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Boissiere-O'Neill T, Lee WR, Blake TL, Sly PD, Vilcins D. Exposure to endocrine-disrupting plasticisers and lung function in children and adolescents: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2024; 243:117751. [PMID: 38061586 DOI: 10.1016/j.envres.2023.117751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/21/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024]
Abstract
Exposure to endocrine-disrupting plasticisers (EDPs), such as phthalates and bisphenols, has been associated with reduced lung function in children and adolescents. However, the existing literature yields conflicting results. This systematic review and meta-analysis aimed to assess the epidemiologic evidence investigating the association between EDP exposure and lung function in children and adolescents. A comprehensive search of five databases identified 25 relevant studies. We employed a random-effects meta-analysis on spirometry measures. The effect size of interest was the change in lung function in standard deviation (SD) units resulting from a two-fold increase in exposure levels. We found that certain phthalates marginally reduced lung function in children. Forced expiratory volume in 1 s (FEV1) was reduced by a two-fold increase in mono-benzyl phthalate (MBzP) (β = -0.025 SD, 95%CI: 0.042, -0.008), mono-ethyl-oxo-hexyl phthalate (MEOHP) (β = -0.035 SD, 95%CI: 0.057, -0.014) and mono-carboxy-nonyl phthalate (MCNP) (β = -0.024 SD, 95%CI: 0.05, -0.003). Forced vital capacity (FVC) was decreased by a two-fold increase in MBzP (β = -0.022 SD, 95%CI: 0.036, -0.008) and MEOHP (β = -0.035 SD, 95%CI: 0.057, -0.014) levels. A two-fold increase in MCNP levels was associated with lower FEV1/FVC (β = -0.023 SD, 95%CI: 0.045, -0.001). Furthermore, a two-fold increase in MEOHP levels reduced forced mid-expiratory flow (FEF25-75) (β = -0.030 SD, 95%CI: 0.055, -0.005) and peak expiratory flow (PEF) (β = -0.056 SD, 95%CI: 0.098, -0.014). Notably, associations were more pronounced in males. Given the potential for reverse causation bias, the association between childhood exposure to EDPs and lung function remains uncertain. Overall, our meta-analysis showed small reductions in lung function with higher phthalate exposure. However, future studies are warranted in younger age groups.
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Affiliation(s)
- Thomas Boissiere-O'Neill
- Child Health Research Centre, The University of Queensland, Centre for Children's Health Research, South Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Wen R Lee
- Child Health Research Centre, The University of Queensland, Centre for Children's Health Research, South Brisbane, Australia
| | - Tamara L Blake
- Child Health Research Centre, The University of Queensland, Centre for Children's Health Research, South Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, Centre for Children's Health Research, South Brisbane, Australia
| | - Dwan Vilcins
- Child Health Research Centre, The University of Queensland, Centre for Children's Health Research, South Brisbane, Australia
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2
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Praprotnik M, Stucin Gantar I, Krivec U, Lucovnik M, Rodman Berlot J, Starc G. Physical fitness trajectories from childhood to adolescence in extremely preterm children: A longitudinal cohort study. Pediatr Pulmonol 2023. [PMID: 37036048 DOI: 10.1002/ppul.26410] [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: 10/25/2022] [Revised: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE Cohort studies on physical fitness (PF) in former extremely preterm children are scarce and yield conflicting results. Therefore, this study aimed to assess the effect of extremely preterm birth on PF in school-age with a focus on bronchopulmonary dysplasia (BPD). METHODS Eighty school-aged children were enrolled in the longitudinal cohort study. Fifty were born extremely preterm (<completed 28 weeks of gestation): 19 had BPD, and 31 did not; 30 term-born healthy children were included as controls. They were monitored annually throughout primary school (ages 7-14 years) with eight annual fitness testings within the Slovenian national surveillance system of children's somatic and motor development (SLOfit). The physical fitness index (PFI), calculated as the mean of percentiles of eight fitness tests, was used as an indicator of overall PF. Generalised estimating equations were used to compare changes in PFI between ages 7 and 14 in the three cohort groups: preterm children with BPD, preterm children without BPD and term controls. RESULTS Preterm children with BPD had significantly and persistently lower PFI than preterm children without BPD and term-born children throughout primary school age. Their PFI was less than half that of national median values (15.1st-19.7th percentile). Preterm children without BPD experienced progressive improvement in PFI during their school age (from 32.6th to 44.7th percentile of national median PFI values), while the ones with BPD did not. CONCLUSION Extreme prematurity per se is not a risk factor for lower PF at school age. However, if complicated by BPD, PF is significantly and sustainably reduced.
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Affiliation(s)
- Marina Praprotnik
- Department for Pulmonary Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Irena Stucin Gantar
- Center for the Treatment of Childhood Diseases, Sentvid pri Sticni, Slovenia
| | - Uros Krivec
- Department for Pulmonary Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Lucovnik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jasna Rodman Berlot
- Department for Pulmonary Diseases, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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3
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Lifelong Lung Sequelae of Prematurity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095273. [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] [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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4
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Duke JW, Lewandowski AJ, Abman SH, Lovering AT. Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm. J Physiol 2022; 600:463-482. [PMID: 34961925 PMCID: PMC9036864 DOI: 10.1113/jp281848] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023] Open
Abstract
Progressive improvements in perinatal care and respiratory management of preterm infants have resulted in increased survival of newborns of extremely low gestational age over the past few decades. However, the incidence of bronchopulmonary dysplasia, the chronic lung disease after preterm birth, has not changed. Studies of the long-term follow-up of adults born preterm have shown persistent abnormalities of respiratory, cardiovascular and cardiopulmonary function, possibly leading to a lower exercise capacity. The underlying causes of these abnormalities are incompletely known, but we hypothesize that dysanapsis, i.e. discordant growth and development, in the respiratory and cardiovascular systems is a central structural feature that leads to a lower exercise capacity in young adults born preterm than those born at term. We discuss how the hypothesized system dysanapsis underscores the observed respiratory, cardiovascular and cardiopulmonary limitations. Specifically, adults born preterm have: (1) normal lung volumes but smaller airways, which causes expiratory airflow limitation and abnormal respiratory mechanics but without impacts on pulmonary gas exchange efficiency; (2) normal total cardiac size but smaller cardiac chambers; and (3) in some cases, evidence of pulmonary hypertension, particularly during exercise, suggesting a reduced pulmonary vascular capacity despite reduced cardiac output. We speculate that these underlying developmental abnormalities may accelerate the normal age-associated decline in exercise capacity, via an accelerated decline in respiratory, cardiovascular and cardiopulmonary function. Finally, we suggest areas of future research, especially the need for longitudinal and interventional studies from infancy into adulthood to better understand how preterm birth alters exercise capacity across the lifespan.
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Affiliation(s)
- Joseph W. Duke
- Northern Arizona University, Department of Biological Sciences, Flagstaff, AZ, USA
| | - Adam J. Lewandowski
- University of Oxford, Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Steven H. Abman
- University of Colorado Anschutz School of Medicine, Department of Pediatrics, Aurora, CO, USA,Pediatric Heart Lung Center, Children’s Hospital Colorado, Aurora, CO, USA
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5
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Barnard CR, Peters M, Sindler AL, Farrell ET, Baker KR, Palta M, Stauss HM, Dagle JM, Segar J, Pierce GL, Eldridge MW, Bates ML. Increased aortic stiffness and elevated blood pressure in response to exercise in adult survivors of prematurity. Physiol Rep 2021; 8:e14462. [PMID: 32562387 PMCID: PMC7305240 DOI: 10.14814/phy2.14462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/12/2020] [Accepted: 04/26/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Adults born prematurely have an increased risk of early heart failure. The impact of prematurity on left and right ventricular function has been well documented, but little is known about the impact on the systemic vasculature. The goals of this study were to measure aortic stiffness and the blood pressure response to physiological stressors; in particular, normoxic and hypoxic exercise. Methods Preterm participants (n = 10) were recruited from the Newborn Lung Project Cohort and matched with term‐born, age‐matched subjects (n = 12). Aortic pulse wave velocity was derived from the brachial arterial waveform and the heart rate and blood pressure responses to incremental exercise in normoxia (21% O2) or hypoxia (12% O2) were evaluated. Results Aortic pulse wave velocity was higher in the preterm groups. Additionally, heart rate, systolic blood pressure, and pulse pressure were higher throughout the normoxic exercise bout, consistent with higher conduit artery stiffness. Hypoxic exercise caused a decline in diastolic pressure in this group, but not in term‐born controls. Conclusions In this first report of the blood pressure response to exercise in adults born prematurely, we found exercise‐induced hypertension relative to a term‐born control group that is associated with increased large artery stiffness. These experiments performed in hypoxia reveal abnormalities in vascular function in adult survivors of prematurity that may further deteriorate as this population ages.
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Affiliation(s)
| | - Matthew Peters
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Amy L Sindler
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Emily T Farrell
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Kim R Baker
- Department of Cardiology, University of Wisconsin, Madison, WI, USA
| | - Mari Palta
- Department of Population Health, University of Wisconsin, Madison, WI, USA
| | - Harald M Stauss
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - John M Dagle
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Jeffrey Segar
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA.,The John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin, Madison, WI, USA.,Department of Kinesiology, University of Wisconsin, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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6
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Siddaiah R, Oji-Mmuo CN, Montes DT, Fuentes N, Spear D, Donnelly A, Silveyra P. MicroRNA Signatures Associated with Bronchopulmonary Dysplasia Severity in Tracheal Aspirates of Preterm Infants. Biomedicines 2021; 9:biomedicines9030257. [PMID: 33807742 PMCID: PMC8000397 DOI: 10.3390/biomedicines9030257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/04/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that develops in neonates as a consequence of preterm birth, arrested fetal lung development, and inflammation. The incidence of BPD remains on the rise as a result of increasing survival of extremely preterm infants. Severe BPD contributes to significant health care costs and is associated with prolonged hospitalizations, respiratory infections, and neurodevelopmental deficits. In this study, we aimed to detect novel biomarkers of BPD severity. We collected tracheal aspirates (TAs) from preterm babies with mild/moderate (n = 8) and severe (n = 17) BPD, and we profiled the expression of 1048 miRNAs using a PCR array. Associations with biological pathways were determined with the Ingenuity Pathway Analysis (IPA) software. We found 31 miRNAs differentially expressed between the two disease groups (2-fold change, false discovery rate (FDR) < 0.05). Of these, 4 miRNAs displayed significantly higher expression levels, and 27 miRNAs had significantly lower expression levels in the severe BPD group when compared to the mild/moderate BPD group. IPA identified cell signaling and inflammation pathways associated with miRNA signatures. We conclude that TAs of extremely premature infants contain miRNA signatures associated with severe BPD. These may serve as potential biomarkers of disease severity in infants with BPD.
