1
|
Cristea AI, Tracy MC, Bauer SE, Guaman MC, Welty SE, Baker CD, Bhombal S, Collaco JM, Courtney SE, DiGeronimo RJ, Eldredge LC, Gibbs K, Hayden LP, Keszler M, Lai K, McGrath-Morrow SA, Moore PE, Rose R, Sindelar R, Truog WE, Nelin LD, Abman S. Approaches to Interdisciplinary Care for Infants with Severe Bronchopulmonary Dysplasia: A Survey of the Bronchopulmonary Dysplasia Collaborative. Am J Perinatol 2024; 41:e536-e544. [PMID: 36477715 DOI: 10.1055/s-0042-1755589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Bronchopulmonary dysplasia (BPD) remains the most common late morbidity for extremely premature infants. Care of infants with BPD requires a longitudinal approach from the neonatal intensive care unit to ambulatory care though interdisciplinary programs. Current approaches for the development of optimal programs vary among centers. STUDY DESIGN We conducted a survey of 18 academic centers that are members of the BPD Collaborative, a consortium of institutions with an established interdisciplinary BPD program. We aimed to characterize the approach, composition, and current practices of the interdisciplinary teams in inpatient and outpatient domains. RESULTS Variations exist among centers, including composition of the interdisciplinary team, whether the team is the primary or consult service, timing of the first team assessment of the patient, frequency and nature of rounds during the hospitalization, and the timing of ambulatory visits postdischarge. CONCLUSION Further studies to assess long-term outcomes are needed to optimize interdisciplinary care of infants with severe BPD. KEY POINTS · Care of infants with BPD requires a longitudinal approach from the NICU to ambulatory care.. · Benefits of interdisciplinary care for children have been observed in other chronic conditions.. · Current approaches for the development of optimal interdisciplinary BPD programs vary among centers..
Collapse
Affiliation(s)
- A Ioana Cristea
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Michael C Tracy
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Sarah E Bauer
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Milenka Cuevas Guaman
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Stephen E Welty
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Christopher D Baker
- Department of Pediatrics-Pulmonary Medicine, University of Colorado, Denver, Colorado
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Sherry E Courtney
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansa
| | - Robert J DiGeronimo
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Laurie C Eldredge
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Kathleen Gibbs
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lystra P Hayden
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin Keszler
- Department of Pediatrics, Women and Infants Hospital, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Khanh Lai
- Department of Pediatrics, Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Sharon A McGrath-Morrow
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul E Moore
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Rose
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Richard Sindelar
- Division of Neonatology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - William E Truog
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Leif D Nelin
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Steven Abman
- Department of Pediatrics-Pulmonary Medicine, University of Colorado, Denver, Colorado
| |
Collapse
|
2
|
Hirata K, Nishikawa M, Nozaki M, Kitajima H, Yanagihara I, Wada K, Fujimura M. Urine Desmosine as a Novel Biomarker for Bronchopulmonary Dysplasia and Postprematurity Respiratory Disease in Extremely Preterm or Low Birth Weight Infants. Am J Perinatol 2024; 41:e1030-e1036. [PMID: 36384237 DOI: 10.1055/a-1979-8501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether elevated urine desmosine levels at 3 weeks of age were associated with severe radiological findings, bronchopulmonary dysplasia (BPD), and post-prematurity respiratory disease (PRD) in extremely preterm (EP) or extremely low birth weight (ELBW) infants. STUDY DESIGN This study recruited 37 EP (22-27 completed weeks) or ELBW (<1,000 g) infants. Urine was collected between 21 and 28 postnatal days, and desmosine was measured using an enzyme-linked immunosorbent assay kit; the urine creatinine level was also measured. Bubbly/cystic lungs were characterized by emphysematous chest X-rays on postnatal day 28. Furthermore, provision of supplemental oxygen or positive-pressure respiratory support at 40 weeks' postmenstrual age defined BPD, and increased medical utilization at 18 months of corrected age defined PRD. The desmosine/creatinine threshold was determined by receiver operating characteristic analysis. The adjusted risk and 95% confidence interval (CI) for elevated urine desmosine/creatinine levels were estimated by logistic regression analysis. RESULTS Elevated urine desmosine/creatinine levels higher than the threshold were significantly associated with bubbly/cystic lungs (8/13 [61.5%] vs. 2/24 [8.3%], p = 0.001), BPD (10/13 [76.9%] vs. 8/24 [33.3%], p = 0.02), and PRD (6/13 [46.2%] vs. 2/24 [8.3%], p = 0.01). After adjusting for gestational age, birth weight, and sex, the urine desmosine/creatinine levels were significantly higher in those who were highly at risk of bubbly/cystic lungs (odds ratio [OR], 13.2; 95% CI, 1.67-105) and PRD (OR, 13.8; 95% CI, 1.31-144). CONCLUSION Elevated urine desmosine/creatinine levels on the third postnatal week were associated with bubbly/cystic lungs on day 28 and PRD at 18 months of corrected age in EP or ELBW infants. KEY POINTS · Urine desmosine was prospectively measured in 3-week-old EP/ELBW infants.. · Elevated urine desmosine levels were associated with emphysematous radiological findings on day 28, PRD at 18 months of corrected age.. · Urine desmosine may be a promising biomarker indicating lung damage in EP/ELBW infants..
Collapse
Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masatoshi Nozaki
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Itaru Yanagihara
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| |
Collapse
|
3
|
Zhang F, Wang M, Li Z, Deng J, Fan Y, Gou Z, Zhou Y, Huang L, Lu L. Rapamycin attenuates pyroptosis by suppressing mTOR phosphorylation and promoting autophagy in LPS-induced bronchopulmonary dysplasia. Exp Lung Res 2023; 49:178-192. [PMID: 37874145 DOI: 10.1080/01902148.2023.2266236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE/AIM Bronchopulmonary dysplasia (BPD) is associated with poor survival in preterm infants. Intrauterine infection can aggravate the degree of obstruction of alveolar development in premature infants; however, the pathogenic mechanism remains unclear. In this study, we sought to determine whether pyroptosis could be inhibited by downregulating mammalian target of rapamycin (mTOR) activation and inducing autophagy in BPD-affected lung tissue. MATERIALS AND METHODS We established a neonatal rat model of BPD induced by intrauterine infection via intraperitoneally injecting pregnant rats with lipopolysaccharide (LPS). Subsequently, mTOR levels and pyroptosis were evaluated using immunohistochemistry, immunofluorescence, TUNEL staining, and western blotting. The Shapiro-Wilk test was employed to assess the normality of the experimental data. Unpaired t-tests were used to compare the means between two groups, and comparisons between multiple groups were performed using analysis of variance. RESULTS Pyroptosis of lung epithelial cells increased in BPD lung tissues. After administering an mTOR phosphorylation inhibitor (rapamycin) to neonatal rats with BPD, the level of autophagy increased, while the expression of autophagy cargo adaptors, LC3 and p62, did not differ. Following rapamycin treatment, NLRP3, Pro-caspase-1, caspase-1, pro-IL-1β, IL-1β, IL-18/Pro-IL-18, N-GSDMD/GSDMD, Pro-caspase-11, and caspase-11 were negatively regulated in BPD lung tissues. The opposite results were observed after treatment with the autophagy inhibitor MHY1485, showing an increase in pyroptosis and a significant decrease in the number of alveoli in BPD. CONCLUSIONS Rapamycin reduces pyroptosis in neonatal rats with LPS-induced BPD by inhibiting mTOR phosphorylation and inducing autophagy; hence, it may represent a potential therapeutic for treating BPD.
