.75, 90.7, and 22.2%, respectively. At the initial PFTs, 10 (83.3%) patients demonstrated a significant bronchodilator response. FVC and FEV1 increased by 8.212%/year and 5.007%/year, respectively, and the FEV1/FVC ratio decreased by an average of 3.537%/year. MMEF25-75% showed improvement at an average rate of 1.583% every year. Overall, FEV1 and MMEF25-75% showed different degrees of improvement after the use of inhaled bronchodilators at each PFT session for 10 patients, and FEV1 measures demonstrated significant (>12%) β2-bronchodilation in 56% of PFT sessions. Conclusions: Pediatric patients with PIBO showed an obstructive defect in pulmonary function. The FVC, FEV1, and MMEF25-75% improved as they grew older, while the FEV1/FVC ratio decreased. This may be due to the development of lung parenchyma more than airway growth. Airway obstruction in some patients improved with the use of β2 agonists.
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Affiliation(s)
- Xiuhua Yu
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Jiaoyang Wei
- Department of Pediatrics, The Hospital of Shandong Technology and Business University, Yantai, China
| | - Yanchun Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Lu Zhang
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Hongming Che
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Li Liu
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
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26
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Zhang Z, Guo L, Lu X, Zhang C, Huang L, Wang X, Duan F, Liang H, Chen P, Zeng L, Shao J, Li H, Li L, Liu L, Li C, Zhang J, Ma CY, Kwan KY, Liu W, Xu Y, Gu X, Jiang H, Du H, Zhang T, Wu Y, Yu G, Chen J, Luo R, Liao C, Tse HF, Chen Z, Chen HJ, Xia H, Lian Q. Clinical analysis and pluripotent stem cells-based model reveal possible impacts of ACE2 and lung progenitor cells on infants vulnerable to COVID-19. Theranostics 2021; 11:2170-2181. [PMID: 33500718 PMCID: PMC7797681 DOI: 10.7150/thno.53136] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/17/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: An increasing number of children with severe coronavirus disease 2019 (COVID-19) is being reported, yet the spectrum of disease severity and expression patterns of angiotensin-converting enzyme 2 (ACE2) in children at different developmental stages are largely unknow. Methods: We analysed clinical features in a cohort of 173 children with COVID-19 (0-15 yrs.-old) between January 22, 2020 and March 15, 2020. We systematically examined the expression and distribution of ACE2 in different developmental stages of children by using a combination of children's lung biopsies, pluripotent stem cell-derived lung cells, RNA-sequencing profiles, and ex vivo SARS-CoV-2 pseudoviral infections. Results: It revealed that infants (< 1yrs.-old), with a weaker potency of immune response, are more vulnerable to develop pneumonia whereas older children (> 1 yrs.-old) are more resistant to lung injury. The expression levels of ACE2 however do not vary by age in children's lung. ACE2 is notably expressed not only in Alveolar Type II (AT II) cells, but also in SOX9 positive lung progenitor cells detected in both pluripotent stem cell derivatives and infants' lungs. The ACE2+SOX9+ cells are readily infected by SARS-CoV-2 pseudovirus and the numbers of the double positive cells are significantly decreased in older children. Conclusions: Infants (< 1 yrs.-old) with SARS-CoV-2 infection are more vulnerable to lung injuries. ACE2 expression in multiple types of lung cells including SOX9 positive progenitor cells, in cooperation with an unestablished immune system, could be risk factors contributing to vulnerability of infants with COVID-19. There is a need to continue monitoring lung development in young children who have recovered from SARS-CoV-2 infection.
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27
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Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia? CHILDREN-BASEL 2020; 7:children7120283. [PMID: 33321724 PMCID: PMC7763238 DOI: 10.3390/children7120283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.
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28
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Zysman M, Baptista BR, Essari LA, Taghizadeh S, Thibault de Ménonville C, Giffard C, Issa A, Franco-Montoya ML, Breau M, Souktani R, Aissat A, Caeymaex L, Lizé M, Van Nhieu JT, Jung C, Rottier R, Cruzeiro MD, Adnot S, Epaud R, Chabot F, Lanone S, Boczkowski J, Boyer L. Targeting p16 INK4a Promotes Lipofibroblasts and Alveolar Regeneration after Early-Life Injury. Am J Respir Crit Care Med 2020; 202:1088-1104. [PMID: 32628504 DOI: 10.1164/rccm.201908-1573oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Rationale: Promoting endogenous pulmonary regeneration is crucial after damage to restore normal lungs and prevent the onset of chronic adult lung diseases.Objectives: To investigate whether the cell-cycle inhibitor p16INK4a limits lung regeneration after newborn bronchopulmonary dysplasia (BPD), a condition characterized by the arrest of alveolar development, leading to adult sequelae.Methods: We exposed p16INK4a-/- and p16INK4a ATTAC (apoptosis through targeted activation of caspase 8) transgenic mice to postnatal hyperoxia, followed by pneumonectomy of the p16INK4a-/- mice. We measured p16INK4a in blood mononuclear cells of preterm newborns, 7- to 15-year-old survivors of BPD, and the lungs of patients with BPD.Measurements and Main Results: p16INK4a concentrations increased in lung fibroblasts after hyperoxia-induced BPD in mice and persisted into adulthood. p16INK4a deficiency did not protect against hyperoxic lesions in newborn pups but promoted restoration of the lung architecture by adulthood. Curative clearance of p16INK4a-positive cells once hyperoxic lung lesions were established restored normal lungs by adulthood. p16INK4a deficiency increased neutral lipid synthesis and promoted lipofibroblast and alveolar type 2 (AT2) cell development within the stem-cell niche. Besides, lipofibroblasts support self-renewal of AT2 cells into alveolospheres. Induction with a PPARγ (peroxisome proliferator-activated receptor γ) agonist after hyperoxia also increased lipofibroblast and AT2 cell numbers and restored alveolar architecture in hyperoxia-exposed mice. After pneumonectomy, p16INK4a deficiency again led to an increase in lipofibroblast and AT2 cell numbers in the contralateral lung. Finally, we observed p16INK4a mRNA overexpression in the blood and lungs of preterm newborns, which persisted in the blood of older survivors of BPD.Conclusions: These data demonstrate the potential of targeting p16INK4a and promoting lipofibroblast development to stimulate alveolar regeneration from childhood to adulthood.