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Affiliation(s)
- Roopa Siddaiah
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA; (R.S.); (C.N.O.-M.); (D.S.); (A.D.)
| | - Christiana N. Oji-Mmuo
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA; (R.S.); (C.N.O.-M.); (D.S.); (A.D.)
| | - Deborah T. Montes
- Biobehavioral Laboratory, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Nathalie Fuentes
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Debra Spear
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA; (R.S.); (C.N.O.-M.); (D.S.); (A.D.)
| | - Ann Donnelly
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA; (R.S.); (C.N.O.-M.); (D.S.); (A.D.)
| | - Patricia Silveyra
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA; (R.S.); (C.N.O.-M.); (D.S.); (A.D.)
- Biobehavioral Laboratory, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN 47405, USA
- Correspondence:
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7
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Owen-Jones Z, Perrochon A, Hermand E, Ponthier L, Fourcade L, Borel B. Evolution of Muscular Oxygenation during a Walking Test in Preterm Children. J Pediatr 2020; 227:142-148.e1. [PMID: 32750391 DOI: 10.1016/j.jpeds.2020.07.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore measures of peripheral muscular oxygenation, coupled to gait characteristics, between preterm and full-term children during a 6-minute walking test (6MWT). STUDY DESIGN Prepubescent children performed a 6MWT. During the test, changes in muscular oxyhemoglobin, deoxyhemoglobin, and total hemoglobin were measured with Near-infrared spectroscopy technology, positioned on subjects' calves. Gait variables were monitored with the OptoGait system. RESULTS Forty-five children (33 full-term children and 12 preterm children, mean age, 4.9 ± 0.7 and 4.6 ± 0.9 years, respectively) participated in this study. Statistical analysis highlighted a decreased walking performance for preterm children, with significantly lower walking distance (P < .05) than children born full-term (405.1 ± 91.8 m vs 461.0 ± 73.3 m respectively; -9%). A concomitant increase of oxygen extraction (over the time course of Variation of desoxyhemoglobin) was observed from the third minute of the test (P < .05). No statistically significant difference was found for other near-infrared spectroscopy measures. Finally, the analysis of gait variables highlighted a group effect for walking speed (P < .05) and stride length (P < .01). CONCLUSIONS Premature children showed decreased walking performance and greater change in peripheral muscular oxygen extraction, associated with slower walking speed and stride length. This may point to a muscular maladjustment and reduced functional capacities for children born preterm. These phenomena could be responsible for greater muscular fatigue.
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Affiliation(s)
- Zoey Owen-Jones
- ILFOMER, Institut Limousin de Formation aux Métiers de la Réadaptation, Limoges, France; Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France
| | - Anaick Perrochon
- ILFOMER, Institut Limousin de Formation aux Métiers de la Réadaptation, Limoges, France; Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France
| | - Eric Hermand
- Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France; Laboratoire UMR INSERM U1272, "Hypoxie and Poumon", University Paris 13, Bobigny, France
| | - Laure Ponthier
- Service de Réanimation Néonatal et Pédiatrique, CHU de Limoges, Limoges, France
| | - Laurent Fourcade
- Département de Chirurgie Pédiatrique, Hopital Mère Enfant, Université de Limoges, Limoges, France
| | - Benoit Borel
- ILFOMER, Institut Limousin de Formation aux Métiers de la Réadaptation, Limoges, France; Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France.
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8
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Luo HJ, Wang LY, Chen PS, Hsieh WS, Hsu CH, Peng S, Jeng SF. Neonatal respiratory status predicts longitudinal respiratory health outcomes in preterm infants. Pediatr Pulmonol 2019; 54:814-821. [PMID: 30839172 DOI: 10.1002/ppul.24303] [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: 11/17/2018] [Revised: 02/08/2019] [Accepted: 02/14/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To examine the relationship between neonatal respiratory status and longitudinal respiratory health outcomes in preterm infants with very low birth weight (VLBW, birth weight <1500 g). METHODS A total of 109 VLBW preterm infants were prospectively assessed for respiratory status using the Toce clinical and radiographic scoring method on a postnatal day 28, and severity of bronchopulmonary dysplasia (BPD) at 36-weeks postmenstrual age (PMA), respiratory morbidity within 1 year of corrected age (CA), pulmonary function test, and six-minute walk test at 4 years of age. RESULTS A high Toce clinical score on day 28 was associated with the occurrence of respiratory morbidity within 1 year of CA and poor pulmonary function and functional exercise performance at 4 years of age in VLBW preterm infants (all P < 0.05). BPD at 36-weeks PMA was associated with an increased risk of respiratory morbidity within 1 year of CA and its negative impact on pulmonary function and functional exercise performance at 4 years of age was most pronounced in the severe form (all P < 0.05). CONCLUSIONS Early assessments of neonatal respiratory status including Toce clinical score and the severity of BPD are valid to identify VLBW preterm infants who are at risk of adverse longitudinal respiratory health outcomes.
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Affiliation(s)
- Hong-Ji Luo
- Department of Physical Therapy and Assistive Technology, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Li-Ying Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Shan Chen
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Departments of Pediatrics, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Steven Peng
- Department of Radiology, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
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9
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Endesfelder S, Strauß E, Scheuer T, Schmitz T, Bührer C. Antioxidative effects of caffeine in a hyperoxia-based rat model of bronchopulmonary dysplasia. Respir Res 2019; 20:88. [PMID: 31077204 PMCID: PMC6511176 DOI: 10.1186/s12931-019-1063-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background While additional oxygen supply is often required for the survival of very premature infants in intensive care, this also brings an increasing risk of progressive lung diseases and poor long-term lung outcomes. Caffeine is administered to neonates in neonatal intensive care for the prevention and treatment of apneas and has been shown to reduce BPD incidence and the need for mechanical ventilation, although it is still unclear whether this is due to a direct pulmonary action via antagonism of adenosine receptors and/or an indirect action. This experimental study aims to investigate the action of caffeine on the oxidative stress response in pulmonary tissue in a hyperoxia-based model of bronchopulmonary dysplasia in newborn rats. Methods Newborn Wistar rats were exposed to 21% or 80% oxygen for 3 (P3) or 5 (P5) postnatal days with or without recovery on room air until postnatal day 15 (P15) and treated with vehicle or caffeine (10 mg/kg) every 48 h beginning on the day of birth. The lung tissue of the rat pups was examined for oxidative stress response at P3 and P5 immediately after oxygen exposure or after recovery in ambient air (P15) by immunohistological staining and analysis of lung homogenates by ELISA and qPCR. Results Lungs of newborn rats, corresponding to the saccular stage of lung development and to the human lung developmental stage of preterms, showed increased rates of total glutathione and hydrogen peroxide, oxidative damage to DNA and lipids, and induction of second-phase mediators of antioxidative stress response (superoxide dismutase, heme oxygenase-1, and the Nrf2/Keap1 system) in response to hyperoxia. Caffeine reduced oxidative DNA damage and had a protective interference with the oxidative stress response. Conclusion In addition to the pharmacological antagonism of adenosine receptors, caffeine appears to be a potent antioxidant and modulates the hyperoxia-induced pulmonary oxidative stress response and thus protective properties in the BPD-associated animal model. Free-radical-induced damage caused by oxidative stress seems to be a biological mechanism progress of newborn diseases. New aspects of antioxidative therapeutic strategies to passivate oxidative stress-related injury should be in focus of further investigations. Electronic supplementary material The online version of this article (10.1186/s12931-019-1063-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefanie Endesfelder
- Department of Neonatology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Evelyn Strauß
- Department of Neonatology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Till Scheuer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Schmitz
- Department of Neonatology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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10
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Halil H, Buyuktiryaki M, Atay FY, Oncel MY, Uras N. Reopening of the ductus arteriosus in preterm infants; Clinical aspects and subsequent consequences. J Neonatal Perinatal Med 2019; 11:273-279. [PMID: 30149471 DOI: 10.3233/npm-17136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patent ductus arteriosus is a common problem frequently encountered in preterm infants. We aimed to study the risk factors associated with reopening of patent ductus arteriosus and their short term outcomes in preterm infants. METHODS A total of 162 preterm infants born between November 2013 and December 2015 with gestaional age less than 32 weeks and treated for hemodynamically significant patent ductus arteriosus are included in our study. RESULTS 113(69.8%) showed permanent closure and 49(30.2%) infants revealed symptoms of reopening after effective closure of patent ductus arteriosus. Low birth weight and small gestational age were more common in reopening group. Multivariete analysis showed that sepsis and multiple courses of drug treatment were independent factors affecting reopening of hemodynamically significant patent ductus arteriosus (OR: 3.01, 95% CI 1.48-6.13, p = 0.002) and (OR: 2.67, 95% CI 1.23-5.82, p = 0.013) respectively. Reopened group had a remarkable higher rate of developing necrotising nnterocolitis, bronchopulmonary dysplasia and retinopathy of prematurity than the closed group. (16.3% vs 4.4%, p = 0.01, 55.1% vs 28.3%, p = 0.001 and 55.1% vs 23.0%, p = 0.0001 respectively). CONCLUSION Late neonatal sepsis and the need of multiple drug courses to close patent ductus arteriosus are risk factors affecting the reopening of patent ductus arteriosus in preterm infants.