Collapse
Affiliation(s)
- Feng Zhang
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
- Clinic Medical College, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Minrong Wang
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
- Clinic Medical College, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Zhongni Li
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
- Clinic Medical College, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Jiehong Deng
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
- Clinic Medical College, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Yang Fan
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Zhixian Gou
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Yue Zhou
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Li Huang
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| | - Liqun Lu
- Department of Pediatrics, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
- Clinic Medical College, Chengdu Medical College, Chengdu, Sichuan Province, P.R. China
| |
Collapse
|
4
|
Sotiropoulos JX, Oei JL. The role of oxygen in the development and treatment of bronchopulmonary dysplasia. Semin Perinatol 2023; 47:151814. [PMID: 37783577 DOI: 10.1016/j.semperi.2023.151814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Oxygen (O2) is crucial for both the development and treatment of one of the most important consequences of prematurity: bronchopulmonary dysplasia (BPD). In fetal life, the hypoxic environment is important for alveolar development and maturation. After birth, O2 becomes a double-edged sword. While O2 is needed to prevent hypoxia, it also causes oxidative stress leading to a plethora of morbidities, including retinopathy and BPD. The advent of continuous O2 monitoring with pulse oximeters has allowed clinicians to recognize the narrow therapeutic margins of oxygenation for the preterm infant, but more knowledge is needed to understand what these ranges are at different stages of the preterm infant's life, including at birth, in the neonatal intensive care unit and after hospital discharge. Future research, especially in innovative technologies such as automated O2 control and remote oximetry, will improve the understanding and treatment of the O2 needs of infants with BPD.
Collapse
Affiliation(s)
- J X Sotiropoulos
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Australia; Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia; NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - J L Oei
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Australia; Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia; NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Australia.
| |
Collapse
|
5
|
Kosik K, Sowińska A, Seremak-Mrozikiewicz A, Abu-Amara JA, Al-Saad SR, Karbowski LM, Gryczka K, Kurzawińska G, Szymankiewicz-Bręborowicz M, Drews K, Szpecht D. Polymorphisms of fibronectin-1 (rs3796123; rs1968510; rs10202709; rs6725958; and rs35343655) are not associated with bronchopulmonary dysplasia in preterm infants. Mol Cell Biochem 2022; 477:1645-1652. [PMID: 35230604 DOI: 10.1007/s11010-022-04397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mainly affects premature newborns. Many different factors, increasingly genetic, are involved in the pathogenesis of BPD. The aim of the study is to investigate the possible influence of fibronectin SNP on the occurrence of BPD. The study included 108 infants born between 24 and 32 weeks of gestation. BPD was diagnosed based on the National Institutes of Health Consensus definition. The 5 FN1 gene polymorphisms assessed in the study were the following: rs3796123; rs1968510; rs10202709; rs6725958; and rs35343655. BPD developed in 30 (27.8%) out of the 108 preterm infants. Incidence of BPD was higher in infants with lower APGAR scores and low birthweight. Investigation did not confirm any significant prevalence for BPD development in any genotypes and alleles of FN1. Further studies should be performed to confirm the role of genetic factors in etiology and pathogenesis of BPD.
Collapse
Affiliation(s)
- Katarzyna Kosik
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | | | | | - Katarzyna Gryczka
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Grażyna Kurzawińska
- Department of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Krzysztof Drews
- Department of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
6
|
Yallapragada SG, Savani RC, Goss KN. Cardiovascular impact and sequelae of bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3453-3463. [PMID: 33756045 DOI: 10.1002/ppul.25370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022]
Abstract
The development, growth, and function of the cardiac, pulmonary, and vascular systems are closely intertwined during both fetal and postnatal life. In utero, placental, environmental, and genetic insults may contribute to abnormal pulmonary alveolarization and vascularization that increase susceptibility to the development of bronchopulmonary dysplasia (BPD) in preterm infants. However, the shared milieu of stressors may also contribute to abnormal cardiac or vascular development in the fetus and neonate, leading to the potential for cardiovascular dysfunction. Further, cardiac or pulmonary maladaptation can potentiate dysfunction in the other organ, amplify the risk for BPD in the neonate, and increase the trajectory for overall neonatal morbidity. Beyond infancy, there is an increased risk for systemic and pulmonary vascular disease including hypertension, as well as potential cardiac dysfunction, particularly within the right ventricle. This review will focus on the cardiovascular antecedents of BPD in the fetus, cardiovascular consequences of preterm birth in the neonate including associations with BPD, and cardiovascular impact of prematurity and BPD throughout the lifespan.
Collapse
Affiliation(s)
- Sushmita G Yallapragada
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rashmin C Savani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kara N Goss
- Division of Pulmonary and Critical Care, Departments of Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
7
|
Stading R, Couroucli X, Lingappan K, Moorthy B. The role of cytochrome P450 (CYP) enzymes in hyperoxic lung injury. Expert Opin Drug Metab Toxicol 2020; 17:171-178. [PMID: 33215946 DOI: 10.1080/17425255.2021.1853705] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Hyperoxic lung injury is a condition that can occur in patients in need of supplemental oxygen, such as premature infants with bronchopulmonary dysplasia or adults with acute respiratory distress syndrome. Cytochrome P450 (CYP) enzymes play critical roles in the metabolism of endogenous and exogenous compounds. AREAS COVERED Through their complex pathways, some subfamilies of these enzymes may contribute to or protect against hyperoxic lung injury. Oxidative stress from reactive oxygen species (ROS) production is most likely a major contributor of hyperoxic lung injury. CYP1A enzymes have been shown to protect against hyperoxic lung injury while CYP1B enzymes seem to contribute to it. CYP2J2 enzymes help protect against hyperoxic lung injury by triggering EET production, thereby, increasing antioxidant enzymes. The metabolism of arachidonic acid to ω-terminal hydroxyeicosatetraenoic acid (20-HETEs) by CYP4A and CYP4F enzymes could impact hyperoxic lung injury via the vasodilating effects of 20-HETE. CYP2E1 and CYP2A enzymes may contribute to the oxidative stress in the lungs caused by ethanol- and nicotine-metabolism, respectively. EXPERT OPINION Overall, the CYP enzymes, depending upon the isoform, play a contributory or protective role in hyperoxic lung injury, and are, therefore, ideal candidates for developing drugs that can treat oxygen-mediated lung injury.
Collapse
Affiliation(s)
- Rachel Stading
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, TX, USA
| | - Xanthi Couroucli
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, TX, USA
| | - Krithika Lingappan
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, TX, USA
| | - Bhagavatula Moorthy
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, TX, USA
| |
Collapse
|
8
|
Dylag AM, Kopin HG, O’Reilly MA, Wang H, Davis SD, Ren CL, Pryhuber GS. Early Neonatal Oxygen Exposure Predicts Pulmonary Morbidity and Functional Deficits at 1 Year. J Pediatr 2020; 223:20-28.e2. [PMID: 32711747 PMCID: PMC9337224 DOI: 10.1016/j.jpeds.2020.04.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/09/2020] [Accepted: 04/14/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the predictive value of cumulative oxygen exposure thresholds over the first 2 postnatal weeks, linking them to bronchopulmonary dysplasia (BPD) and 1-year pulmonary morbidity and lung function in extremely low gestational age newborns. STUDY DESIGN Infants (N = 704) enrolled in the Prematurity and Respiratory Outcomes Program, a multicenter prospective cohort study, that survived to discharge were followed through their neonatal intensive care unit hospitalization to 1-year corrected age. Cumulative oxygen exposure (OxygenAUC14) thresholds were derived from univariate models of BPD, stratifying infants into high-, intermediate-, and low-oxygen exposure groups. These groups were then used in multivariate logistic regressions to prospectively predict post-prematurity respiratory disease (PRD), respiratory morbidity score (RMS) in the entire cohort, and pulmonary function z scores (N = 108 subset of infants) at 1-year corrected age. RESULTS Over the first 14 postnatal days, infants exposed to high oxygen averaged ≥33.1% oxygen, infants exposed to intermediate oxygen averaged 29.1%-33.1%, and infants exposed to low oxygen were below both cutoffs. In multivariate models, infants exposed to high oxygen showed increased PRD and RMS, whereas infants exposed to intermediate oxygen demonstrated increased moderate/severe RMS. Infants in the high/intermediate groups had decreased forced expiratory volume at 0.5 seconds/forced vital capacity ratio. CONCLUSIONS OxygenAUC14 establishes 3 thresholds of oxygen exposure that risk stratify infants early in their neonatal course, thereby predicting short-term (BPD) and 1-year (PRD, RMS) respiratory morbidity. Infants with greater OxygenAUC14 have altered pulmonary function tests at 1 year of age, indicating early evidence of obstructive lung disease and flow limitation, which may predispose extremely low gestational age newborns to increased long-term pulmonary morbidity. TRIAL REGISTRATION ClinicalTrials.gov: NCT01435187.