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Affiliation(s)
- Maéva Zysman
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Bruno Ribeiro Baptista
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Service de Pneumologie, Centre Hospitalier Universitaire, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Laure-Aléa Essari
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Service de Pneumologie, Centre Hospitalier Universitaire, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Sara Taghizadeh
- Department of Pulmonary and Critical Care Medicine, Key Laboratory of Interventional Pulmonology of Zheijiang Province, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | | | - Amelle Issa
- Centre de Recherche Clinique, Centre de Ressource Biologique, Centre Hospitalier Intercommunal, Creteil, France
| | | | | | | | - Abdel Aissat
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Laurence Caeymaex
- Soins Intensifs Néonataux, Centre Hospitalier Intercommunal, Creteil, France
| | - Muriel Lizé
- Molecular and Experimental Pneumology Group, Clinic for Cardiology and Pneumology, University Medical Center Goettingen, Goettingen, Germany
| | - Jeanne Tran Van Nhieu
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Service de Pathologie, Hôpital Henri Mondor, AP-HP, Hôpital Henri Mondor, Creteil, France
| | - Camille Jung
- Centre de Recherche Clinique, Centre de Ressource Biologique, Centre Hospitalier Intercommunal, Creteil, France
| | - Robert Rottier
- Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Cell Biology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marcio Do Cruzeiro
- INSERM U1016, Institut Cochin, Paris, France.,UMR 8104, Centre National de la Recherche Scientifique, Paris, France.,Université Paris Descartes, Sorbonne, Paris, France
| | - Serge Adnot
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Service de Physiologie, Hôpital Henri Mondor, AP-HP, Creteil, France; and
| | - Ralph Epaud
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Service de Pédiatrie, Centre des Maladies Respiratoire Rares, Centre Hospitalier Intercommunal, Creteil, France
| | - François Chabot
- Service de Pneumologie, Centre Hospitalier Universitaire, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Sophie Lanone
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | | | - Laurent Boyer
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Service de Physiologie, Hôpital Henri Mondor, AP-HP, Creteil, France; and
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29
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Thomen RP, Woods JC, Sturm PF, Jain V, Walkup LL, Higano NS, Quirk JD, Varisco BM. Lung microstructure in adolescent idiopathic scoliosis before and after posterior spinal fusion. PLoS One 2020; 15:e0240265. [PMID: 33031412 PMCID: PMC7544066 DOI: 10.1371/journal.pone.0240265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is associated with decreased respiratory quality of life and impaired diaphragm function. Recent hyperpolarized helium (HHe) MRI studies show alveolarization continues throughout adolescence, and mechanical forces are known to impact alveolarization. We therefore hypothesized that patients with AIS would have alterations in alveolar size, alveolar number, or alveolar septal dimensions compared to adolescents without AIS, and that posterior spinal fusion (PSF) might reverse these differences. We conducted a prospective observational trial using HHe MRI to test for changes in alveolar microstructure in control and AIS subjects at baseline and one year. After obtaining written informed consent from subjects’ legal guardians and assent from the subjects, we performed HHe and proton MRI in 14 AIS and 16 control subjects aged 8–21 years. The mean age of control subjects (12.9 years) was significantly less than AIS (14.9 years, p = 0.003). At baseline, there were no significant differences in alveolar size, number, or alveolar duct morphometry between AIS and control subjects or between the concave (compressed) and convex (expanded) lungs of AIS subjects. At one year after PSF AIS subjects had an increase in alveolar density in the formerly convex lung (p = 0.05), likely reflecting a change in thoracic anatomy, but there were no other significant changes in lung microstructure. Modeling of alveolar size over time demonstrated similar rates of alveolar growth in control and AIS subjects in both right and left lungs pre- and post-PSF. Although this study suffered from poor age-matching, we found no evidence that AIS or PSF impacts lung microstructure. Trial registration: Clinical trial registration number NCT03539770.
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Affiliation(s)
- Robert P. Thomen
- School of Medicine, University of Missouri, Columbia, Missouri, United States of America
- Division of Radiology, University of Missouri, Columbia, Missouri, United States of America
| | - Jason C. Woods
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- Pulmonary Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States of America
| | - Peter F. Sturm
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- Orthopaedics, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States of America
| | - Viral Jain
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- Orthopaedics, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States of America
| | - Laura L. Walkup
- Pulmonary Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States of America
| | - Nara S. Higano
- Pulmonary Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States of America
| | - James D. Quirk
- Mallincrodt Institute of Radiology, Washington University, St. Louis, MO, United States of America
- School of Medicine, Washington University, St. Louis, MO, United States of America
| | - Brian M. Varisco
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- Critical Care Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States of America
- * E-mail:
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30
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Tracy MC, Cornfield DN. Bronchopulmonary Dysplasia: Then, Now, and Next. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2020; 33:99-109. [PMID: 35922031 PMCID: PMC9354034 DOI: 10.1089/ped.2020.1205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/14/2020] [Indexed: 06/12/2023]
Abstract
Bronchopulmonary dysplasia (BPD) has evolved considerably since its first description over 50 years ago. This review aims to provide a historical framework for conceptualizing BPD and a current understanding of the changing definition, epidemiology, pathophysiology, treatment, and outcomes of BPD. The transdisciplinary approach that led to the initial phenotypic description of BPD continues to hold promise today. Investigators are refining the definition of BPD in light of changes in clinical care and increasing survival rates of very preterm infants. Despite improvements in perinatal care the incidence of BPD continues to increase. There is growing recognition that antenatal risk factors play a key role in the development of BPD. Strategies designed to prevent or limit neonatal lung injury continue to evolve. Defining the phenotype of infants with BPD can meaningfully direct treatment. Infants with BPD benefit from an interdisciplinary approach to longitudinal care with a focus on growth and neurocognitive development. While the ultimate impact of BPD on long-term pulmonary morbidity remains an active area of investigation, current data indicate that most children and adolescents with a history of BPD have a quality of life comparable to that of other preterm infants.