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Affiliation(s)
- H Halil
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - M Buyuktiryaki
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - F Yavanoglu Atay
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - M Yekta Oncel
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - N Uras
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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11
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Vrijlandt EJLE, Reijneveld SA, Aris-Meijer JL, Bos AF. Respiratory Health in Adolescents Born Moderately-Late Preterm in a Community-Based Cohort. J Pediatr 2018; 203:429-436. [PMID: 30266509 DOI: 10.1016/j.jpeds.2018.07.083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/14/2018] [Accepted: 07/25/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the long-term effects of moderately-late preterm (MLP) birth on respiratory and allergic symptoms, lung function, and exercise capacity in adolescence. STUDY DESIGN Outcome variables in this prospective cohort were prevalence of symptoms determined by International Study of Asthma and Allergies in Childhood questionnaires, lung function, and exercise measures. RESULTS Response rate was 47% and did not vary importantly by background characteristics. In total, 71 children (aged 13-14 years) participated in the measurements, 37 born MLP and 34 born full term. Both groups were comparable in height, weight, and exercise activities but differed in gestational age (MLP 34 ± 1 weeks, full term 39 ± 0.9 weeks) and birth weight (MLP 2442 ± 539 g, full term 3693 ± 393 g). Adolescents born MLP reported more (dry) cough (MLP 25% vs those born full term 3%, P = .016) and hay fever (MLP 34% vs those born full term 9%, P = .015). Adolescents born MLP did not report more wheeze, dyspnea, asthma, and eczema. Most lung function measurements were within the normal range for both groups, except peak expiratory flow (MLP 86% of predicted vs those born full term 93%, P = .05) and maximum expiratory flow when 75% of the forced vital capacity has been exhaled (MLP 86% predicted vs those born full term 96% predicted, P = .06), which were at the lower limit of normal. We observed no differences between the groups in exercise parameters. CONCLUSION Moderately late preterm birth has little effect on respiratory health in adolescence. Adolescents born MLP report few symptoms, have only slightly more lung function abnormalities than those born full term, and do not differ in the maximal exercise test and in physical activity level. TRIAL REGISTRATION ISRCTN 80622320.
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Affiliation(s)
- Elianne J L E Vrijlandt
- Department of Pediatrics, Pediatric Pulmonology, Beatrix Children's Hospital Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Judith L Aris-Meijer
- Department of Epidemiology and Bioinformatics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Department of Paediatrics, Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Okur N, Tayman C, Büyüktiryaki M, Kadıoğlu Şimşek G, Ozer Bekmez B, Altuğ N. Can lactate levels be used as a marker of patent ductus arteriosus in preterm babies? J Clin Lab Anal 2018; 33:e22664. [PMID: 30175415 DOI: 10.1002/jcla.22664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Serum lactate levels provide information on metabolic capacity at the cellular level. In addition, lactate reflects tissue perfusion and oxygenation status. The aim of this study was to determine the usefulness of high lactate levels as a marker in hemodynamically significant patent ductus arteriosus (hsPDA), which may lead to tissue perfusion defects. METHODS Preterm infants with gestational age ≤32 weeks and birthweight ≤1500 g were included. Lactate levels were determined at postnatal 48-72 hours before echocardiographic evaluation. Eligible infants were divided into two groups as infants with and without hsPDA. Cut-off values for lactate were taken as lactate >4 mmol/L, identified as a high lactate level. Infants were also divided into two groups according to lactate levels as group I: lactate levels >4 mmol/L and group II: lactate levels ≤4 mmol/L. Haemodynamic PDA and lactate levels were compared. RESULTS A total of 119 patients with gestational age ≤32 weeks and birthweight ≤1500 g were included in the study. Fifty patients had echocardiographic hsPDA and 69 patients had no PDA. Twelve (24%) of the patients with hsPDA and 22 (31.9%) of the non-hsPDA patients had a lactate level of 4 mmol/L (P = 0.392). There was no correlation between hsPDA presence and lactate levels (P = 0.35). CONCLUSION High lactate levels are multifactorial and usually indicate impairment of tissue perfusion. There are a number of factors that can lead to impaired tissue perfusion in preterm infants. For the first time in this study, it was shown that lactate levels did not significantly increase in the presence of hemodynamically significant PDA. This may be due to the fact that peripheral tissue perfusion in the presence of hemodynamic PDA does not deteriorate enough to cause an increase in anaerobic metabolism.
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Affiliation(s)
- Nilüfer Okur
- Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Cüneyt Tayman
- Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Mehmet Büyüktiryaki
- Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Buse Ozer Bekmez
- Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Nahide Altuğ
- Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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13
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Sindičić Dessardo N, Mustać E, Banac S, Dessardo S. Paths of causal influence from prenatal inflammation and preterm gestation to childhood asthma symptoms. J Asthma 2018; 56:823-832. [PMID: 29972330 DOI: 10.1080/02770903.2018.1493603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Long-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. The aim was to investigate paths of assumed causality leading from foetal inflammatory response syndrome (FIRS) to asthma symptoms in preterms. Methods: Demographic, antenatal, delivery and outcome data were collected from 262 infants with less than 32 completed weeks of gestational age over a 10-year period in a prospective cohort study. The presence of symptoms of asthma beyond the age of 5 years was the primary outcome measure. The causal effect of FIRS on childhood asthma was tested with three different logistic regression models and two structural equation models (SEM). Results: FIRS (OR = 4.7) and subsequent chronic lung disease of prematurity (OR = 7.7) and early childhood wheezing (OR = 9.5) are the most important risk factors for development of asthma symptoms in children born with less than 32 weeks of gestational age. The path analysis showed that FIRS has a large direct (0.59), medium indirect (0.11) and large overall (0.70) effect on CLD; large negative direct effect on ECW (-0.34) and a large positive indirect effect (0.74), mediated by CLD. On the occurrence of asthma symptoms, FIRS has a medium negative direct effect (-0.18) and a medium positive indirect effect (0.26), mediated by CLD and ECW. Conclusion: Prenatal inflammation plays an important role in the development of chronic respiratory disturbances in preterm infants. This influence is mainly related to structural and developmental lung abnormalities initiated in utero as consequences of FIRS, resulting in CLD of prematurity, and overcoming the protective mechanisms of chorioamnionitis.
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Affiliation(s)
| | - Elvira Mustać
- a Department of Pediatrics, University of Rijeka , Rijeka , Croatia
| | - Srdjan Banac
- a Department of Pediatrics, University of Rijeka , Rijeka , Croatia
| | - Sandro Dessardo
- a Department of Pediatrics, University of Rijeka , Rijeka , Croatia
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14
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Krishnan S, Dozor AJ, Bacharier L, Lang JE, Irvin CG, Kaminsky D, Farber HJ, Gerald L, Brown M, Holbrook JT, Wise RA, Ryu J, Bose S, Yasin R, Saams J, Henderson RJ, Teague WG. Clinical characterization of children with resistant airflow obstruction, a multicenter study. J Asthma 2018; 56:611-617. [PMID: 29771599 DOI: 10.1080/02770903.2018.1477956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To characterize a cohort of children with airflow limitation resistant to bronchodilator (BD) therapy. METHODS Pulmonary function tests performed in children 6-17 years of age at 15 centers in a clinical research consortium were screened for resistant airflow limitation, defined as a post-BD FEV1 and/or an FEV1/FVC less than the lower limits of normal. Demographic and clinical data were analyzed for associations with pulmonary function. RESULTS 582 children were identified. Median age was 13 years (IQR: 11, 16), 60% were males; 62% were Caucasian, 28% were African-American; 19% were obese; 32% were born prematurely and 21% exposed to second hand smoke. Pulmonary diagnoses included asthma (93%), prior significant pneumonia (28%), and bronchiectasis (5%). 65% reported allergic rhinitis, and 11% chronic sinusitis. Subjects without a history of asthma had significantly lower post-BD FEV1% predicted (p = 0.008). Subjects without allergic rhinitis had lower post-BD FEV1% predicted (p = 0.003). Children with allergic rhinitis, male sex, obesity and Black race had better pulmonary function post-BD. There was lower pulmonary function in children after age 11 years without a history of allergic rhinitis, as compared to those with a history of allergic rhinitis. CONCLUSIONS The most prevalent diagnosis in children with BD-resistant airflow limitation is asthma. Allergic rhinitis and premature birth are common co-morbidities. Children without a history of asthma, as well as those with asthma but no allergic rhinitis, had lower pulmonary function. Children with BD-resistant airflow limitation may represent a sub-group of children with persistent obstruction and high risk for life-long airway disease.