Collapse
Affiliation(s)
- Andrew M. Dylag
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY
| | - Hannah G. Kopin
- School of Medicine, School of Public Health Sciences, University of Rochester, Rochester, NY
| | - Michael A. O’Reilly
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Clement L. Ren
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, IN
| | - Gloria S. Pryhuber
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY
| |
Collapse
|
9
|
Li J, Gong X. 14-3-3β Is necessary in the regulation of polarization and directional migration of alveolar myofibroblasts by lipopolysaccharide. Exp Lung Res 2020; 46:1-10. [PMID: 31920140 DOI: 10.1080/01902148.2019.1711464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims:Bronchopulmonary dysplasia (BPD) is characterized by alveolarization arrest. During alveolarization, alveolar myofibroblasts are thought to migrate into the septal tips and elongate secondary septa. Lipopolysaccharide (LPS) exposure has been reported to disrupt directional migration and final location of alveolar myofibroblasts in a rat model of BPD induced by intra-amniotic injection of LPS. However, molecular mechanisms that control directional migration of alveolar myofibroblasts have not so far been investigated clearly. Materials and Methods: We assessed the polarization of myofibroblast using scrape wounding assays combined with Golgi tracking. Transwell migration assay was used to detect the directional migration of myofibroblasts. Pull-down assays were performed to isolate the active GTP-bound form using the RhoA activation assay kits. Western blotting analysis was performed to evaluate the changes in protein expression. Functional analysis was performed via siRNA interference. Results: Here, we showed that LPS might affect the directional migration of myofibroblasts by disturbing the polarization of myofibroblasts. In addition, as a main member of RhoGTPases family which plays a vital role in establishing and maintaining cell polarity, RhoA activity was significantly upregulated in myofibroblasts treated with LPS, while activity of epidermal growth factor receptor (EGFR) was upregulated and overexpression of its ligand, TGF-α, in myofibroblasts by LPS treatment. AG1478, an EGFR inhibitor, could abrogate the upregulated RhoA activity of myofibroblasts by LPS and rhTGF-α. Moreover, if we knock down 14-3-3β, LPS and rhTGF-α could not activate RhoA and disturb myofibroblasts polarization. Conclusions: Taken together, our findings suggest that LPS exposure may increase RhoA activity of myofibroblasts by TGF-α/EGFR/14-3-3β signaling pathway, and then disturb myofibroblasts polarization and directional migration.
Collapse
Affiliation(s)
- Jianhui Li
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| |
Collapse
|
10
|
Abstract
In the absence of effective interventions to prevent preterm births, improved survival of infants who are born at the biological limits of viability has relied on advances in perinatal care over the past 50 years. Except for extremely preterm infants with suboptimal perinatal care or major antenatal events that cause severe respiratory failure at birth, most extremely preterm infants now survive, but they often develop chronic lung dysfunction termed bronchopulmonary dysplasia (BPD; also known as chronic lung disease). Despite major efforts to minimize injurious but often life-saving postnatal interventions (such as oxygen, mechanical ventilation and corticosteroids), BPD remains the most frequent complication of extreme preterm birth. BPD is now recognized as the result of an aberrant reparative response to both antenatal injury and repetitive postnatal injury to the developing lungs. Consequently, lung development is markedly impaired, which leads to persistent airway and pulmonary vascular disease that can affect adult lung function. Greater insights into the pathobiology of BPD will provide a better understanding of disease mechanisms and lung repair and regeneration, which will enable the discovery of novel therapeutic targets. In parallel, clinical and translational studies that improve the classification of disease phenotypes and enable early identification of at-risk preterm infants should improve trial design and individualized care to enhance outcomes in preterm infants.
Collapse
|
11
|
Hyun JK, Choi SY, Jung YJ, Lee JH. Effect of Delayed Elevation of Thyrotropin on Feeding Intolerance in Very Low Birth Weight Infants. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
12
|
Polysomnography in Preterm Infants with Bronchopulmonary Dysplasia for Monitoring Sleep-Disordered Breathing and Pulmonary Reserve. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00141-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
13
|
Kumar VHS, Wang H, Nielsen L. Adaptive immune responses are altered in adult mice following neonatal hyperoxia. Physiol Rep 2019; 6. [PMID: 29368801 PMCID: PMC5789729 DOI: 10.14814/phy2.13577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/17/2017] [Accepted: 12/18/2017] [Indexed: 01/25/2023] Open
Abstract
Premature infants with bronchopulmonary dysplasia (BPD), are at risk for frequent respiratory infections and reduced pulmonary function. We studied whether neonatal hyperoxia disrupts adaptive immune responses in adult mice, contributing to higher respiratory‐related morbidities seen in these infants. Newborn mice litters were randomized at 3 days to 85% O2 or room air (RA) for 12 days. Whole lung mRNA was isolated in both the groups at 2 weeks and 3 months. Gene expression for T‐cell and B‐cell adaptive immune response was performed by real‐time PCR and qRT‐PCR; protein expression (p21, IL4, IL10, IL27, cd4) was performed by enzyme immunoassay along with p21 immunohistochemistry. Hyperoxia increased expression of p21 and decreased expression of 19 genes representing T/B‐cell activation by ≥ fourfold; three of them significantly (Rag1, Cd1d1, Cd28) compared to the RA group at 2 weeks. Despite RA recovery, the expression of IFNγ, IL27, and CD40 was significantly reduced at 3 months in the hyperoxia group. Expression of p21 was significantly higher and IL27 protein lower at 2 weeks following hyperoxia. Adult mice exposed to neonatal hyperoxia had lower IL4 and IL10 in the lung at 3 months. Adaptive immune responses are developmentally regulated and neonatal hyperoxia suppresses expression of genes involved in T‐/B‐cell activation with continued alterations in gene expression at 3 months. Dysfunction of adaptive immune responses increases the risk for susceptibility to infection in premature infants.
Collapse
Affiliation(s)
| | - Huamei Wang
- Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Lori Nielsen
- Department of Pediatrics, University at Buffalo, Buffalo, New York
| |
Collapse
|
14
|
Vento G, Vendettuoli V, Aurilia C, Tana M, Tirone C, Lio A, Matassa PG, Priolo F, Catenazzi P, Corsello M, Zecca E, Mosca F. A modified physiologic test for bronchopulmonary dysplasia: a clinical tool for weaning from CPAP and/or oxygen-therapy the premature babies? Ital J Pediatr 2019; 45:2. [PMID: 30609929 PMCID: PMC6320608 DOI: 10.1186/s13052-018-0582-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/09/2018] [Indexed: 12/01/2022] Open
Abstract
Background A physiologic test for estimating BPD rate has been developed by Walsh and collaborators. Actually there are not standard criteria for weaning from CPAP and/or oxygen therapy the premature babies. Aim of this study was to verify if a physiologic test, modified respect to that developed by Walsh and collaborators for estimating BPD rate, can be used as a clinical tool for weaning the premature babies from CPAP and/or oxygen therapy. Methods Neonates with BW 500–1250 g and GA ≤ 32 weeks, receiving FiO2 ≤ 0.30 by hood or CPAP, were prospectively studied at 28 days of life and at 36 weeks of postmestrual age. The test was performed in 3 steps: baseline, challenge (FiO2 and CPAP reduction to room air) and post test (room air). Monitoring of transcutaneous CO2 was added to SpO2 and the newborns passing the test were left in room air. Results Six of 23 tested babies (26%) passed the challenge at 28 days of life, 4 of 10 tested babies (40%) passed the challenge at 36 weeks. Median values of SpO2 were significantly higher in the neonates passing the test, respect to the failing patients. At the same time median values of TcPCO2 were significantly higher in the latter babies. Conclusion TcPCO2 monitoring appeared to be a new useful parameter for failure prediction of weaning. The test represented a clinical guide because the newborns passing it were left in room air.