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Affiliation(s)
- Michael C. Tracy
- Center for Excellence in Pulmonary Biology, Division of Pediatric Pulmonary, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - David N. Cornfield
- Center for Excellence in Pulmonary Biology, Division of Pediatric Pulmonary, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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31
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Vanhaverbeke K, Van Eyck A, Van Hoorenbeeck K, De Winter B, Snoeckx A, Mulder T, Verhulst S. Lung imaging in bronchopulmonary dysplasia: a systematic review. Respir Med 2020; 171:106101. [DOI: 10.1016/j.rmed.2020.106101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 01/19/2023]
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Prenzel F, Vogel M, Siekmeyer W, Körner A, Kiess W, Vom Hove M. Exercise capacity in children with bronchopulmonary dysplasia at school age. Respir Med 2020; 171:106102. [PMID: 32823240 DOI: 10.1016/j.rmed.2020.106102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the exercise capacity, exercise habits, and lung function of preterm born children with bronchopulmonary dysplasia (BPD) compared to term born controls at school age. METHODS Cardiopulmonary exercise test (CPET) by cycle ergometer and pulmonary function test were performed in children with BPD (n = 42) and compared with a term born control group (n = 42). Daily activity, participation in sports and respiratory symptoms were assessed by questionnaire. RESULTS Children with BPD versus controls had significantly lower values for oxygen consumption (V̇O2 [mL/min] 1442 ± 417 vs. 1766 ± 541), minute ventilation (VE [L/min] 48 ± 14.92 vs. 60 ± 18.33), and workload (W [watt] 96.1 ± 16.7 vs. 110.6 ± 17.2) at peak exercise and a lower anaerobic threshold (VO2 AT [mL/min] 1183 ± 345 vs. 1382 ± 398). When corrected for weight, only for the workload (2.7 ± 0.5 vs. 3.1 ± 0.5, p = 0.0013) did significant differences persist. The forced expiratory volume in 1 s and forced expiratory flow between 25 and 75% of expired forced vital capacity were significantly reduced in the BPD group (p < 0.0001). Children with BPD have a higher risk of reporting difficulties in physical activity (OR 2.5) and of suffering from wheezing or shortness of breath while exercising (OR 2.5). CONCLUSION Compared to term born controls, children with BPD at school age show airflow obstruction, a lower workload in CPET, and more respiratory symptoms related to physical activity. The comparable oxygen consumption based on weight suggests a functionally normal alveolar compartment.
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Affiliation(s)
- Freerk Prenzel
- University of Leipzig Medical Center, Department of Pediatrics and Center for Pediatric Research Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, Philipp-Rosenthal-Straße 2704103 Leipzig, Germany.
| | - Werner Siekmeyer
- University of Leipzig Medical Center, Department of Pediatrics and Center for Pediatric Research Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
| | - Antje Körner
- University of Leipzig Medical Center, Department of Pediatrics and Center for Pediatric Research Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
| | - Wieland Kiess
- University of Leipzig Medical Center, Department of Pediatrics and Center for Pediatric Research Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany; LIFE Leipzig Research Center for Civilization Diseases, Philipp-Rosenthal-Straße 2704103 Leipzig, Germany.
| | - Maike Vom Hove
- University of Leipzig Medical Center, Department of Pediatrics and Center for Pediatric Research Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
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Rice JL, McGrath-Morrow SA, Collaco JM. Indoor Air Pollution Sources and Respiratory Symptoms in Bronchopulmonary Dysplasia. J Pediatr 2020; 222:85-90.e2. [PMID: 32417083 PMCID: PMC7321913 DOI: 10.1016/j.jpeds.2020.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/26/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the impact of exposure to indoor air pollution on respiratory health outcomes (healthcare utilization, symptoms, medication use) in infants and children with bronchopulmonary dysplasia (BPD). STUDY DESIGN A total of 244 subjects were included from the Johns Hopkins Bronchopulmonary Dysplasia registry. Parents completed an environmental exposure questionnaire including secondhand smoke and indoor combustion (gas/propane heat, gas or wood stove, gas/wood burning fireplace) exposures in the home. Respiratory symptoms, both acute (healthcare utilization, steroid/antibiotic use) and chronic (cough/wheeze, nocturnal cough, use of beta-agonists, tolerance of physical activity), were also collected. RESULTS Three-quarters of the infants were exposed to at least 1 combustible source of air pollution in the home, and this exposure was associated with an increased risk of hospitalization in infants and children on home respiratory support. Only 14% of the study population reported secondhand smoke exposure, but we found that this was associated with chronic respiratory symptoms, including activity limitation and nocturnal cough. Infants on respiratory support also had increased daytime cough and wheezing. Approximately one-third reported having an air purifier in the home, and its presence attenuated the effect of secondhand smoke exposure on reported activity limitation. CONCLUSIONS Exposure to combustible sources of indoor air pollution was associated with increased respiratory morbidity in a group of high risk of infants with BPD. Our results support that indoor air pollution is a modifiable risk factor for respiratory health in infants with BPD.