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Affiliation(s)
- Sankaran Krishnan
- a Division of Pediatric Pulmonology, Allergy and Sleep Medicine , New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY
| | - Allen J Dozor
- a Division of Pediatric Pulmonology, Allergy and Sleep Medicine , New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY
| | - Leonard Bacharier
- b Division of Allergy, Immunology and Pulmonary Medicine , Washington University School of Medicine at St Louis , Seattle , WA
| | - Jason E Lang
- c Division of Pulmonary and Sleep Medicine, Dept. Of Pediatrics , Duke Univ. School of medicine , Durham , NC
| | - Charles G Irvin
- d Department of Medicine , University of Vermont , Burlington , VT
| | - David Kaminsky
- d Department of Medicine , University of Vermont , Burlington , VT
| | - Harold J Farber
- e Pediatric Pulmonology , Baylor College of Medicine and Texas Children's Hospital , Houston , TX
| | - Lynn Gerald
- f College of Public Health , University of Arizona , Tucson , AZ
| | - Mark Brown
- f College of Public Health , University of Arizona , Tucson , AZ
| | - Janet T Holbrook
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - Robert A Wise
- h Pulmonary Medicine , Johns Hopkins University , Baltimore , MD
| | - Julie Ryu
- i Pulmonary Medicine, Rady Children's Hospital , University of California at San Diego , San Diego , CA
| | - Sonali Bose
- h Pulmonary Medicine , Johns Hopkins University , Baltimore , MD
| | - Razan Yasin
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - Joy Saams
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - Robert J Henderson
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - William G Teague
- j Pediatric Pulmonology , University of Virginia , Charlottesville , VA
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15
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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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16
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Kaczmarczyk K, Wiszomirska I, Szturmowicz M, Magiera A, Błażkiewicz M. Are preterm-born survivors at risk of long-term respiratory disease? Ther Adv Respir Dis 2017; 11:277-287. [PMID: 28614994 PMCID: PMC5933633 DOI: 10.1177/1753465817710595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the long-term impact of preterm birth on respiratory function in female patients born preterm, we undertook spirometric examinations twice, as they reached the age of puberty, then follow-up examinations of part of the same cohort in adulthood. We sought evidence that preterm birth is correlated with poorer spirometric results into adulthood. METHODS A total of 70 girls (aged 12.2 ± 1.5 years in 1997) who had been born preterm (at 34.7 ± 1.86 weeks, none having experienced bronchopulmonary dysplasia) took part in spriometric examinations in 1997 and again in 1998. Of those, after a gap of 17 years, a group of 12 were successfully recontacted and participated in the 2015 examination as adults (then aged 27.6 ± 2.6 years, born at 34.5 ± 1.92 weeks). We compared spirometric results across the adolescent and adult examinations, and compared the adult results with an adult reference group. RESULTS The percentage values of FEV1 (forced expiratory volume in 1 s), FVC (forced vital capacity) and MVV (maximal voluntary ventilation) showed significant improvement between the two examinations in the early adolescent period. In adulthood, FEV1%pred (percentage predicted forced expiratory volume in 1 s) showed no statistically significant difference. The mean values of both FVC and FVC%pred (percentage predicted forced vital capacity) for the preterm-born group were lower than for the reference group, but this was not statistically significant. The preterm-born group showed lower values of such parameters as forced expiratory flow at 25-75% of FVC, MEF25 (maximal expiratory flow at 25% of forced vital capacity) and FEV1/FVC as compared with the reference group, but again without statistical significance. CONCLUSIONS (1) A somewhat below-norm level of respiratory parameters among preterm-born girls entering pubescence may attest to continued negative impact on their respiratory system. (2) A significant improvement in their spirometric results 1 year later may indicate that pubescence helps compensate for the earlier negative effect of preterm birth. (3) No significant differences were seen in lung function in preterm-born adults as compared with a reference group of adults, although the preterm-born group did exhibit lower values of all parameters studied and more frequent obstructive disorders.
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Affiliation(s)
- Katarzyna Kaczmarczyk
- Head of Physiology Department, Faculty of
Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw,
Marymoncka 34 Street, Warsaw, Poland
| | - Ida Wiszomirska
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Magdalena Szturmowicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Andrzej Magiera
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Michalina Błażkiewicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
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17
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de Wijs-Meijler DP, Duncker DJ, Tibboel D, Schermuly RT, Weissmann N, Merkus D, Reiss IK. Oxidative injury of the pulmonary circulation in the perinatal period: Short- and long-term consequences for the human cardiopulmonary system. Pulm Circ 2017; 7:55-66. [PMID: 28680565 PMCID: PMC5448552 DOI: 10.1086/689748] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/22/2016] [Indexed: 01/09/2023] Open
Abstract
Development of the pulmonary circulation is a complex process with a spatial pattern that is tightly controlled. This process is vulnerable for disruption by various events in the prenatal and early postnatal periods. Disruption of normal pulmonary vascular development leads to abnormal structure and function of the lung vasculature, causing neonatal pulmonary vascular diseases. Premature babies are especially at risk of the development of these diseases, including persistent pulmonary hypertension and bronchopulmonary dysplasia. Reactive oxygen species play a key role in the pathogenesis of neonatal pulmonary vascular diseases and can be caused by hyperoxia, mechanical ventilation, hypoxia, and inflammation. Besides the well-established short-term consequences, exposure of the developing lung to injurious stimuli in the perinatal period, including oxidative stress, may also contribute to the development of pulmonary vascular diseases later in life, through so-called "fetal or perinatal programming." Because of these long-term consequences, it is important to develop a follow-up program tailored to adolescent survivors of neonatal pulmonary vascular diseases, aimed at early detection of adult pulmonary vascular diseases, and thereby opening the possibility of early intervention and interfering with disease progression. This review focuses on pathophysiologic events in the perinatal period that have been shown to disrupt human normal pulmonary vascular development, leading to neonatal pulmonary vascular diseases that can extend even into adulthood. This knowledge may be particularly important for ex-premature adults who are at risk of the long-term consequences of pulmonary vascular diseases, thereby contributing disproportionately to the burden of adult cardiovascular disease in the future.
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Affiliation(s)
- Daphne P. de Wijs-Meijler
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk J. Duncker
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dick Tibboel
- Intensive Care Unit, Department of Pediatric Surgery, Sophia Children’s Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ralph T. Schermuly
- University of Giessen and Marburg Lung Center (UGMLC), Excellence Cluster Cardio-Pulmonary Systems (ECCPS), Department of Internal Medicine, Members of the German Center for Lung Research, Justus-Liebig-University, Giessen, Germany
| | - Norbert Weissmann
- University of Giessen and Marburg Lung Center (UGMLC), Excellence Cluster Cardio-Pulmonary Systems (ECCPS), Department of Internal Medicine, Members of the German Center for Lung Research, Justus-Liebig-University, Giessen, Germany
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K.M. Reiss
- Division of Neonatology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Sheikh K, Bhalla A, Ouriadov A, Young HM, Yamashita CM, Luu TM, Katz S, Parraga G. Pulmonary magnetic resonance imaging biomarkers of lung structure and function in adult survivors of bronchopulmonary dysplasia with COPD. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1282033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Khadija Sheikh
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
- Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
| | - Anurag Bhalla
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
| | - Alexei Ouriadov
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
| | - Heather M. Young
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
- Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
| | - Cory M. Yamashita
- Division of Respirology, Department of Medicine, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
| | - Thuy Mai Luu
- Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montréal, Canada
| | - Sherri Katz
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Grace Parraga
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
- Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St, London, Canada N6A 5B7
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19
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Hildebrand M, Øglund GP, Wells JC, Ekelund U. Prenatal, birth and early life predictors of sedentary behavior in young people: a systematic review. Int J Behav Nutr Phys Act 2016; 13:63. [PMID: 27268003 PMCID: PMC4897914 DOI: 10.1186/s12966-016-0389-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to systematically summarize the evidence on whether prenatal, birth and early life factors up to 6 years of age predict sedentary behavior in young people (≤18 years). METHODS PRISMA guidelines were followed, and searches were conducted in PubMed, SPORTDiscus, EMBASE and Web of Science up to December 1, 2015. We included observational (non-intervention) and longitudinal studies, that reported data on the association between one or more of the potential predictors and objectively or subjectively measured sedentary behavior. Study quality was assessed using a formal checklist and data extraction was performed using standardized forms independently by two researchers. RESULTS More than 18,000 articles were screened, and 16 studies, examining 10 different predictors, were included. Study quality was variable (0.36-0.95). Two studies suggest that heritability and BMI in children aged 2-6 years were significant predictors of sedentary behavior later in life, while four and seven studies suggest no evidence for an association between gestational age, birth weight and sedentary behavior respectively. There was insufficient evidence whether other prenatal, birth and early life factors act as predictors of later sedentary behavior in young people. CONCLUSION The results suggest that heritability and early childhood BMI may predict sedentary behavior in young people. However, small number of studies included and methodological limitations, including subjective and poorly validated sedentary behavior assessment, limits the conclusions. TRIAL REGISTRATION The systematic review is registered in the International Prospective Register of Systematic Reviews, PROSPERO, 17.10.2014 ( CRD42014014156 ).
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Affiliation(s)
- Maria Hildebrand
- The Department of Sports Medicine, Norwegian School of Sport Sciences, P.O Box 4014, Ullevål Stadion, 0806, Oslo, Norway.
| | - Guro P Øglund
- The Department of Sports Medicine, Norwegian School of Sport Sciences, P.O Box 4014, Ullevål Stadion, 0806, Oslo, Norway
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - Ulf Ekelund
- The Department of Sports Medicine, Norwegian School of Sport Sciences, P.O Box 4014, Ullevål Stadion, 0806, Oslo, Norway.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
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20
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Abstract
RATIONALE Preterm birth, and its often-required medical interventions, can result in respiratory and gas exchange deficits into childhood. However, the long-term sequelae into adulthood are not well understood. OBJECTIVES To determine exercise capacity and pulmonary gas exchange efficiency during exercise in adult survivors of preterm birth. METHODS Preterm (n = 14), very low birth weight (<1,500 g) adults (20-23 yr) and term-born, age-matched control subjects (n = 16) performed incremental exercise on a cycle ergometer to volitional exhaustion while breathing one of two oxygen concentrations: normoxia (fraction of inspired oxygen, 0.21) or hypoxia (fraction of inspired oxygen, 0.12). MEASUREMENTS AND MAIN RESULTS Ventilation, mixed expired gases, arterial blood gases, power output, and oxygen consumption were measured during rest and exercise. We calculated the alveolar-to-arterial oxygen difference to determine pulmonary gas exchange efficiency. Preterm subjects had lower power output at volitional exhaustion than did control subjects in normoxia (150 ± 10 vs. 180 ± 10 W; P = 0.01), despite similar normoxic oxygen consumption. However, during hypoxic exercise, there was no difference in power output at volitional exhaustion between the two groups (116 ± 10 vs. 135 ± 10 W; P = 0.11). Preterm subjects also exhibited a more acidotic, acid-base balance throughout exercise compared with control subjects. In contrast to other studies, adults born preterm, as a group developed a wider alveolar-to-arterial oxygen difference and lower PaO2 than did control subjects during normoxic but not hypoxic exercise. CONCLUSIONS This study demonstrates that pulmonary gas exchange efficiency is lower in some adult survivors of preterm birth during exercise compared with control subjects. The gas exchange inefficiency, when present, is accompanied by low arterial blood oxygen tension. Preterm subjects also exhibit reduced power output. Overall, our findings suggest potential long-term consequences of extreme preterm birth and very low birth weight on cardiopulmonary function.