Collapse
Affiliation(s)
- Giovanni Vento
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Valentina Vendettuoli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Claudia Aurilia
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Milena Tana
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Tirone
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Lio
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Giuseppe Matassa
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Francesca Priolo
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Catenazzi
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mirta Corsello
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Zecca
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
15
|
Giridhar S, Kumar J, Attri SV, Dutta S, Kumar P. Intramuscular Followed by Oral Vitamin A Supplementation in Neonates with Birth Weight from 750 to 1250 g: A Randomized Controlled Trial. Indian J Clin Biochem 2019; 35:197-204. [PMID: 32226251 DOI: 10.1007/s12291-018-0807-1] [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] [Received: 09/16/2018] [Accepted: 12/24/2018] [Indexed: 01/09/2023]
Abstract
Multiple intramuscular (IM) injections of vitamin A have been shown to decrease bronchopulmonary dysplasia in very low birth weight (VLBW) neonates. However, this regime is neither practical nor popular. Oral vitamin A has failed to achieve adequate plasma levels. We aimed to investigate if a schedule of initial IM followed by oral supplementation can reduce vitamin A deficiency. This was a blinded, randomized controlled trial, conducted in a level III neonatal unit. Neonates with birth weight from 750 to 1250 g, were enrolled at the age of 24-96 h of life. They were randomly allocated to vitamin A supplementation (VAS) (n = 61) or placebo group (n = 59). VAS group received vitamin A 5000 IU IM on alternate days till establishment of adequate enteral feeds, followed by oral 10,000 IU daily for 28 days. The primary outcome was incidence of vitamin A deficiency (plasma retinol < 200 μg/L) on day 28. A total of 120 neonates with mean (SD) gestation age and birth weight of 31 (2.4) weeks and 1065 (141) g, respectively were enrolled. More than 90% of cases were vitamin A deficient at the baseline. The proportion of vitamin A deficient infants on day 28 of study was significantly lower in VAS group compared to placebo group (4% vs. 61%, p < 0.001). The median (1st-3rd quartile) plasma retinol levels (μg/L) were significantly higher in VAS group compared to placebo [489 (295,627) vs. 184 (156,240), p < 0.001]. We conclude that the IM followed by oral VAS significantly reduced the incidence of vitamin A deficiency in VLBW infants.
Collapse
Affiliation(s)
- S Giridhar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Jogender Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Savita Verma Attri
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| |
Collapse
|
16
|
Pasha AB, Chen XQ, Zhou GP. Bronchopulmonary dysplasia: Pathogenesis and treatment. Exp Ther Med 2018; 16:4315-4321. [PMID: 30542380 PMCID: PMC6257511 DOI: 10.3892/etm.2018.6780] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/06/2018] [Indexed: 11/06/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease of infancy, which mostly affects premature infants with significant morbidity and mortality. Premature infants who require to be treated for conditions including respiratory distress syndrome have a higher risk of developing BPD. In spite of the improvement in clinical methods, the incidence of BPD has not reduced. In the present review, the pathogenesis of BPD is described along with the treatments available at present and the role of nursing in the management of BPD. Emerging preventive therapies for BPD are also discussed, including the use of recombinant human superoxide dismutase, which has been proven effective in reducing respiratory injury and its long-term effects.
Collapse
Affiliation(s)
- Asfia Banu Pasha
- Department of Pediatrics, The First Affiliated Hospital, School of International Education, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao-Qing Chen
- Department of Pediatrics, The First Affiliated Hospital, School of International Education, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Guo-Ping Zhou
- Department of Pediatrics, The First Affiliated Hospital, School of International Education, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| |
Collapse
|
17
|
Knockdown of LncRNA MALAT1 contributes to cell apoptosis via regulating NF-κB/CD80 axis in neonatal respiratory distress syndrome. Int J Biochem Cell Biol 2018; 104:138-148. [PMID: 30243953 DOI: 10.1016/j.biocel.2018.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 01/28/2023]
Abstract
Neonatal respiratory distress syndrome (NRDS) is a leading cause of morbidity in premature newborns and is a common reason for admission to the neonatal intensive care unit (NICU). Recent studies found that the pathogenesis of NRDS is not simply lung immaturity. Apoptosis is an essential process for the development and maturation of the lungs. In this study, we report a critical role of lncRNA MALAT1 in regulating CD80 transcription in the NRDS-associated apoptosis via binding with NF-κB. We first showed MALAT1 and CD80 were highly expressed in the peripheral blood mononuclear cells of NRDS with infection exposure. Then we found MALAT1 expressions were significantly increased by the treatment of LPS. We confirmed knockdown of MALAT1 promoted cell viability by CCK-8 assays, cell apoptosis by flow cytometric assays and cytoskeleton destruction by immunocytochemistry. We confirmed CD80 expression level was associated with cell apoptosis by affecting PARP and caspase-3. Then we demonstrated knockdown of MALAT1 promoted CD80 transcription in A549 cells. Furthermore, we confirmed that MALAT1 downregulated transcriptional expression of CD80 by interfering with NF-κB activation and disrupting its binding efficiency with the CD80 promoter in the cell nucleus. In conclusion, we first identified lncRNA MALAT1 as an important prognosis maker for NRDS patients. Most significantly, this study then demonstrated a novel regulatory function of knocked-down MALAT1 on the transcriptional level of CD80 by enhancing the binding of NF-κB to CD80 promoter. Since the interaction between MALAT1 and CD80 plays an essential role in the cell apoptosis of NRDS, our findings demonstrate the possibility of using MALAT1 as therapeutic target for treatment of NRDS, and extend existing knowledge about the molecular mechanism that underlies NRDS pathogensis.
Collapse
|
18
|
Maron BA, Abman SH. Translational Advances in the Field of Pulmonary Hypertension. Focusing on Developmental Origins and Disease Inception for the Prevention of Pulmonary Hypertension. Am J Respir Crit Care Med 2017; 195:292-301. [PMID: 27854133 DOI: 10.1164/rccm.201604-0882pp] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Bradley A Maron
- 1 Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,2 Department of Cardiology, Boston VA Healthcare System, Boston, Massachusetts; and
| | - Steven H Abman
- 3 Section of Pulmonary Medicine and.,4 Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Denver Anschutz Medical Center and Children's Hospital Colorado, Aurora, Colorado
| |
Collapse
|
19
|
van Well GTJ, Daalderop LA, Wolfs T, Kramer BW. Human perinatal immunity in physiological conditions and during infection. Mol Cell Pediatr 2017; 4:4. [PMID: 28432664 PMCID: PMC5400776 DOI: 10.1186/s40348-017-0070-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/27/2017] [Indexed: 12/14/2022] Open
Abstract
The intrauterine environment was long considered sterile. However, several infectious threats are already present during fetal life. This review focuses on the postnatal immunological consequences of prenatal exposure to microorganisms and related inflammatory stimuli. Both the innate and adaptive immune systems of the fetus and neonate are immature, which makes them highly susceptible to infections. There is good evidence that prenatal infections are a primary cause of preterm births. Additionally, the association between antenatal inflammation and adverse neonatal outcomes has been well established. The lung, gastrointestinal tract, and skin are exposed to amniotic fluid during pregnancy and are probable targets of infection and subsequent inflammation during pregnancy. We found a large number of studies focusing on prenatal infection and the host response. Intrauterine infection and fetal immune responses are well studied, and we describe clinical data on cellular, cytokine, and humoral responses to different microbial challenges. The link to postnatal immunological effects including immune paralysis and/or excessive immune activation, however, turned out to be much more complicated. We found studies relating prenatal infectious or inflammatory hits to well-known neonatal diseases such as respiratory distress syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis. Despite these data, a direct link between prenatal hits and postnatal immunological outcome could not be undisputedly established. We did however identify several unresolved topics and propose questions for further research.
Collapse
Affiliation(s)
- Gijs T J van Well
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Maastricht University Medical Center (Maastricht UMC+), Maastricht, The Netherlands.