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Affiliation(s)
- Jessica L. Rice
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sharon A. McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph M. Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Arigliani M, Valentini E, Stocco C, De Pieri C, Castriotta L, Barbato V, Cuberli E, Orsaria M, Cattarossi L, Cogo P. Regional ventilation inhomogeneity in survivors of extremely preterm birth. Pediatr Pulmonol 2020; 55:1366-1374. [PMID: 32212328 DOI: 10.1002/ppul.24742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/13/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Survivors of extreme prematurity may have disrupted lung development. We hypothesized that the multiple breath washout (MBW) index Scond, which is intended to reflect ventilation inhomogeneity from the conducting airways, could be a sensitive marker of respiratory impairment in this group. METHODS Spirometry, TLco, and MBW were cross-sectionally evaluated at 8 to 14 years of age in children born at <28 weeks between 2004 and 2010 in Udine, Italy. Age-matched controls born at term were also included. Bronchopulmonary dysplasia (BPD) was defined as oxygen-dependence at 36 weeks postmenstrual age. The limits of normal were the 5th percentile of the reference population (Global Lung Initiative) for spirometry and TLco and the 95th percentile of controls for Lung Clearance Index, Scond, and Sacin from MBW. RESULTS Results were obtained in 47 extremely preterm children (53% boys, mean ± standard deviation age 11.3 ± 2.0 years, 40% with BPD) and 60 controls (50% boys, 11.6 ± 1.9 years). There were significant differences between preterm children and controls in all lung function outcomes, except for Sacin. Among children born <28 weeks, Scond tended to be frequently abnormal than FEV1 z-score (29% vs 14%, P = .06). At multivariable linear regression, in the preterm group, current asthma was significantly associated with a higher Scond (B = 0.019, 95% confidence interval, 0.000-0.038), whereas BPD was not. CONCLUSION Almost a third of extremely preterm children at school age showed Scond alterations that affected also children without BPD. Longitudinal studies should clarify the prognostic meaning of Scond abnormalities in this group.
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Affiliation(s)
- Michele Arigliani
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Elena Valentini
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Chiara Stocco
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Carlo De Pieri
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Vincenzo Barbato
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Elisa Cuberli
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Maria Orsaria
- Department of Medicine, Surgical Pathology Section, University Hospital of Udine, Udine, Italy
| | - Luigi Cattarossi
- Department of Medicine, Neonatal Intensive Care Unit, University Hospital of Udine, Udine, Italy
| | - Paola Cogo
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
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Amodeo I, Raffaeli G, Pesenti N, Macchini F, Condò V, Borzani I, Persico N, Fabietti I, Ophorst M, Ghirardello S, Gangi S, Colnaghi M, Mosca F, Cavallaro G. The NeoAPACHE Study Protocol I: Assessment of the Radiographic Pulmonary Area and Long-Term Respiratory Function in Newborns With Congenital Diaphragmatic Hernia. Front Pediatr 2020; 8:581809. [PMID: 33194913 PMCID: PMC7661933 DOI: 10.3389/fped.2020.581809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
In newborns with congenital diaphragmatic hernia (CDH), the radiographic lung area is correlated with functional residual capacity (FRC) and represents an alternative method to estimate lung hypoplasia. In a cohort of newborn CDH survivors, we retrospectively evaluated the relationship between radiographic lung area measured on the 1st day of life and long-term respiratory function. As a secondary analysis, we compared radiographic lung areas and respiratory function between patients undergoing fetal endoscopic tracheal occlusion (FETO) and patients managed expectantly (non-FETO). Total, ipsilateral, and contralateral radiographic areas were obtained by tracing lung perimeter as delineated by the diaphragm and rib cage, excluding mediastinal structures and herniated organs. Tidal volume (VT), respiratory rate (RR), and their Z-Scores when compared to the norm were collected from pulmonary function tests (PFTs) performed at 12 ± 6 months of age. Linear regression analyses using the absolute Z-Score values for each parameter were performed. In CDH survivors, an increase in total and ipsilateral lung area measured at birth was related to a reduction in the absolute Z-Score for VT in PFTs (p = 0.046 and p = 0.023, respectively), indicating a trend toward an improvement in pulmonary volumes and VT normalization. Radiographic lung areas were not significantly different between FETO and non-FETO patients, suggesting a volumetric lung increase due to prenatal intervention. However, the mean Z-Score value for RR was significantly higher in the FETO group (p < 0.001), probably due to impaired diaphragmatic motility in the most severe cases. Further analyses are necessary to better characterize the role of the radiographic pulmonary area in the prognostic evaluation of respiratory function in patients with CDH. Clinical Trial Registration: This trial was registered at ClinicalTrials.gov with the identifier NCT04396028.