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21
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Okur N, Buyuktiryaki M, Uras N, Oncel MY, Ertekin O, Canpolat FE, Oguz SS. Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities? J Matern Fetal Neonatal Med 2015; 29:3218-22. [PMID: 26697923 DOI: 10.3109/14767058.2015.1121475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Platelet mass index (PMI) is related to the platelet functionality. The aim of this study was to evaluate the correlation between PMI and the occurrence of various inflammation-related morbidities of prematurity, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis in very low-birth weight (VLBW) infants. METHODS This retrospective analysis of VLBW infants admitted to a level 3 neonatal intensive care unit from October 2012 and 2014, n = 330. Platelet mass was calculated and recorded on the day of birth and between 3 and 7 days (second measure) for each patient. Statistical analysis included analysis of paired samples t test and independent samples t test. RESULT Among VLBW neonates, PMI values were lower in infants with ROP (p = 0.016), BPD (p = 0.002), IVH (p = 0.018) and NEC (p = 0.011) when compared with the control group in the second measurement. CONCLUSIONS In this study, we found that premature infants with BPD, NEC, ROP, IVH and sepsis had lower PMI levels in early postnatal life than infants without these diseases. This might be associated with the inflammatory process.
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Affiliation(s)
- Nilufer Okur
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Mehmet Buyuktiryaki
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Nurdan Uras
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Mehmet Yekta Oncel
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Omer Ertekin
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Fuat Emre Canpolat
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
| | - Serife Suna Oguz
- a Division of Neonatology , Zekai Tahir Burak Maternity Teaching Hospital , Ankara , Turkey
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Bray L, Shaw NJ, Snodin J. Living and managing with the long-term implications of neonatal chronic lung disease: The experiences and perspectives of children and their parents. Heart Lung 2015; 44:512-6. [DOI: 10.1016/j.hrtlng.2015.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/23/2015] [Accepted: 08/10/2015] [Indexed: 12/01/2022]
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Ventilatory and sensory responses in adult survivors of preterm birth and bronchopulmonary dysplasia with reduced exercise capacity. Ann Am Thorac Soc 2015; 11:1528-37. [PMID: 25380058 DOI: 10.1513/annalsats.201312-466oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Adults born very to extremely preterm, with or without bronchopulmonary dysplasia (BPD), have obstructive lung disease, but it is unknown whether this results in respiratory limitations, such as mechanical constraints to Vt expansion during exercise leading to intolerable dyspnea and reduced exercise tolerance, as it does in patients with chronic obstructive pulmonary disease. OBJECTIVES To test the hypothesis that adult survivors of preterm birth (≤32 wk gestational age) with (n = 20) and without BPD (n = 15) with reduced exercise capacity demonstrate clinically important respiratory limitations at near-maximal exercise compared with full-term control subjects (n = 20). METHODS Detailed ventilatory and sensory measurements were made before and during exercise on all patients in the three study groups. MEASUREMENTS AND MAIN RESULTS During exercise at 90% of peak [Formula: see text]o2 ([Formula: see text]o2peak), inspiratory reserve volume decreased to ∼0.5 L in all groups, but this occurred at significantly lower absolute workloads and [Formula: see text]e in ex-preterm subjects with and without BPD compared with full-term control subjects. Severe dyspnea was present and similar at comparable [Formula: see text]e between all groups, but leg discomfort at comparable workloads was greater in ex-preterm subjects with and without BPD compared with control subjects. At 50 to 90% of [Formula: see text]o2peak, exercise-induced expiratory flow limitation was significantly greater in ex-preterm subjects with BPD compared with ex-preterm subjects without BPD and control subjects. The degree of expiratory flow limitation in ex-preterm subjects with and without BPD was significantly related to neonatal O2 therapy duration. CONCLUSIONS Severe dyspnea and leg discomfort associated with critical constraints on Vt expansion may lead to reduced exercise tolerance in adults born very or extremely preterm, whether or not their birth was complicated by BPD and despite differences in expiratory flow limitation. In this regard, adults born very or extremely preterm have respiratory limitations to exercise similar to patients with chronic obstructive pulmonary disease.
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HIF-1α Plays a Critical Role in the Gestational Sidestream Smoke-Induced Bronchopulmonary Dysplasia in Mice. PLoS One 2015; 10:e0137757. [PMID: 26361040 PMCID: PMC4567349 DOI: 10.1371/journal.pone.0137757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
Rationale Smoking during pregnancy increases the risk of bronchopulmonary dysplasia (BPD) and, in mice, gestational exposure to sidestream cigarette smoke (SS) induces BPD-like condition characterized by alveolar simplification, impaired angiogenesis, and suppressed surfactant protein production. Normal fetal development occurs in a hypoxic environment and nicotinic acetylcholine receptors (nAChRs) regulate the hypoxia-inducible factor (HIF)-1α that controls apoptosis and angiogenesis. To understand SS-induced BPD, we hypothesized that gestational SS affected alveolar development through HIF-1α. Methods Pregnant BALB/c mice were exposed to air (control) or SS throughout the gestational period and the 7-day-old lungs of the progeny were examined. Results Gestational SS increased apoptosis of alveolar and airway epithelial cells. This response was associated with increased alveolar volumes, higher levels of proapoptotic factors (FOXO3a, HIPK2, p53, BIM, BIK, and BAX) and the antiangiogenic factor (GAX), and lower levels of antiapoptotic factors (Akt-PI3K, NF-κB, HIF-1α, and Bcl-2) in the lung. Although gestational SS increased the cells containing the proangiogenic bombesin-like-peptide, it markedly decreased the expression of its receptor GRPR in the lung. The effects of SS on apoptosis were attenuated by the nAChR antagonist mecamylamine. Conclusions Gestational SS-induced BPD is potentially regulated by nAChRs and associated with downregulation of HIF-1α, increased apoptosis of epithelial cells, and increased alveolar volumes. Thus, in mice, exposure to sidestream tobacco smoke during pregnancy promotes BPD-like condition that is potentially mediated through the nAChR/HIF-1α pathway.
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Lowe J, Watkins WJ, Kotecha SJ, Edwards MO, Henderson AJ, Kotecha S. Physical activity in school-age children born preterm. J Pediatr 2015; 166:877-83. [PMID: 25601656 DOI: 10.1016/j.jpeds.2014.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/29/2014] [Accepted: 12/04/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare objectively measured physical activity in 11- and 15-year-old children who were born preterm with term-born controls and related physical activity measures to lung function measures. STUDY DESIGN We used data from the Avon Longitudinal Study of Parents and Children. We compared total physical activity, moderate-to-vigorous physical activity, and sedentary behavior between children born at 25-32, 33-34, 35-36, and 37-43 weeks' gestation at ages 11 and 15 years. At age 11 years, physical activity measures were correlated with lung spirometry recorded at age 7-9 years. RESULTS Valid physical activity data at age 11 years were available for 5025, 197, 57, and 48 children born at 37-43, 35-36, 33-34, and 25-32 weeks' gestation, respectively. At age 15 years, valid physical activity data were available for 1829, 62, 32, and 24 children born at 37-43, 35-36, 33-34, and 25-32 weeks' gestation. Boys were more physically active than girls at both ages. There were no differences in total physical activity, moderate-to-vigorous physical activity, or sedentary behavior in children between the different gestation groups. Physical activity at age 11 years did not correlate with spirometry measures at age 7-9 years. CONCLUSIONS Physical activity was similar for the different gestational groups and did not correlate with lung spirometry. Physical activity does not appear to be limited in preterm-born children despite lung function deficits noted in childhood.
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Affiliation(s)
- John Lowe
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - W John Watkins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Martin O Edwards
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - A John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom.
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Kotecha SJ, Edwards MO, Watkins WJ, Lowe J, Henderson AJ, Kotecha S. Effect of bronchodilators on forced expiratory volume in 1 s in preterm-born participants aged 5 and over: a systematic review. Neonatology 2015; 107:231-240. [PMID: 25721674 DOI: 10.1159/000371539] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/15/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Preterm-born participants are at risk of long-term deficits in percentage predicted forced expiratory volume in 1 s (%FEV1). Since it is unclear if these deficits respond to bronchodilators, we systematically reviewed the evidence for reversibility of deficits in %FEV1 by bronchodilators in preterm-born participants. DESIGN Studies reporting a change in %FEV1 in response to bronchodilator treatment in preterm-born participants at ≥5 years of age, with or without a term-born control group, were identified. The quality of studies was assessed by adapted tools. Due to considerable heterogeneity between studies, formal meta-analysis was not possible. RESULTS From 8,839 titles, 22 studies were identified after an updated search in May 2013. Twenty-one studies assessed the response to a single inhaled dose of a bronchodilator, and 1 study assessed longer-term effects. Most studies observed decreased %FEV1 in preterm-born participants compared with controls. Most studies observed improved %FEV1 after a single dose of bronchodilator, with the largest improvements noted in those with bronchopulmonary dysplasia, who had greater deficits of %FEV1 when compared with preterm and term controls. One long-term study investigated a 2-week terbutaline administration, but the initial FEV1 after a single dose did not show a change in %FEV1 of ≥15%, but 5/29 (17%) children had an increased %FEV1 of ≥10%. CONCLUSIONS In this systematic review, disparate studies were identified. Although single doses of bronchodilators appear to improve the FEV1 in the short term, further studies are required to assess their longer-term benefits not only on airway obstruction, but also their effect on respiratory symptoms.