- School for Nutrition and Metabolism (NUTRIM), Maastricht University Medical Center (Maastricht UMC+), Maastricht, The Netherlands.
| | - Leonie A Daalderop
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Maastricht University Medical Center (Maastricht UMC+), Maastricht, The Netherlands
| | - Tim Wolfs
- Department of Pediatrics, Laboratory of Pediatrics, Maastricht University Medical Center (Maastricht UMC+), Maastricht, The Netherlands
- School for Developmental Biology and Oncology (GROW), Maastricht University Medical Center (Maastricht UMC+), Maastricht, The Netherlands
| | - Boris W Kramer
- Department of Pediatrics, Division of Neonatology, Maastricht University Medical Center (Maastricht UMC+), Maastricht, The Netherlands
- School for Developmental Biology and Oncology (GROW), Maastricht University Medical Center (Maastricht UMC+), Maastricht, The Netherlands
| |
Collapse
|
20
|
Lio A, Rosati P, Pastorino R, Cota F, Tana M, Tirone C, Aurilia C, Ricci C, Gambacorta A, Paladini A, Mappa I, Buongiorno S, Zannoni GF, Romagnoli C, Vento G. Fetal Doppler velocimetry and bronchopulmonary dysplasia risk among growth-restricted preterm infants: an observational study. BMJ Open 2017; 7:e015232. [PMID: 28729313 PMCID: PMC5541508 DOI: 10.1136/bmjopen-2016-015232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate whether fetal growth restriction (FGR) diagnosis, based on pathological prenatal fetal Doppler velocimetry, is associated with bronchopulmonary dysplasia (BPD) independently of being small for gestational age (SGA) per se at birth among very preterm infants. DESIGN Prospective, observational study. FGR was defined as failing fetal growth in utero and fetal Doppler velocimetry abnormalities. SETTING Policlinico Universitario Agostino Gemelli, Roma, Italy. PATIENTS Preterm newborns with gestational age ≤30 weeks and birth weight (BW) ≤1250 g. MAIN OUTCOME MEASURES Bronchopulmonary dysplasia. RESULTS In the study period, 178 newborns were eligible for the study. Thirty-nine infants (22%) were considered fetal growth-restricted infants. Among the 154 survived babies at 36 weeks postmenstrual age, 12 out of 36 (33%) of the FGR group developed BPD versus 8 out of 118 (7%) of the NO-FGR group (p<0.001). BPD rate was sixfold higher among the SGA-FGR infants compared with the SGA-NO-FGR infants. In a multivariable model, FGR was significantly associated with BPD risk (OR 5.1, CI 1.4 to 18.8, p=0.01), independently from BW z-score that still remains a strong risk factor (OR 0.5, CI 0.3 to 0.9, p=0.01). CONCLUSION Among SGA preterm infants, BPD risk dramatically increases when placenta dysfunction is the surrounding cause of low BW. Antenatal fetal Doppler surveillance could be a useful tool for studying placenta wellness and predicting BPD risk among preterm babies. Further research is needed to better understand how FGR affects lung development.
Collapse
Affiliation(s)
- Alessandra Lio
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Rosati
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cota
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Milena Tana
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Tirone
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Aurilia
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cinzia Ricci
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Gambacorta
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Paladini
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Buongiorno
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Franco Zannoni
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Costantino Romagnoli
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli—Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
21
|
Hibbs AM, Muhlebach MS. Infection and Inflammation: Catalysts of Pulmonary Morbidity in Bronchopulmonary Dysplasia. RESPIRATORY OUTCOMES IN PRETERM INFANTS 2017. [PMCID: PMC7121702 DOI: 10.1007/978-3-319-48835-6_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio USA
| | - Marianne S. Muhlebach
- Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, North Carolina USA
| |
Collapse
|
22
|
Baranov AA, Namazova-Baranova LS, Volodin NN, Davydova IV, Ovsyannikov DU, Ivanov DO, Boytsova EV, Yatsik GV, Antonov AG, Ionov OV, Ryndin AU, Grebennikov VA, Soldatova IG, Chubarova AI. Managing Children with Bronchopulmonary Dysplasia. PEDIATRIC PHARMACOLOGY 2016. [DOI: 10.15690/pf.v13i4.1603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bronchopulmonary dysplasia is one of the most significant early childhood chronic respiratory diseases. The article features modern approaches to preventing, diagnosing and treating broncho-pulmonary dysplasia, as well as ways of preventing complications and undesirable disease outcomes in patients older than 3 years. Members of professional associations — Union of Pediatricians of Russia and Russian Association of Perinatal Medicine Specialists — have summarized the experience of managing this category of patients at leading Russian pediatric centers according to the principles of evidence-based medicine and have provided scientific and practical data corresponding to the world level of knowledge with regard to the present problem.
Collapse
Affiliation(s)
- A. A. Baranov
- Scientific Center of Children’s Health; Pirogov Russian National Research Medical University
| | - L. S. Namazova-Baranova
- Scientific Center of Children’s Health; Pirogov Russian National Research Medical University; Sechenov First Moscow State Medical University
| | - N. N. Volodin
- D. Rogachev Federal Scientific-Clinical Center of Child Hematology, Oncology and Immunology
| | - I. V. Davydova
- Scientific Center of Children’s Health; Sechenov First Moscow State Medical University
| | | | - D. O. Ivanov
- St. Petersburg State Pediatric Medical University
| | - E. V. Boytsova
- Scientific Research Institute of Pulmonology at the I.P. Pavlov St. Petersburg State Medical University
| | | | - A. G. Antonov
- V.I. Kulakov Scientific Center of Obstetrics, Gynaecology and Perinatology
| | - O. V. Ionov
- V.I. Kulakov Scientific Center of Obstetrics, Gynaecology and Perinatology
| | - A. U. Ryndin
- V.I. Kulakov Scientific Center of Obstetrics, Gynaecology and Perinatology
| | | | | | | |
Collapse
|
23
|
Kumar VHS, Lakshminrusimha S, Kishkurno S, Paturi BS, Gugino SF, Nielsen L, Wang H, Ryan RM. Neonatal hyperoxia increases airway reactivity and inflammation in adult mice. Pediatr Pulmonol 2016; 51:1131-1141. [PMID: 27116319 DOI: 10.1002/ppul.23430] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 01/23/2016] [Accepted: 03/08/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Supplemental O2 to treat bronchopulmonary dysplasia (BPD) in premature infants, is a major risk factor producing alteration in lung function, airway reactivity, and predisposition to respiratory infections. This study explores inflammatory and airway responses following neonatal hyperoxia in adult mice. METHODS Newborn mouse litters were randomized to 85% O2 or room air (RA) on P3 for 12 days; mice were sacrificed either on P15 or at 15 weeks following recovery in RA. Airway hyper reactivity (AHR) was assessed in vivo (8 and 12 weeks) and in vitro (15 weeks) with methacholine; Lung and BAL were assayed for inflammatory mediators, cell counts, CD3 immunohistochemistry, and histopathology. RESULTS Hyperoxic mice had increased airway reactivity at baseline and following methacholine challenge in vivo (8 and 12 weeks); isolated tracheal rings had a significantly higher constriction response to methacholine in vitro compared to RA group. Inflammatory markers were higher at 2 weeks (MCP-1, IL-12, INF-γ) and at 15 weeks (LTB4 , VEGF); Lipoxin-A4 was lower in the hyperoxia group at both time points. Increased airway smooth muscle thickness and angiogenesis in the lung was seen at 15 weeks. Hyperoxic lungs exhibited alveolar simplification at 2 and 15 weeks. Absolute lymphocyte count was higher in lavage fluid with an increased CD3 cell count at 15 weeks suggesting persistent inflammation in adult mice following neonatal hyperoxia. CONCLUSIONS Exposure to hyperoxia in newborn mice increases long-term airway reactivity with persistent lung inflammation associated with a marked increase in lymphocytes, suggesting long-term consequences in adults. Pediatr Pulmonol. 2016;51:1131-1141. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Vasantha H S Kumar
- Department of Pediatrics, University at Buffalo, The State University of New York, New York.