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Affiliation(s)
- Ilaria Amodeo
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Nicola Pesenti
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Condò
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Borzani
- Pediatric Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Persico
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Isabella Fabietti
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marijke Ophorst
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvana Gangi
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariarosa Colnaghi
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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36
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Cardoen F, Vermeulen F, Proesmans M, Moens M, De Boeck K. Lung function evolution in children with old and new type bronchopulmonary dysplasia: a retrospective cohort analysis. Eur J Pediatr 2019; 178:1859-1866. [PMID: 31486896 DOI: 10.1007/s00431-019-03453-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 11/25/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is one of the most important sequelae of premature birth. There is concern that in some patients, lung injuries early in life may have lifelong consequences. In this retrospective observational cohort study, lung function evolution in children with BPD was investigated from childhood to young adulthood. Data from 355 pulmonary function tests (PFT) in 24 patients were analyzed, with a median age at first PFT of 7.6 years and at last PFT 18.2 years. FEV1 and FEV1/FVC were below the 5th percentile in respectively 18 and 13/24 patients. Comparing first and last measurement, there was significant worsening in FEV1 from a mean of 71.3% pred (SD 18.3) to 66.7% pred (SD 21.7) (p < 0.05) and in FEV1/FVC from 85.4% pred (SD 15.2) to 79.8% pred (SD 17.3) (p = 0.01). Evaluation of the individual lung function changes with linear regression showed deterioration in FEV1, FVC, and FEV1/FVC in respectively 17, 13, and 17/24 patients. Total group analysis showed significant deterioration in FEV1 (- 0.7%/year, p = 0.002) and FEV1/FVC (- 0.5%/year, p = 0.01). None of the 11 patients born up to 1990 improved in FEV1 vs 7 of the 13 patients born after 1990 (p = 0.006).Conclusion: This points out to further deterioration of the lung function during childhood in this selected group of children with BPD.What is Known:• Data on longitudinal changes in lung function in children with BPD are scarce.What is New:• In children with BPD at the severe end of the disease spectrum, lung function does not improve over time. On the contrary, in two-thirds of the subjects studied FEV1and FEV1/FVC worsen over time.• Lung function evolution towards adulthood was somewhat more favorable in children born after 1990 compared with those born earlier, probably reflecting improvements in neonatal care in subjects with new type BPD.
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Affiliation(s)
- Frederik Cardoen
- Department of Pediatric Pulmonology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - François Vermeulen
- Department of Pediatric Pulmonology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marijke Proesmans
- Department of Pediatric Pulmonology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marleen Moens
- Rehabilitation Center Pulderbos, Reebergenlaan 4, 2242, Zandhoven, Belgium
| | - Kris De Boeck
- Department of Pediatric Pulmonology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Abstract
In the absence of effective interventions to prevent preterm births, improved survival of infants who are born at the biological limits of viability has relied on advances in perinatal care over the past 50 years. Except for extremely preterm infants with suboptimal perinatal care or major antenatal events that cause severe respiratory failure at birth, most extremely preterm infants now survive, but they often develop chronic lung dysfunction termed bronchopulmonary dysplasia (BPD; also known as chronic lung disease). Despite major efforts to minimize injurious but often life-saving postnatal interventions (such as oxygen, mechanical ventilation and corticosteroids), BPD remains the most frequent complication of extreme preterm birth. BPD is now recognized as the result of an aberrant reparative response to both antenatal injury and repetitive postnatal injury to the developing lungs. Consequently, lung development is markedly impaired, which leads to persistent airway and pulmonary vascular disease that can affect adult lung function. Greater insights into the pathobiology of BPD will provide a better understanding of disease mechanisms and lung repair and regeneration, which will enable the discovery of novel therapeutic targets. In parallel, clinical and translational studies that improve the classification of disease phenotypes and enable early identification of at-risk preterm infants should improve trial design and individualized care to enhance outcomes in preterm infants.
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38
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Respiratory Phenotypes for Preterm Infants, Children, and Adults: Bronchopulmonary Dysplasia and More. Ann Am Thorac Soc 2019; 15:530-538. [PMID: 29328889 DOI: 10.1513/annalsats.201709-756fr] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ongoing advancements in neonatal care since the late 1980s have led to increased numbers of premature infants surviving well beyond the neonatal period. As a result of increased survival, many individuals born preterm manifest chronic respiratory symptoms throughout infancy, childhood, and adult life. The archetypical respiratory disease of prematurity, bronchopulmonary dysplasia, is the second most common chronic pediatric respiratory disease after asthma. However, there are several commonly held misconceptions. These misconceptions include that bronchopulmonary dysplasia is rare, that bronchopulmonary dysplasia resolves within the first few years of life, and that bronchopulmonary dysplasia does not impact respiratory health in adult life. This focused review describes a spectrum of respiratory conditions that individuals born prematurely may experience throughout their lifespan. Specifically, this review provides quantitative estimates of the number of individuals with alveolar, airway, and vascular phenotypes associated with bronchopulmonary dysplasia, as well as non-bronchopulmonary dysplasia respiratory phenotypes such as airway malacia, obstructive sleep apnea, and control of breathing issues. Furthermore, this review illustrates what is known about the potential for progression and/or lack of resolution of these respiratory phenotypes in childhood and adult life. Recognizing the spectrum of respiratory phenotypes associated with individuals born preterm and providing comprehensive and personalized care to these individuals may help to modulate adverse respiratory outcomes in later life.
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39
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Slaughter JL, Cua CL, Notestine JL, Rivera BK, Marzec L, Hade EM, Maitre NL, Klebanoff MA, Ilgenfritz M, Le VT, Lewandowski DJ, Backes CH. Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation. BMC Pediatr 2019; 19:333. [PMID: 31519154 PMCID: PMC6743099 DOI: 10.1186/s12887-019-1708-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm. METHODS Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort. DISCUSSION The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in "high-risk" infants most likely to receive benefit. TRIAL REGISTRATION ClinicalTrials.gov NCT03782610. Registered 20 December 2018.