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Berger J, Bhandari V. Animal models of bronchopulmonary dysplasia. The term mouse models. Am J Physiol Lung Cell Mol Physiol 2014; 307:L936-47. [PMID: 25305249 DOI: 10.1152/ajplung.00159.2014] [Citation(s) in RCA: 186] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The etiology of bronchopulmonary dysplasia (BPD) is multifactorial, with genetics, ante- and postnatal sepsis, invasive mechanical ventilation, and exposure to hyperoxia being well described as contributing factors. Much of what is known about the pathogenesis of BPD is derived from animal models being exposed to the environmental factors noted above. This review will briefly cover the various mouse models of BPD, focusing mainly on the hyperoxia-induced lung injury models. We will also include hypoxia, hypoxia/hyperoxia, inflammation-induced, and transgenic models in room air. Attention to the stage of lung development at the timing of the initiation of the environmental insult and the duration of lung injury is critical to attempt to mimic the human disease pulmonary phenotype, both in the short term and in outcomes extending into childhood, adolescence, and adulthood. The various indexes of alveolar and vascular development as well as pulmonary function including pulmonary hypertension will be highlighted. The advantages (and limitations) of using such approaches will be discussed in the context of understanding the pathogenesis of and targeting therapeutic interventions to ameliorate human BPD.
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Affiliation(s)
- Jessica Berger
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Vineet Bhandari
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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Pulmonary hemosiderosis in children with bronchopulmonary dysplasia. Case Rep Pediatr 2014; 2014:876195. [PMID: 25309768 PMCID: PMC4182842 DOI: 10.1155/2014/876195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/27/2014] [Indexed: 11/17/2022] Open
Abstract
We describe a possible association between pulmonary hemosiderosis (PH) and a history of bronchopulmonary dysplasia (BPD). Both patients were born at 28-week gestation and presented with PH at ages 22 months and 6 years, respectively. Both initially presented with cough and tachypnea, and bronchoalveolar lavage showed evidence of hemosiderin-laden macrophages. Initial hemoglobin levels were < 4 g/dL and chest radiographs showed diffuse infiltrates that cleared dramatically within days after initiation of intravenous corticosteroids. In the first case, frank pulmonary blood was observed upon initial intubation, prompting the need for high frequency ventilation, immediate corticosteroids, and antibiotics. The mechanical ventilation wean was made possible by the addition of mycophenolate mofetil (MMF) and hydroxychloroquine. Slow tapering off of medications was accomplished over 6 years. These cases represent a possible correlation between prematurity-associated BPD and PH. We present a review of the literature regarding this possible association. In addition, MMF proved to be life-saving in one of the PH cases, as it has been in pulmonary hemorrhage related to systemic lupus erythematosus. Further studies are warranted to investigate the possible association between PH and prematurity-related BPD, as well as the use of MMF in the treatment of PH.
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Dessardo NS, Dessardo S, Mustać E, Banac S, Petrović O, Peter B. Chronic lung disease of prematurity and early childhood wheezing: is foetal inflammatory response syndrome to blame? Early Hum Dev 2014; 90:493-9. [PMID: 25051540 DOI: 10.1016/j.earlhumdev.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/29/2014] [Accepted: 07/01/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Long-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. AIMS We aimed to investigate the perinatal and maternal risk factors involved in the development of chronic respiratory morbidity in preterm infants, with an emphasis on the importance of Foetal Inflammatory Response Syndrome (FIRS). STUDY DESIGN Prospective cohort study. SUBJECTS Demographic, antenatal, delivery and outcomes data were collected from 262 infants with less than 32 completed weeks of gestational age, over a 10-year period. OUTCOME MEASURES Presence of chronic lung disease of prematurity and early childhood wheezing. RESULTS In multivariate logistic regression analysis the presence of FIRS appears to be the most important risk factor for both, chronic lung disease of prematurity (OR 31.05, 95% CI 10.7-87.75, p<0.001) and early childhood wheezing (OR 5.63, 95% CI 2.42-13.05, p=0.01). In the alternative regression model for early childhood wheezing, with chronic lung disease included as a variable, the statistical significance of FIRS completely vanished (OR 1.15, 95% CI 0.39-3.34, p=0.79), whilst chronic lung disease became the most important risk factor (OR 23.45, 95% CI 8.5-63.25, p<0.001). CONCLUSIONS Prenatal and early neonatal events are of utmost importance in the development of chronic respiratory symptoms in children. The influence of FIRS on the development of chronic respiratory symptoms goes far beyond its impact on gestational age and may be related to direct inflammation-mediated lung tissue damage. CLD appears to be an intermittent step on the way from FIRS to ECW.
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Affiliation(s)
| | - Sandro Dessardo
- Department of Pediatrics, University Hospital Center Rijeka, Croatia.
| | - Elvira Mustać
- Institute of Pathology, University of Rijeka, Croatia.
| | - Srđan Banac
- Department of Pediatrics, University of Rijeka, Croatia.
| | - Oleg Petrović
- Institute of Perinatology, Department of Gynecology and Obstetrics, University Hospital Center Rijeka, Croatia.
| | - Branimir Peter
- Institute of Neonatology, Department of Gynecology and Obstetrics, University Hospital Center Rijeka, Croatia.
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Paek DS, Sakurai R, Saraswat A, Li Y, Khorram O, Torday JS, Rehan VK. Metyrapone alleviates deleterious effects of maternal food restriction on lung development and growth of rat offspring. Reprod Sci 2014; 22:207-22. [PMID: 24916330 DOI: 10.1177/1933719114537712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Maternal food restriction (MFR) causes intrauterine growth restriction, a known risk factor for developing chronic lung disease. However, it is unknown whether this negative outcome is gender specific or preventable by blocking the MFR-induced hyperglucocorticoidism. Using a well-established rat model, we used metyrapone (MTP), an inhibitor of glucocorticoid synthesis, to study the MFR-induced lung changes on postnatal day (p) 21 in a gender-specific manner. From embryonic day 10 until delivery, pregnant dams were fed either an ad libitum diet or a 50% caloric restricted diet with or without MTP supplementation. Postnatally, the offspring were fed ad libitum from healthy dams until p21. Morphometric, Western blot, and immunohistochemical analysis of the lungs demonstrated that MTP mitigated the MFR-mediated decrease in alveolar count, decrease in adipogenic protein peroxisome proliferator-activated receptor γ, increase in myogenic proteins (fibronectin, α-smooth muscle actin, and calponin), increase in Wnt signaling intermediates (lymphoid enhancer-binding factor 1 and β-catenin), and increase in glucocorticoid receptor (GR) levels. The MFR-induced lung phenotype and the effects of MTP were similar in both genders. To elucidate the mechanism of MFR-induced shift of the adipogenic-to-myogenic phenotype, lung fibroblasts were used to independently study the effects of (1) nutrient restriction and (2) excess steroid exposure. Nutrient deprivation increased myogenic proteins, Wnt signaling intermediates, and GR, all changes blocked by protein supplementation. MTP also blocked, likely by normalizing nicotinamide adenine dinucleotide phosphate levels, the corticosterone-induced increase in myogenic proteins, but had no effect on GR levels. In summary, protein restriction and increased glucocorticoid levels appear to be the key players in MFR-induced lung disease, affecting both genders.
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Affiliation(s)
- David S Paek
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California, Torrance, Los Angeles, CA, USA
| | - Reiko Sakurai
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California, Torrance, Los Angeles, CA, USA
| | - Aditi Saraswat
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California, Torrance, Los Angeles, CA, USA
| | - Yishi Li
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California, Torrance, Los Angeles, CA, USA
| | - Omid Khorram
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California, Torrance, Los Angeles, CA, USA
| | - John S Torday
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California, Torrance, Los Angeles, CA, USA
| | - Virender K Rehan
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California, Torrance, Los Angeles, CA, USA
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York TP, Eaves LJ, Neale MC, Strauss JF. The contribution of genetic and environmental factors to the duration of pregnancy. Am J Obstet Gynecol 2014; 210:398-405. [PMID: 24096276 DOI: 10.1016/j.ajog.2013.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/26/2013] [Accepted: 10/01/2013] [Indexed: 02/06/2023]
Abstract
This review describes how improvements in biometric-genetic studies of twin kinships, half-sibships, and cousinships have now demonstrated a sizeable fetal genetic and maternal genetic contribution to the spontaneous onset of labor. This is an important development because previous literature for the most part reports only an influence of the maternal genome. Current estimates of the percent of variation that is attributable to fetal genetic factors range from 11-35%; the range for the maternal genetic contribution is 13-20%. These same studies demonstrate an even larger influence of environmental sources over and above the influence of genetic sources and previously identified environmental risk factors. With these estimates in hand, a major goal for research on pregnancy duration is to identify specific allelic variation and environmental risk to account for this estimated genetic and environmental variation. A review of the current literature can serve as a guide for future research efforts.
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Affiliation(s)
- Timothy P York
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA.
| | - Lindon J Eaves
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Michael C Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Jerome F Strauss
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA
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Abstract
Nearly half a million preterm infants are born each year in the United States. Preterm delivery has significant psychosocial implications for mothers, particularly when their baby spends time in the neonatal intensive care unit (NICU). The decrease in length of gestation causes mothers to have to parent prematurely, without the less time for emotional preparation than mothers of full-term infants. Parents of NICU infants experience stress related to feelings of helplessness, exclusion and alienation, and lack sufficient knowledge regarding parenting and interacting with their infants in the NICU. There are a number of interventions that nurses can do that help reduce the stress of mothers of infants in the NICU.