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University at Buffalo, The State University of New York, New York
| | - Sergei Kishkurno
- Department of Pediatrics, University at Buffalo, The State University of New York, New York
| | - Babu S Paturi
- Department of Pediatrics, University at Buffalo, The State University of New York, New York
| | - Sylvia F Gugino
- Department of Pediatrics, University at Buffalo, The State University of New York, New York
| | - Lori Nielsen
- Department of Pediatrics, University at Buffalo, The State University of New York, New York
| | - Huamei Wang
- Department of Pediatrics, University at Buffalo, The State University of New York, New York
| | - Rita M Ryan
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
24
|
D'Angio CT, Ambalavanan N, Carlo WA, McDonald SA, Skogstrand K, Hougaard DM, Shankaran S, Goldberg RN, Ehrenkranz RA, Tyson JE, Stoll BJ, Das A, Higgins RD. Blood Cytokine Profiles Associated with Distinct Patterns of Bronchopulmonary Dysplasia among Extremely Low Birth Weight Infants. J Pediatr 2016; 174:45-51.e5. [PMID: 27117196 PMCID: PMC4925295 DOI: 10.1016/j.jpeds.2016.03.058] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/25/2016] [Accepted: 03/23/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore differences in blood cytokine profiles among distinct bronchopulmonary dysplasia (BPD) patterns. STUDY DESIGN We evaluated blood spots collected from 943 infants born at ≤1000 g and surviving to 28 days on postnatal days 1, 3, 7, 14, and 21 for 25 cytokines. Infants were assigned to the following lung disease patterns: (1) no lung disease (NLD); (2) respiratory distress syndrome without BPD; (3) classic BPD (persistent exposure to supplemental oxygen until 28 days of age); or (4) atypical BPD (period without supplemental oxygen before 28 days). Median cytokine levels for infants with BPD were compared with the IQR of results among infants with NLD. RESULTS The distribution of enrolled infants by group was as follows: 69 (NLD), 73 (respiratory distress syndrome), 381 (classic BPD), and 160 (atypical BPD). The remaining 260 infants could not be classified because of missing data (104) or not fitting a predefined pattern (156). Median levels of 3 cytokines (elevated interleukin [IL]-8, matrix metalloproteinase-9; decreased granulocyte macrophage colony-stimulating factor) fell outside the IQR for at least 2 time points in both infants with atypical and classic BPD. Profiles of 7 cytokines (IL-6, IL-10, IL-18, macrophage inflammatory protein-1α, C-reactive protein, brain-derived neurotrophic factor, regulated on activation, normal T cell expressed and secreted) differed between infants with classic and atypical BPD. CONCLUSIONS Blood cytokine profiles may differ between infants developing classic and atypical BPD. These dissimilarities suggest the possibility that differing mechanisms could explain the varied patterns of pathophysiology of lung disease in extremely premature infants.
Collapse
Affiliation(s)
- Carl T D'Angio
- Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Scott A McDonald
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Kristin Skogstrand
- Danish Centre for Neonatal Screening, Department of Clinical Biochemistry, Immunology and Genetics, Statens Serum Institut, Copenhagen, Denmark
| | - David M Hougaard
- Danish Centre for Neonatal Screening, Department of Clinical Biochemistry, Immunology and Genetics, Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | - Jon E Tyson
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX
| | - Barbara J Stoll
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Rockville, MD
| | - Rosemary D Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| |
Collapse
|
25
|
|
26
|
Choi CW, Lee J, Oh JY, Lee SH, Lee HJ, Kim BI. Protective effect of chorioamnionitis on the development of bronchopulmonary dysplasia triggered by postnatal systemic inflammation in neonatal rats. Pediatr Res 2016; 79:287-94. [PMID: 26551413 PMCID: PMC4829878 DOI: 10.1038/pr.2015.224] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/08/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prenatal or postnatal systemic inflammation can contribute to the development of bronchopulmonary dysplasia (BPD). We investigated whether prenatal intra-amniotic (i.a.) inflammation or early postnatal systemic inflammation can induce BPD in a rat model. METHODS One microgram of lipopolysaccharide (LPS) or vehicle was injected into the amniotic sacs 2 d before delivery (E20). After birth, 0.25 mg/kg of LPS or vehicle was injected into the peritoneum of pups on postnatal day (P)1, P3, and P5. On P7 and P14, peripheral blood (PB), bronchoalveolar lavage fluid (BALF), and lung tissue were obtained and analyzed. RESULTS Postnatal i.p. injections of LPS significantly increased neutrophil counts in PB and BALF on P7 and P14. Similarly, proinflammatory cytokine and angiogenic factor transcript levels were increased in the lung by i.p. LPS on P7. Alveolar and pulmonary vascular development was markedly disrupted by i.p. LPS on P14. However, pretreatment with i.a. LPS significantly negated the detrimental effects of postnatal i.p. LPS on PB and BALF neutrophil counts and on lung proinflammatory cytokine expression and histopathological changes. CONCLUSION Exposure to early postnatal systemic LPS induces BPD, an arrest in alveolarization, in neonatal rats. Preceding exposure to i.a. LPS protects the lungs against BPD triggered by postnatal systemic inflammation.
Collapse
Affiliation(s)
- Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Juyoung Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea,()
| |
Collapse
|
27
|
Abstract
Despite advances in the care of preterm infants, these infants remain at risk bronchopulmonary dysplasia (BPD), which results in prolonged need for supplemental oxygen, recurrent respiratory exacerbations, and exercise intolerance. Recent investigations have highlighted the important contribution of the developing pulmonary circulation to lung development, showing that these infants are also at risk for pulmonary vascular disease (PVD), including pulmonary hypertension (PH) and pulmonary vascular abnormalities. Several epidemiologic studies have delineated the incidence of PH in preterm infants and the impact on outcomes. These studies have also highlighted gaps in the understanding of PVD in BPD.
Collapse
Affiliation(s)
- Peter M Mourani
- Section of Pediatric Critical Care, Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado, School of Medicine, 13121 East 17th Avenue, MS8414, Aurora, CO 80045, USA.
| | - Steven H Abman
- Section of Pulmonary Medicine, Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado, School of Medicine, Mail Stop B395, 13123 East 16th Avenue, Aurora, CO 80045, USA
| |
Collapse
|
28
|
Yang WC, Chen CY, Chou HC, Hsieh WS, Tsao PN. Angiogenic Factors in Cord Blood of Preterm Infants Predicts Subsequently Developing Bronchopulmonary Dysplasia. Pediatr Neonatol 2015; 56:382-5. [PMID: 25997993 DOI: 10.1016/j.pedneo.2015.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/20/2015] [Accepted: 02/09/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) of prematurity is associated with impaired angiogenesis. Excess soluble fms-like tyrosine kinase-1 (sFlt-1) and lower levels of vascular endothelial growth factor (VEGF) impaired alveolarization in preterm rats. Overexpression of placenta growth factor (PlGF) in mice caused airspace enlargement, which is similar to BPD pathologically. Our study aimed to clarify whether cord blood levels of these angiogenic factors were associated with the development of BPD in preterm infants. METHODS Preterm infants of gestational age (GA) <35 weeks who already had all the data of cord blood VEGF, PlGF, and sFlt-1 levels in our previous studies were enrolled. Cord blood levels of VEGF, PlGF, and sFlt-1 were collected. BPD was defined as the need for supplemental oxygen or mechanical ventilation support at the postmenstrual age of 36 weeks. We used the Mann-Whitney U test for comparison between infants with and without BPD, and multivariate analysis with logistic regression to assess the association of these molecules and the development of BPD. RESULTS Infants with BPD had lower GA [(27 weeks (24-34) vs. 31 weeks (28-24)], lower birth body weight [882 g (620-1232) vs. 1538 g (886-2328)], a higher incidence of respiratory distress syndrome (RDS) (58% vs. 14%), and a higher level of PlGF [21.45 pg/dL (6.03-474.01) vs. 7.43 pg/dL (0.09-23.75)] as compared with those infants without BPD. The levels of VEGF and sFlt-1 did not differ significantly between the two groups. Multivariate logistic regression revealed that lower birth body weight (p = 0.022) and higher level of PlGF (p = 0.012) were significantly correlated with the development of BPD independently. There was no significant association between the level of VEGF or sFlt-1 and the development of BPD. CONCLUSION Cord blood level of PlGF, rather than VEGF or sFlt-1, was significantly increased in the BPD group. Consistent with our previous report, cord blood level of PlGF may be considered as a biomarker to predict subsequently developing BPD in preterm infants.