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Affiliation(s)
- Jonathan L Slaughter
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Clifford L Cua
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer L Notestine
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian K Rivera
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Laura Marzec
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Erinn M Hade
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Nathalie L Maitre
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA.,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Megan Ilgenfritz
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA
| | - Vi T Le
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dennis J Lewandowski
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carl H Backes
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA. .,Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Way, Columbus, Ohio, 43205, USA. .,The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA. .,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
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40
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Kjellberg M, Sanchez-Crespo A, Jonsson B. Ten-year-old children with a history of bronchopulmonary dysplasia have regional abnormalities in ventilation perfusion matching. Pediatr Pulmonol 2019; 54:602-609. [PMID: 30887678 DOI: 10.1002/ppul.24273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/16/2019] [Indexed: 01/25/2023]
Abstract
AIM The ratio of ventilation to blood flow is an important determinant for regional gas exchange in the lung and hypoxemia is one of the clinical hallmarks in infants with bronchopulmonary dysplasia (BPD). We have previously demonstrated ventilation/perfusion ratio (V/Q) abnormalities in infants with BPD at 36 weekś postconceptional age. The status of V/Q matching in older children with a history of BPD in infancy is unknown. In this study, we examined if 10-year-old children with a history of BPD had V/Q impairments. METHODS Three-dimensional V/Q-scintigraphy (SPECT) was performed in 26 children. RESULTS In the BPD group, lung volume with mismatch, (V>Q) was larger compared to areas with reverse mismatch (Q>V), 26.2% and 11.8%, respectively, implying that perfusion defects contribute more than ventilation defects in the V/Q mismatch. Also, the mean fractional distribution of V and Q to V/Q in children with BPD was reduced compared to healthy children, 31% and 51% compared to 64% and 89%, respectively (P < 0.01). CONCLUSION At 10 years of age children with a history of BPD had ventilation/perfusion abnormalities, with prominent perfusion defects. These V/Q abnormalities suggest the presence of residual alveolar-capillary impairment.
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Affiliation(s)
- Malin Kjellberg
- Institute of Women's and Children's Health, Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Alejandro Sanchez-Crespo
- Institution of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Univeristy Hospital, Stockholm, Sweden
| | - Baldvin Jonsson
- Institute of Women's and Children's Health, Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden
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41
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Colom AJ, Teper AM. Post-infectious bronchiolitis obliterans. Pediatr Pulmonol 2019; 54:212-219. [PMID: 30548423 DOI: 10.1002/ppul.24221] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 11/01/2018] [Indexed: 12/20/2022]
Abstract
Bronchiolitis obliterans is a rare and severe chronic lung disease resulting from a lower respiratory tract lesion. It may occur after a bone marrow or lung transplantation, infectious diseases, or less frequently after inhaling toxic substances or after connective tissue diseases. Pathology, pathogenesis, and molecular biology, as well as the best treatment of bronchiolitis obliterans, remain the subject of ongoing research. This review discusses our current knowledge of different areas of bronchiolitis obliterans associated with infectious lesions.
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Affiliation(s)
- Alejandro J Colom
- Centro Respiratorio, Hospital de Niños "Dr. Ricardo Gutiérrez", Buenos Aires, Argentina
| | - Alejandro M Teper
- Centro Respiratorio, Hospital de Niños "Dr. Ricardo Gutiérrez", Buenos Aires, Argentina
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42
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McGrath-Morrow SA, Collaco JM. Bronchopulmonary dysplasia: what are its links to COPD? Ther Adv Respir Dis 2019; 13:1753466619892492. [PMID: 31818194 PMCID: PMC6904782 DOI: 10.1177/1753466619892492] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/13/2019] [Indexed: 12/23/2022] Open
Abstract
Emerging evidence suggests that adverse early life events can affect long-term health trajectories throughout life. Preterm birth, in particular, is a significant early life event that affects approximately 10% of live births. Worldwide, prematurity is the number one cause of death in children less than 5 years of age and has been shown to disrupt normal lung development with lasting effects into adult life. Along with impaired lung development, interventions used to support gas exchange and other sequelae of prematurity can lead to the development of bronchopulmonary dysplasia (BPD). BPD is a chronic respiratory disease of infancy characterized by alveolar simplification, small airways disease, and pulmonary vascular changes. Although many survivors of BPD improve with age, survivors of BPD often have chronic lung disease characterized by airflow obstruction and intermittent pulmonary exacerbations. Long-term lung function trajectories as measured by FEV1 can be lower in children and adults with a history BPD. In this review, we discuss the epidemiology and manifestations of BPD and its long-term consequences throughout childhood and into adulthood. Available evidence suggests that disrupted lung development, genetic susceptibility and subsequent environment and infectious events that occur in prenatal and postnatal life likely increase the predisposition of children with BPD to develop early onset chronic obstructive pulmonary disease (COPD). The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Sharon A. McGrath-Morrow
- Eudowood Division of Pediatric Respiratory
Sciences, David M. Rubenstein Building, Suite 3075B, 200 North Wolfe Street,
Baltimore, MD, 21287-2533, USA
| | - Joseph M. Collaco
- Department of Pediatrics, Eudowood Division of
Respiratory Sciences, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
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Urs R, Kotecha S, Hall GL, Simpson SJ. Persistent and progressive long-term lung disease in survivors of preterm birth. Paediatr Respir Rev 2018; 28:87-94. [PMID: 29752125 DOI: 10.1016/j.prrv.2018.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 02/05/2023]
Abstract
Preterm birth accounts for approximately 11% of births globally, with rates increasing across many countries. Concurrent advances in neonatal care have led to increased survival of infants of lower gestational age (GA). However, infants born <32 weeks of GA experience adverse respiratory outcomes, manifesting with increased respiratory symptoms, hospitalisation and health care utilisation into early childhood. The development of bronchopulmonary dysplasia (BPD) - the chronic lung disease of prematurity - further increases the risk of poor respiratory outcomes throughout childhood, into adolescence and adulthood. Indeed, survivors of preterm birth have shown increased respiratory symptoms, altered lung structure, persistent and even declining lung function throughout childhood. The mechanisms behind this persistent and sometimes progressive lung disease are unclear, and the implications place those born preterm at increased risk of respiratory morbidity into adulthood. This review aims to summarise what is known about the long-term pulmonary outcomes of contemporary preterm birth, examine the possible mechanisms of long-term respiratory morbidity in those born preterm and discuss addressing the unknowns and potentials for targeted treatments.