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Tsopanoglou SP, Davidson J, Goulart AL, Barros MCDM, dos Santos AMN. Functional capacity during exercise in very-low-birth-weight premature children. Pediatr Pulmonol 2014; 49:91-8. [PMID: 23359551 DOI: 10.1002/ppul.22754] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 11/08/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The functional capacity of children born prematurely with very-low-birth weight was compared with that of children born at full-term using the six-minute walk test (6MWT) and the ten-minutes shuttle walk test (10MSWT). The factors affecting walking distance were analyzed. METHODS A cross-sectional study was conducted with two groups of children aged 6-9 years, matched by sex and age. One group included children born before 37 weeks of gestation weighing <1,500 g and the second group included children born at term. Both groups were submitted to the 6MWT and 10MWST, performed on the same day with an interval of 20 min between tests and the sequence of the tests was randomized, by sealed-envelope technique. Physiological parameters were measured at the beginning and end of each test. The walking distance and factors affecting the walking distance were analyzed. RESULTS Thirty-seven children born prematurely and 37 born at term were studied. The premature children walked shorter distances in the 6MWT (480.9 ± 80.5 m vs. 518.3 ± 51.8 m, P = 0.010) than term children, and both groups walked similar distances in the 10MSWT (391.5 ± 99.0 m vs. 406.1 ± 79.2 m, P = 0.487). By multiple linear regression analysis, adjusted for confounders, walking distance was associated with height (OR: 3.6) and oxygen dependency at 28 days (OR: -67.7) in the 6MWT (P < 0.001) and with height (OR: 4.9) and oxygen dependency at 28 days (OR: -91.0) in the 10MSWT (P < 0.001). CONCLUSION In conclusion, this study suggests that children born prematurely with very low birth weight, especially those who had bronchopulmonary dysplasia present limited functional capacity during exercise.
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O'Reilly M, Sozo F, Harding R. Impact of preterm birth and bronchopulmonary dysplasia on the developing lung: Long-term consequences for respiratory health. Clin Exp Pharmacol Physiol 2013; 40:765-73. [DOI: 10.1111/1440-1681.12068] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/07/2013] [Accepted: 02/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Megan O'Reilly
- Department of Anatomy and Developmental Biology; Monash University; Melbourne Victoria Australia
| | - Foula Sozo
- Department of Anatomy and Developmental Biology; Monash University; Melbourne Victoria Australia
| | - Richard Harding
- Department of Anatomy and Developmental Biology; Monash University; Melbourne Victoria Australia
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Lovering AT, Laurie SS, Elliott JE, Beasley KM, Yang X, Gust CE, Mangum TS, Goodman RD, Hawn JA, Gladstone IM. Normal pulmonary gas exchange efficiency and absence of exercise-induced arterial hypoxemia in adults with bronchopulmonary dysplasia. J Appl Physiol (1985) 2013; 115:1050-6. [DOI: 10.1152/japplphysiol.00592.2013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cardiopulmonary function is reduced in adults born very preterm, but it is unknown if this results in reduced pulmonary gas exchange efficiency during exercise and, consequently, leads to reduced aerobic capacity in subjects with and without bronchopulmonary dysplasia (BPD). We hypothesized that an excessively large alveolar to arterial oxygen difference (AaDO2) and resulting exercise-induced arterial hypoxemia (EIAH) would contribute to reduced aerobic fitness in adults born very preterm with and without BPD. Measurements of pulmonary function, lung volumes and diffusion capacity for carbon monoxide (DLco) were made at rest. Measurements of maximal oxygen consumption, peak workload, temperature- and tonometry-corrected arterial blood gases, and direct measure of hemoglobin saturation with oxygen (SaO2) were made preexercise and during cycle ergometer exercise in ex-preterm subjects ≤32-wk gestational age, with BPD ( n = 12), without BPD (PRE; n = 12), and full term controls (CONT; n = 12) breathing room air. Both BPD and PRE had reduced pulmonary function and reduced DLco compared with CONT. The AaDO2 was not significantly different between groups, and there was no evidence of EIAH (SaO2 < 95% and/or AaDO2 ≥ 40 Torr) in any subject group preexercise or at any workload. Arterial O2 content was not significantly different between the groups preexercise or during exercise. However, peak power output was decreased in BPD and PRE subjects compared with CONT. We conclude that EIAH in adult subjects born very preterm with and without BPD does not likely contribute to the reduction in aerobic exercise capacity observed in these subjects.
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Affiliation(s)
| | - Steven S. Laurie
- University of Oregon, Department of Human Physiology, Eugene, Oregon
| | | | - Kara M. Beasley
- University of Oregon, Department of Human Physiology, Eugene, Oregon
| | - Ximeng Yang
- University of Oregon, Department of Human Physiology, Eugene, Oregon
| | - Caitlyn E. Gust
- University of Oregon, Department of Human Physiology, Eugene, Oregon
| | - Tyler S. Mangum
- University of Oregon, Department of Human Physiology, Eugene, Oregon
| | - Randall D. Goodman
- University of Oregon, Department of Human Physiology, Eugene, Oregon
- Oregon Heart and Vascular Institute, Springfield, Oregon; and
| | - Jerold A. Hawn
- University of Oregon, Department of Human Physiology, Eugene, Oregon
- Oregon Heart and Vascular Institute, Springfield, Oregon; and
| | - Igor M. Gladstone
- University of Oregon, Department of Human Physiology, Eugene, Oregon
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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York TP, Eaves LJ, Lichtenstein P, Neale MC, Svensson A, Latendresse S, Långström N, Strauss JF. Fetal and maternal genes' influence on gestational age in a quantitative genetic analysis of 244,000 Swedish births. Am J Epidemiol 2013; 178:543-50. [PMID: 23568591 DOI: 10.1093/aje/kwt005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although there is increasing evidence that genetic factors influence gestational age, it is unclear to what extent this is due to fetal and/or maternal genes. In this study, we apply a novel analytical model to estimate genetic and environmental contributions to pregnancy history records obtained from 165,952 Swedish families consisting of offspring of twins, full siblings, and half-siblings (1987-2008). Results indicated that fetal genetic factors explained 13.1% (95% confidence interval (CI): 6.8, 19.4) of the variation in gestational age at delivery, while maternal genetic factors accounted for 20.6% (95% CI: 18.1, 23.2). The largest contribution to differences in the timing of birth were environmental factors, of which 10.1% (95% CI: 7.0, 13.2) was due to factors shared by births of the same mother, and 56.2% (95% CI: 53.0, 59.4) was pregnancy specific. Similar models fit to the same data dichotomized at clinically meaningful thresholds (e.g., preterm birth) resulted in less stable parameter estimates, but the collective results supported a model of homogeneous genetic and environmental effects across the range of gestational age. Since environmental factors explained most differences in the timing of birth, genetic studies may benefit from understanding the specific effect of fetal and maternal genes in the context of these yet-unidentified factors.
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Affiliation(s)
- Timothy P York
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Singh SP, Gundavarapu S, Smith KR, Chand HS, Saeed AI, Mishra NC, Hutt J, Barrett EG, Husain M, Harrod KS, Langley RJ, Sopori ML. Gestational exposure of mice to secondhand cigarette smoke causes bronchopulmonary dysplasia blocked by the nicotinic receptor antagonist mecamylamine. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:957-64. [PMID: 23757602 PMCID: PMC3734504 DOI: 10.1289/ehp.1306611] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/07/2013] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cigarette smoke (CS) exposure during gestation may increase the risk of bronchopulmonary dysplasia (BPD)-a developmental lung condition primarily seen in neonates that is characterized by hypoalveolarization, decreased angiogenesis, and diminished surfactant protein production and may increase the risk of chronic obstructive pulmonary disease. OBJECTIVE We investigated whether gestational exposure to secondhand CS (SS) induced BPD and sought to ascertain the role of nicotinic acetylcholine receptors (nAChRs) in this response. METHODS We exposed BALB/c and C57BL/6 mice to filtered air (control) or SS throughout the gestation period or postnatally up to 10 weeks. Lungs were examined at 7 days, 10 weeks, and 8 months after birth. RESULTS Gestational but not postnatal exposure to SS caused a typical BPD-like condition: suppressed angiogenesis [decreased vascular endothelial growth factor (VEGF), VEGF receptor, and CD34/CD31 (hematopoietic progenitor cell marker/endothelial cell marker)], irreversible hypoalveolarization, and significantly decreased levels of Clara cells, Clara cell secretory protein, and surfactant proteins B and C, without affecting airway ciliated cells. Importantly, concomitant exposure to SS and the nAChR antagonist mecamylamine during gestation blocked the development of BPD. CONCLUSIONS Gestational exposure to SS irreversibly disrupts lung development leading to a BPD-like condition with hypoalveolarization, decreased angiogenesis, and diminished lung secretory function. Nicotinic receptors are critical in the induction of gestational SS-induced BPD, and the use of nAChR antagonists during pregnancy may block CS-induced BPD.