Collapse
Affiliation(s)
- Wen-Chien Yang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Research Center of Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
29
|
Assessing the Response to Inhaled Albuterol by Monitoring Patient Effort-Related Trends With a Servo-I Ventilator in Neurally Adjusted Ventilatory Assist Mode: A Case Presentation. Adv Neonatal Care 2015; 15:E3-E11. [PMID: 26035121 DOI: 10.1097/anc.0000000000000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants with chronic lung disease tend to be difficult to care for due to the heterogeneous nature of both their disease and the treatments required. Multiple types of medications, treatments, and nursing interventions are often needed to attain clinical success, and it is frequently difficult to discern which are effective versus the ones that offer no benefit. This article presents a case study that chronicles the care of an infant with chronic lung disease treated with albuterol. An innovative form of ventilation with monitoring of the electrical activity of the diaphragm with a special sensor-embedded catheter is used to assess the effectiveness of albuterol administration. PURPOSE This case study presents the monitoring of the effectiveness of albuterol in an infant with chronic lung disease measuring the electrical activity of the diaphragm catheter (Edi) and the various monitoring systems on the Servo-i ventilator in Neurally Adjusted Ventilatory Assist (NAVA) Mode. CASE FINDINGS/RESULTS The clinicians followed various respiratory trends monitored by the Servo-i ventilator after albuterol dosing to document the clinical utility of using albuterol in this infant. The monitoring provided by NAVA showed an improvement in both lung mechanics and clinical condition immediately after albuterol administration. IMPLICATIONS FOR PRACTICE The infant had a positive response to albuterol dosing that subsequently led to reduced length of stay, reduced costs, and reduced family anxiety. This type of monitoring could help nurses and clinicians discern whether a given treatment or medication was effective. IMPLICATIONS FOR RESEARCH This method of clinical monitoring could provide a means to assess clinical utility of respiratory medications, treatments, and nursing interventions in certain populations of neonates and infants. The impact of objective monitoring on required sedation, weight gain, ventilator days, length of hospitalization, and overall hospital costs are other possible areas for future research.
Collapse
|
30
|
Kim SB, Lee JH, Lee J, Shin SH, Eun HS, Lee SM, Sohn JA, Kim HS, Choi BM, Park MS, Park KI, Namgung R, Park MS. The efficacy and safety of Montelukast sodium in the prevention of bronchopulmonary dysplasia. KOREAN JOURNAL OF PEDIATRICS 2015; 58:347-53. [PMID: 26512261 PMCID: PMC4623454 DOI: 10.3345/kjp.2015.58.9.347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/21/2014] [Accepted: 11/04/2014] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this study was to evaluate the efficacy and safety of Montelukast sodium in the prevention of bronchopulmonarydysplasia (BPD). Methods The Interventional study was designed as a multicenter, prospective, and randomized trial, with open labeled and parallel-experimental groups, 66 infants were enrolled and allocated to either the case group (n=30) or the control group (n=36) based on gestational age (GA). Infants in the case group were given Montelukast sodium (Singulair) based on their body weight (BW). Zero week was defined as the start time of the study. Results The incidence of moderate to severe BPD was not different between the groups (case group: 13 of 30 [43.3%] vs. control group: 19 of 36 [52.8%], P=0.912). Additionally, secondary outcomes such as ventilation index, mean airway pressure and resort to systemic steroids were not significantly different. There were no serious adverse drug reactions in either group, and furthermore the rate of occurrence of mild drug related-events were not significantly different (case group: 10 of 42 [23.8%] vs. control group: 6 of 48 (15.8%), P=0.414). Conclusion Montelukast was not effective in reducing moderate or severe BPD. There were no significant adverse drug events associated with Montelukast treatment.
Collapse
Affiliation(s)
- Sang Bum Kim
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Juyoung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jin A Sohn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Sung Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
31
|
Abman SH, Conway SJ. Developmental determinants and changing patterns of respiratory outcomes after preterm birth. ACTA ACUST UNITED AC 2014; 100:127-33. [PMID: 24659395 DOI: 10.1002/bdra.23242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Steven H Abman
- Pediatric Heart Lung Center, Pediatric Pulmonary Medicine, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, Colorado
| | | |
Collapse
|
32
|
Mirza H, Ziegler J, Ford S, Padbury J, Tucker R, Laptook A. Pulmonary hypertension in preterm infants: prevalence and association with bronchopulmonary dysplasia. J Pediatr 2014; 165:909-14.e1. [PMID: 25189821 DOI: 10.1016/j.jpeds.2014.07.040] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 07/03/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether early pulmonary hypertension (PH) at 10-14 days of life in preterm infants is associated with bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA). STUDY DESIGN This was a prospective observational cohort study of infants <28 weeks' gestation. Exclusion criteria were any major anomaly, genetic syndrome, or death before the initial echocardiogram. Echocardiograms were performed between 10 and 14 days of life and at 36 weeks' PMA to assess PH. BPD and its severity were determined at 36 weeks PMA by the National Institutes of Health workshop definition. RESULTS From March 2011 to April 2013, of 146 consecutively admitted infants <28 weeks, 120 were enrolled. One infant was excluded, 17 did not consent, and 8 died before undergoing a study echocardiogram. At 10-14 days of life, 10 infants had early PH (8%). Male sex (56% vs 40%), gestational age (26(+2) ± 1(+2) vs 25(+6) ± 1(+4) weeks), birth weight (837 ± 205 g vs 763 ± 182 g), and small for gestational age (14% vs 20%) were not significantly different among infants with no PH and early PH, respectively. Infants with early PH required >0.3 fraction of inspired oxygen by day 10 of life (70% vs 27%, P < .01). Moderate/severe BPD or death was greater among infants with early PH (90%) compared with no PH (47%, relative risk 1.9, 95% CI 1.43-2.53). CONCLUSION In this prospective, single-center cohort, early PH was associated with moderate/severe BPD or death at 36 weeks' PMA.
Collapse
Affiliation(s)
- Hussnain Mirza
- Department of Pediatrics, Women & Infants Hospital/The Alpert Medical School of Brown University, Providence, RI
| | - James Ziegler
- Division of Pediatric Cardiology, Hasbro Children's Hospital/The Alpert Medical School of Brown University, Providence, RI
| | - Sara Ford
- Division of Pediatric Cardiology, Hasbro Children's Hospital/The Alpert Medical School of Brown University, Providence, RI
| | - James Padbury
- Department of Pediatrics, Women & Infants Hospital/The Alpert Medical School of Brown University, Providence, RI
| | - Richard Tucker
- Department of Pediatrics, Women & Infants Hospital/The Alpert Medical School of Brown University, Providence, RI
| | - Abbot Laptook
- Department of Pediatrics, Women & Infants Hospital/The Alpert Medical School of Brown University, Providence, RI.
| |
Collapse
|
33
|
D'Angio CT, Ryan RM. Animal models of bronchopulmonary dysplasia. The preterm and term rabbit models. Am J Physiol Lung Cell Mol Physiol 2014; 307:L959-69. [PMID: 25326582 DOI: 10.1152/ajplung.00228.2014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is an important lung developmental pathophysiology that affects many premature infants each year. Newborn animal models employing both premature and term animals have been used over the years to study various components of BPD. This review describes some of the neonatal rabbit studies that have contributed to the understanding of BPD, including those using term newborn hyperoxia exposure models, premature hyperoxia models, and a term newborn hyperoxia model with recovery in moderate hyperoxia, all designed to emulate aspects of BPD in human infants. Some investigators perturbed these models to include exposure to neonatal infection/inflammation or postnatal malnutrition. The similarities to lung injury in human premature infants include an acute inflammatory response with the production of cytokines, chemokines, and growth factors that have been implicated in human disease, abnormal pulmonary function, disordered lung architecture, and alveolar simplification, development of fibrosis, and abnormal vascular growth factor expression. Neonatal rabbit models have the drawback of limited access to reagents as well as the lack of readily available transgenic models but, unlike smaller rodent models, are able to be manipulated easily and are significantly less expensive than larger animal models.