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Affiliation(s)
- Rhea Urs
- Telethon Kids Institute, Perth, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
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Arigliani M, Spinelli AM, Liguoro I, Cogo P. Nutrition and Lung Growth. Nutrients 2018; 10:E919. [PMID: 30021997 PMCID: PMC6073340 DOI: 10.3390/nu10070919] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/21/2022] Open
Abstract
Experimental evidence from animal models and epidemiology studies has demonstrated that nutrition affects lung development and may have a lifelong impact on respiratory health. Chronic restriction of nutrients and/or oxygen during pregnancy causes structural changes in the airways and parenchyma that may result in abnormal lung function, which is tracked throughout life. Inadequate nutritional management in very premature infants hampers lung growth and may be a contributing factor in the pathogenesis of bronchopulmonary dysplasia. Recent evidence seems to indicate that infant and childhood malnutrition does not determine lung function impairment even in the presence of reduced lung size due to delayed body growth. This review will focus on the effects of malnutrition occurring at critical time periods such as pregnancy, early life, and childhood, on lung growth and long-term lung function.
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Affiliation(s)
- Michele Arigliani
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Alessandro Mauro Spinelli
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Ilaria Liguoro
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Paola Cogo
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
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Damgaard ALDB, Gregersen R, Lange T, Buchvald F, Hansen BM, Greisen G. The increased purchase of asthma medication for individuals born preterm seems to wane with age: A register-based longitudinal national cohort study. PLoS One 2018; 13:e0199884. [PMID: 29975752 PMCID: PMC6033435 DOI: 10.1371/journal.pone.0199884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/17/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Preterm birth is associated with increased risk of respiratory symptoms in childhood, often treated with asthma medication. We designed a follow-up study to previous research and investigated whether the association of gestational age with purchasing asthma medication diminishes in adulthood. Methods We conducted a register-based study of a national cohort of all infants born in Denmark in 1980–2009 evaluating longitudinal data on individually prescribed asthma medication (both inhaled ß-2 receptor agonist and different controller treatment over 2-year periods) available from 1995–2011. We analyzed the effect of gestational age considering age, birth year, and perinatal variables using logistic regression with a Generalized Estimating Equations model. All data were unambiguously linked through the Civil Registration System. Results We included 1,819,743 individuals in our study population. We found an inverse dose-response relationship between gestational age and asthma medication in earlier age-groups with a gradual decrease in odds ratios with increasing age and loss of statistical significance in early adulthood (18–31 years). For our oldest generations, there was a significant effect of gestational age (p-value = 0.04), which became insignificant when adjusting for confounding and mediating factors (p = 0.44). There were significant interactions between gestational age and age (p<0.0001) and gestational age and birth year, but these were most important during childhood (0–11 years) and for our youngest generations (born after 1995). Conclusion The strong association between gestational age and purchase of prescription asthma medication weakens with age into early adulthood, in consistence with the results from our previous study. The risk for purchasing medication to treat asthma-like symptoms was higher in more recent birth years, but the effect of gestational age was small beyond 11 years of age. Gestational age per se did not seem to be significant for the development of asthma-like symptoms: most of its effect could be explained by other perinatal factors.
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Affiliation(s)
| | - Rasmus Gregersen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Center for Statistical Science, Peking University, Beijing, China
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Buchvald
- Pulmonary Service, Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bo Mølholm Hansen
- Neonatology Service, Department of Pediatrics, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Sørensen JK, Buchvald F, Berg AK, Robinson PD, Nielsen KG. Ventilation inhomogeneity and NO and CO diffusing capacity in ex-premature school children. Respir Med 2018; 140:94-100. [PMID: 29957288 DOI: 10.1016/j.rmed.2018.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
Abstract
AIM Ex-premature school children show mild-to-moderate airway obstruction and decreased CO diffusing capacity. Multiple breath nitrogen washout (N2MBW) and NO diffusing capacity (DLNO) measurements may provide new insight into long-term pulmonary and vascular impairment in bronchopulmonary dysplasia (BPD). METHODS We examined a randomly selected group of 70 ex-premature children (gestational age <28 weeks or birth weight <1500 g; 42 with and 28 without BPD) and 38 term-born healthy controls of 8-13 years of age. Subjects performed N2MBW (lung clearance index, LCI; Sacin, and Scond), DLNO (membrane related diffusing capacity, Dm and pulmonary capillary volume, Vc), Fractional exhaled NO, CO diffusing capacity, conventional spirometry (FEV1, FVC, FEF25-75) and plethysmography (RV, TLC). Respiratory symptoms were assessed by questionnaire. RESULTS Compared to healthy controls, the BPD group had higher z-scores for lung clearance index (P = 0.003), Sacin (P = 0.005), lower CO diffusing capacity (P = 0.025), DLNO (P = 0.022), DLNO/VA z-scores (P = 0.025) and a significant larger proportion had respiratory complaints. Amongst ex-premature children, the BPD group did not differ from the non-BPD group except for a decreased Dm (P = 0.023). Ex-premature with BPD showed predominantly airway obstruction (FEV1/FVC; P < 0.0001), signs of hyperinflation (RV/TLC-ratio; P = 0.028), and 25% had a positive bronchodilator response (>12% in FEV1). CONCLUSION Ex-premature school children exhibited relatively mild but significant long-term respiratory symptoms and pulmonary peripheral impairment judged by N2MBW and DLNO measurements along with well-known airway obstruction. Larger longitudinal studies are needed to assess the clinical use of these advanced methods of assessing ventilation inhomogeneity and DLNO.
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Affiliation(s)
- Jesper Kiehn Sørensen
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Buchvald
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna Korsgaard Berg
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
| | - Kim Gjerum Nielsen
- Danish Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Ioan I, Gemble A, Hamon I, Schweitzer C, Metche S, Bonabel C, Nguyen-Thi PL, Hascoet JM, Demoulin-Alexikova S, Marchal F. Expiratory Flow - Vital Capacity: Airway - Lung Dysanapsis in 7 Year Olds Born Very Preterm? Front Physiol 2018; 9:650. [PMID: 29896122 PMCID: PMC5987129 DOI: 10.3389/fphys.2018.00650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/14/2018] [Indexed: 01/13/2023] Open
Abstract
An index normalizing airway dimension for lung size derived from spirometry was found inversely correlated to lung size in school children born very preterm, indicating larger alveolar volumes draining into comparatively smaller airways. In contrast in children born full term the index was independent of lung size.