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Affiliation(s)
- Shashi P Singh
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, USA
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Mechanisms of acute respiratory distress syndrome in children and adults: a review and suggestions for future research. Pediatr Crit Care Med 2013; 14:631-43. [PMID: 23823199 DOI: 10.1097/pcc.0b013e318291753f] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To provide a current overview of the epidemiology and pathophysiology of acute respiratory distress syndrome in adults and children, and to identify research questions that will address the differences between adults and children with acute respiratory distress syndrome. DATA SOURCES Narrative literature review and author-generated data. DATA SELECTION The epidemiology of acute respiratory distress syndrome in adults and children, lung morphogenesis, and postnatal lung growth and development are reviewed. The pathophysiology of acute respiratory distress syndrome is divided into eight categories: alveolar fluid transport, surfactant, innate immunity, apoptosis, coagulation, direct alveolar epithelial injury by bacterial products, ventilator-associated lung injury, and repair. DATA EXTRACTION AND SYNTHESIS Epidemiologic data suggest significant differences in the prevalence and mortality of acute respiratory distress syndrome between children and adults. Postnatal lung development continues through attainment of adult height, and there is overlap between the regulation of postnatal lung development and inflammatory, apoptotic, alveolar fluid clearance, and repair mechanisms. Therefore, there is a different biological baseline network of gene and protein expression in children as compared with adults. CONCLUSIONS There are significant obstacles to performing research on children with acute respiratory distress syndrome. However, epidemiologic, clinical, and animal studies suggest age-dependent differences in the pathophysiology of acute respiratory distress syndrome. In order to reduce the prevalence and improve the outcome of patients with acute respiratory distress syndrome, translational studies of inflammatory, apoptotic, alveolar fluid clearance, and repair mechanisms are needed. Understanding the differences in pathophysiologic mechanisms in acute respiratory distress syndrome between children and adults should facilitate identification of novel therapeutic interventions to prevent or modulate lung injury and improve lung repair.
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Vollsæter M, Røksund OD, Eide GE, Markestad T, Halvorsen T. Lung function after preterm birth: development from mid-childhood to adulthood. Thorax 2013; 68:767-76. [PMID: 23749815 DOI: 10.1136/thoraxjnl-2012-202980] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND As a result of advances in perinatal care, more small preterm infants survive. There are concerns that preterm birth and its treatments may harm pulmonary development and thereby lead to chronic airway obstruction in adulthood. OBJECTIVE To assess the development of spirometric lung function variables from mid-childhood to adulthood after extreme preterm birth. METHODS Two population-based cohorts born at gestational age ≤28 weeks or with birth weight ≤1000 g performed lung function tests at 10 and 18 and at 18 and 25 years of age, respectively, together with matched term-born controls. The results are presented as z scores, normalised for age, sex and height. Longitudinal development was compared for groups born at term and preterm, split by a history of absence (n=20), mild (n=38) or moderate/severe (n=25) neonatal bronchopulmonary dysplasia (BPD). RESULTS The preterm-born cohorts, particularly those with neonatal BPD, had significantly lower forced expiratory volume in 1 s and mid-expiratory flow than those born at term at all assessments (z scores in the range -0.40 to -1.84). Within each of the subgroups the mean z scores obtained over the study period were largely similar, coefficients of determination ranging from 0.64 to 0.82. The pattern of development for the BPD subgroups did not differ from each other or from the groups born at term (tests of interaction). CONCLUSIONS Airway obstruction was present from mid-childhood to adulthood after extreme preterm birth, most evident after neonatal BPD. Lung function indices were tracking similarly in the preterm and term-born groups.
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Affiliation(s)
- Maria Vollsæter
- Department of Clinical Science, Section for Pediatrics, University of Bergen, Bergen, Norway.
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Kotecha SJ, Edwards MO, Watkins WJ, Henderson AJ, Paranjothy S, Dunstan FD, Kotecha S. Effect of preterm birth on later FEV1: a systematic review and meta-analysis. Thorax 2013; 68:760-6. [PMID: 23604458 DOI: 10.1136/thoraxjnl-2012-203079] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increasing evidence suggests that preterm birth affects later lung function. We systematically reviewed the literature to determine whether percentage predicted forced expiratory volume in 1 s (%FEV1) is lower in later life in preterm-born subjects, with or without bronchopulmonary dysplasia (BPD), compared with term-born controls. METHODS Studies reporting %FEV1, with or without a term-born control group, in later life for preterm-born subjects (<37 weeks gestation) were extracted from eight databases. Data were analysed using Review Manager and STATA. The quality of the studies was assessed. RESULTS From 8839 titles, 1124 full articles were screened and 59 were included: 28 studied preterm-born children without BPD, 24 with BPD28 (supplemental oxygen dependency at 28 days), 15 with BPD36 (supplemental oxygen dependency 36 weeks postmenstrual age) and 34 born preterm. For the preterm-born group without BPD and for the BPD28 and BPD36 groups the mean differences (and 95% CIs) for %FEV1 compared with term-born controls were -7.2% (-8.7% to -5.6%), -16.2% (-19.9% to -12.4%) and -18.9% (-21.1% to -16.7%), respectively. Pooling all data on preterm-born subjects whether or not there was a control group gave a pooled %FEV1 estimate of 91.0% (88.8% to 93.1%) for the preterm-born cohort without BPD, 83.7% (80.2% to 87.2%) for BPD28 and 79.1% (76.9% to 81.3%) for BPD36. Interestingly, %FEV1 for BPD28 has improved over the years. CONCLUSIONS %FEV1 is decreased in preterm-born survivors, even those who do not develop BPD. %FEV1 of survivors of BPD28 has improved over recent years. Long-term respiratory follow-up of preterm-born survivors is required as they may be at risk of developing chronic obstructive pulmonary disease.
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Affiliation(s)
- Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.
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Using Cell-Based Strategies to Break the Link between Bronchopulmonary Dysplasia and the Development of Chronic Lung Disease in Later Life. Pulm Med 2013; 2013:874161. [PMID: 23401768 PMCID: PMC3557634 DOI: 10.1155/2013/874161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/16/2012] [Indexed: 11/17/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity that affects very preterm infants. Although advances in perinatal care have changed the course of lung injury and enabled the survival of infants born as early as 23-24 weeks of gestation, BPD still remains a common complication of extreme prematurity, and there is no specific treatment for it. Furthermore, children, adolescents, and adults who were born very preterm and developed BPD have an increased risk of persistent lung dysfunction, including early-onset emphysema. Therefore, it is possible that early-life pulmonary insults, such as extreme prematurity and BPD, may increase the risk of COPD later in life, especially if exposed to secondary challenges such as respiratory infections and/or smoking. Recent advances in our understanding of stem/progenitor cells and their potential to repair damaged organs offer the possibility of cell-based treatments for neonatal and adult lung injuries. This paper summarizes the long-term pulmonary outcomes of preterm birth and BPD and discusses the recent advances of cell-based therapies for lung diseases, with a particular focus on BPD and COPD.
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Rock J, Königshoff M. Endogenous lung regeneration: potential and limitations. Am J Respir Crit Care Med 2012; 186:1213-9. [PMID: 22997206 DOI: 10.1164/rccm.201207-1151pp] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The exploration of the endogenous regenerative potential of the diseased adult human lung represents an innovative and exciting task. In this pulmonary perspective, we discuss three major components essential for endogenous lung repair and regeneration: epithelial progenitor populations, developmental signaling pathways that regulate their reparative and regenerative potential, and the surrounding extracellular matrix in the human diseased lung. Over the past years, several distinct epithelial progenitor populations have been discovered within the lung, all of which most likely respond to different injuries by varying degrees. It has become evident that several progenitor populations are mutually involved in maintenance and repair, which is highly regulated by developmental pathways, such as Wnt or Notch signaling. Third, endogenous progenitor cells and developmental signaling pathways act in close spatiotemporal synergy with the extracellular matrix. These three components define and refine the highly dynamic microenvironment of the lung, which is altered in a disease-specific fashion in several chronic lung diseases. The search for the right mixture to induce efficient and controlled repair and regeneration of the diseased lung is ongoing and will open completely novel avenues for the treatment of patients with chronic lung disease.
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Affiliation(s)
- Jason Rock
- Department of Anatomy and 2Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Landry JS, Croitoru D, Jin Y, Schwartzman K, Benedetti A, Menzies D. Health care utilization by preterm infants with respiratory complications in Quebec. Can Respir J 2012; 19:255-60. [PMID: 22891185 PMCID: PMC3411390 DOI: 10.1155/2012/606507] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite notable advances in prenatal and neonatal care, respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) remain important complications of preterm births, and their long-term sequelae are poorly understood. OBJECTIVE To describe health care utilization and costs over a 16- to 25-year follow-up period in a cohort of preterm infants with respiratory complications. METHODS Using provincial health administrative databases from Quebec, a cohort of individuals who were born prematurely with complications of RDS and⁄or BPD between 1983 and 1992 were identified. From these databases, which cover all Quebec residents, health services use, medication prescriptions, associated diagnoses and costs were tabulated. RESULTS A total of 3442 subjects with respiratory complications following preterm birth were identified, of whom 773 had been diagnosed with BPD and 2669 had RDS without BPD. Asthma was diagnosed twice as frequently (1.7 to 2.4 times) in the BPD group compared with the RDS group, with more frequent hospital readmission, and outpatient and emergency room visits. Although respiratory causes remained the main reason for consultation in both groups, 3.7% and 3.4% of the outpatient visits were for mental or psychological ailments, such as depression, attention deficit hyperactivity disorder or dysthymia for the BPD and RDS groups, respectively. CONCLUSION BPD patients experienced more hospital admissions, outpatient and emergency rooms visits, and were more likely to suffer from respiratory illnesses and to use respiratory drugs than RDS patients. Neurological and psychiatric complications occurred at a high frequency in both RDS and BPD subjects, and were associated with significant use of antipsychotic and antidepressant medications.
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Affiliation(s)
- Jennifer Sophie Landry
- Respiratory Epidemiology and Clinicial Research Unit, McGill University, Montreal, Quebec.
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Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and a significant challenge for adult physicians. However, there is a misconception that COPD is a disease of only adult smokers. There is a growing body of evidence to support the hypothesis that chronic respiratory diseases such as COPD have their origins in early life. In particular, adverse maternal factors will interact with the environment in a susceptible host promoting altered lung growth and development antenatally and in early childhood. Subsequent lung injury and further gene-environment interactions may result in permanent lung injury manifest by airway obstruction predisposing to COPD. This review will discuss the currently available data regarding risk factors in early life and their role in determining the COPD phenotype.
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