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Affiliation(s)
- Iulia Ioan
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Aurore Gemble
- Department of Pediatrics, Children's Hospital, Vandoeuvre-lès-Nancy, France
| | - Isabelle Hamon
- EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France.,Department of Neonatal Medicine, Regional Maternity Hospital, Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France.,Department of Pediatrics, Children's Hospital, Vandoeuvre-lès-Nancy, France
| | - Stéphanie Metche
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France
| | - Claude Bonabel
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Phi L Nguyen-Thi
- Department of Epidemiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Jean-Michel Hascoet
- EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France.,Department of Neonatal Medicine, Regional Maternity Hospital, Nancy, France
| | - Silvia Demoulin-Alexikova
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - François Marchal
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
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Sohn B, Park S, Park IK, Kim YT, Park JD, Park SH, Kang CH. Lung Volume Reduction Surgery for Respiratory Failure in Infants With Bronchopulmonary Dysplasia. Pediatrics 2018; 141:S395-S398. [PMID: 29610158 DOI: 10.1542/peds.2016-3901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 11/24/2022] Open
Abstract
Lung volume reduction surgery (LVRS) can be performed in patients with severe emphysematous disease. However, LVRS in pediatric patients has not yet been reported. Here, we report our experience with 2 cases of pediatric LVRS. The first patient was a preterm infant girl with severe bronchopulmonary dysplasia, pulmonary hypertension, and hypothyroidism. The emphysematous portion of the right lung was removed via sternotomy and right hemiclamshell incision. The patient was discharged on full-time home ventilator support for 3 months after the surgery. Since then, her respiratory function has improved continuously. She no longer needs oxygen supplementation or ventilator care. Her T-cannula was removed recently. The second patient was also a preterm infant girl with bronchopulmonary dysplasia. She was born with pulmonary hypertension and multiple congenital anomalies, including an atrial septal defect. Despite receiving the best supportive care, she could not be taken off the mechanical ventilator because of severe hypercapnia. We performed LVRS on the right lung via thoracotomy. She was successfully weaned off the mechanical ventilator 1 month after the surgery. She was discharged without severe complications at 3 months after the operation. At present, she is growing well with the help of intermittent home ventilator support. She can now tolerate an oral diet. Our experience shows that LVRS can be considered as a treatment option for pediatric patients with severe emphysematous lung. It is especially helpful for discontinuing prolonged mechanical ventilator care for patients with respiratory failure.
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Affiliation(s)
- Bongyeon Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; and
| | - Sung-Hye Park
- Department of Pathology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea;
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Sherlock LG, Trumpie A, Hernandez-Lagunas L, McKenna S, Fisher S, Bowler R, Wright CJ, Delaney C, Nozik-Grayck E. Redistribution of Extracellular Superoxide Dismutase Causes Neonatal Pulmonary Vascular Remodeling and PH but Protects Against Experimental Bronchopulmonary Dysplasia. Antioxidants (Basel) 2018; 7:antiox7030042. [PMID: 29538340 PMCID: PMC5874528 DOI: 10.3390/antiox7030042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/03/2018] [Accepted: 03/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A naturally occurring single nucleotide polymorphism (SNP), (R213G), in extracellular superoxide dismutase (SOD3), decreases SOD3 matrix binding affinity. Humans and mature mice expressing the R213G SNP exhibit increased cardiovascular disease but decreased lung disease. The impact of this SNP on the neonatal lung at baseline or with injury is unknown. METHODS Wild type and homozygous R213G mice were injected with intraperitoneal bleomycin or phosphate buffered saline (PBS) three times weekly for three weeks and tissue harvested at 22 days of life. Vascular and alveolar development were evaluated by morphometric analysis and immunostaining of lung sections. Pulmonary hypertension (PH) was assessed by right ventricular hypertrophy (RVH). Lung protein expression for superoxide dismutase (SOD) isoforms, catalase, vascular endothelial growth factor receptor 2 (VEGFR2), endothelial nitric oxide synthase (eNOS) and guanosine triphosphate cyclohydrolase-1 (GTPCH-1) was evaluated by western blot. SOD activity and SOD3 expression were measured in serum. RESULTS In R213G mice, SOD3 lung protein expression decreased, serum SOD3 protein expression and SOD serum activity increased compared to wild type (WT) mice. Under control conditions, R213G mice developed pulmonary vascular remodeling (decreased vessel density and increased medial wall thickness) and PH; alveolar development was similar between strains. After bleomycin injury, in contrast to WT, R213G mice were protected from impaired alveolar development and their vascular abnormalities and PH did not worsen. Bleomycin decreased VEGFR2 and GTPCH-1 only in WT mice. CONCLUSION R213G neonatal mice demonstrate impaired vascular development and PH at baseline without alveolar simplification, yet are protected from bleomycin induced lung injury and worsening of pulmonary vascular remodeling and PH. These results show that vessel bound SOD3 is essential in normal pulmonary vascular development, and increased serum SOD3 expression and SOD activity prevent lung injury in experimental bronchopulmonary dysplasia (BPD) and PH.
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Affiliation(s)
- Laurie G Sherlock
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Ashley Trumpie
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Laura Hernandez-Lagunas
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Sarah McKenna
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Susan Fisher
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA.
| | - Clyde J Wright
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Cassidy Delaney
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Eva Nozik-Grayck
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
- Pediatric Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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