Collapse
Affiliation(s)
- Carl T D'Angio
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York and
| | - Rita M Ryan
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
34
|
Baker CD, Abman SH, Mourani PM. Pulmonary Hypertension in Preterm Infants with Bronchopulmonary Dysplasia. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:8-16. [PMID: 24669351 DOI: 10.1089/ped.2013.0323] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/16/2014] [Indexed: 01/02/2023]
Abstract
Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, is a significant contributor to perinatal morbidity and mortality. Premature birth disrupts pulmonary vascular growth and initiates a cascade of events that result in impaired gas exchange, abnormal vasoreactivity, and pulmonary vascular remodeling that may ultimately lead to pulmonary hypertension (PH). Even infants who appear to have mild BPD suffer from varying degrees of pulmonary vascular disease (PVD). Although recent studies have enhanced our understanding of the pathobiology of PVD and PH in BPD, much remains unknown with respect to how PH should be properly defined, as well as the most accurate methods for the diagnosis and treatment of PH in infants with BPD. This article will provide neonatologists and primary care providers, as well as pediatric cardiologists and pulmonologists, with a review of the pathophysiology of PH in preterm infants with BPD and a summary of current clinical recommendations for managing PH in this population.
Collapse
Affiliation(s)
- Christopher D Baker
- Section of Pulmonary Medicine, University of Colorado School of Medicine , Aurora, Colarado. ; Pediatric Heart Lung Center, University of Colorado School of Medicine , Aurora, Colarado
| | - Steven H Abman
- Section of Pulmonary Medicine, University of Colorado School of Medicine , Aurora, Colarado. ; Pediatric Heart Lung Center, University of Colorado School of Medicine , Aurora, Colarado
| | - Peter M Mourani
- Pediatric Heart Lung Center, University of Colorado School of Medicine , Aurora, Colarado. ; Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colarado
| |
Collapse
|
35
|
Fischer HS, Bührer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis. Pediatrics 2013; 132:e1351-60. [PMID: 24144716 DOI: 10.1542/peds.2013-1880] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Mechanical ventilation via an endotracheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants <30 weeks' gestational age (GA). METHODS In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants <30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6. RESULTS We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage. CONCLUSIONS Strategies aimed at avoiding eMV in infants <30 weeks' GA have a small but significant beneficial impact on preventing BPD.
Collapse
Affiliation(s)
- Hendrik S Fischer
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | | |
Collapse
|
36
|
Lagatta JM, Clark RH, Brousseau DC, Hoffmann RG, Spitzer AR. Varying patterns of home oxygen use in infants at 23-43 weeks' gestation discharged from United States neonatal intensive care units. J Pediatr 2013; 163:976-82.e2. [PMID: 23769504 PMCID: PMC4027028 DOI: 10.1016/j.jpeds.2013.04.067] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/14/2013] [Accepted: 04/30/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare proportions of infants at different gestational ages discharged from the neonatal intensive care unit (NICU) on home oxygen, to determine how many were classified with chronic lung disease based on timing of discharge on home oxygen, and to determine the percentage discharged on home oxygen who received mechanical ventilation. STUDY DESIGN We evaluated a retrospective cohort of infants of 23-43 weeks' gestational age discharged from 228 NICUs in 2009, using the Pediatrix Clinical Data Warehouse. Multilevel logistic regression analysis identified predictors of home oxygen use among extremely preterm, early-moderate preterm, late preterm, and term infants. Duration of mechanical ventilation and median length of stay were calculated for infants discharged on home oxygen. RESULTS For the 48877 infants studied, the rate of home oxygen use ranged from 28% (722 of 2621) in extremely preterm infants to 0.7% (246 of 34 934) in late preterm and term infants. Extremely preterm infants composed 56% (722 of 1286) of the infants discharged on home oxygen; late preterm and term infants, 19% (246 of 1286). After gestational age, mechanical ventilation was the main predictor of home oxygen use; however, 61% of the late preterm and term infants discharged on home oxygen did not receive ventilation. The median length of hospital stay was 95 days (IQR, 76-114 days) for extremely preterm infants discharged on home oxygen, but only 15 days (IQR, 10-22 days) for late preterm and term ventilated infants discharged on home oxygen. CONCLUSION Although home oxygen use is uncommon in later-gestation infants, the greater overall numbers of later-gestation infants contribute significantly to the increased need for home oxygen for infants at NICU discharge. Neither respiratory failure nor lengthy hospitalization is a prerequisite for home oxygen use at later gestational age.
Collapse
|
37
|
Displasia broncopulmonar: definiciones y clasificación. An Pediatr (Barc) 2013; 79:262.e1-6. [DOI: 10.1016/j.anpedi.2013.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/11/2013] [Indexed: 11/22/2022] Open
|
38
|
Cristea AI, Carroll AE, Davis SD, Swigonski NL, Ackerman VL. Outcomes of children with severe bronchopulmonary dysplasia who were ventilator dependent at home. Pediatrics 2013; 132:e727-34. [PMID: 23918888 PMCID: PMC3876749 DOI: 10.1542/peds.2012-2990] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To describe the incidence and outcomes of children with chronic respiratory failure secondary to severe bronchopulmonary dysplasia (BPD) on chronic positive pressure ventilation (PPV) via tracheostomy at home. METHODS We retrospectively reviewed medical charts of patients with severe BPD who were PPV dependent at home and who were enrolled in a university-affiliated home ventilator program between 1984 and 2010. We excluded patients with other comorbidities that could contribute to the development of chronic respiratory failure. We reported the incidence of these children in Indiana and cumulative incidences of survival, liberation from PPV, and decannulation. RESULTS Over 27 years, 628 children were cared for in our home ventilator program. Of these, 102 patients met inclusion criteria: 83 (81.4%) were alive and 19 (18.6%) were deceased. Sixty-nine patients (67.6%) were liberated from PPV, and 97.1% of them were weaned before their fifth birthday, with a median age at liberation of 24 months (interquartile range, 19-33). Similarly, 60 patients (58.8%) were decannulated, of which 96.7% completed this process before their sixth birthday, with a median age at decannulation of 37.5 months (interquartile range, 31.5-45). The incidence of children with chronic respiratory failure secondary to BPD who were PPV-dependent at home in Indiana was 1.23 per 100 000 live births in 1984 and increased to 4.77 per 100 000 live births in 2010. CONCLUSIONS Although extreme prematurity associated with severe BPD necessitating PPV at home carries significant risks of morbidity and mortality, successful liberation from mechanical ventilation and decannulation are likely to occur.
Collapse
Affiliation(s)
- A. Ioana Cristea
- Section of Pediatric Pulmonology, and,Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron E. Carroll
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Nancy L. Swigonski
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Pulmonary hypertension contributes significantly to morbidity and mortality of chronic lung disease of infancy, or bronchopulmonary dysplasia (BPD). Advances in pulmonary vascular biology over the past few decades have led to new insights into the pathogenesis of BPD; however, many unique issues persist regarding our understanding of pulmonary vascular development and disease in preterm infants at risk for chronic lung disease. RECENT FINDINGS Recent studies have highlighted the important contribution of the developing pulmonary circulation to lung growth in the setting of preterm birth. These studies suggest that there is a spectrum of pulmonary vascular disease (PVD) in BPD rather than a simple question of whether or not pulmonary hypertension is present. Epidemiological studies underscore gaps in our understanding of PVD in the context of BPD, including universally accepted definitions, approaches to diagnosis and treatment, and patient outcomes. Unfortunately, therapeutic strategies for pulmonary hypertension in BPD are based on small observational studies with poorly defined endpoints and rely on results from older children and adult studies. Yet, unique characteristics of this population create other potential risks for the adoption of these strategies. SUMMARY Despite many recent advances, PVD remains an important contributor to poor outcomes in preterm infants with BPD. Substantial challenges persist, especially with regard to understanding mechanisms and the clinical approach to PVD. Future studies are needed to develop evidence-based definitions and clinical endpoints through which the pathophysiology can be investigated and potential therapeutic interventions evaluated.
Collapse
|
40
|
Abstract
Ureaplasma is an organism with low virulence and is a commensal of the lower genito-urinary tract in females. From here, it can gain entry in the amniotic fluid to cause inflammation in the amniotic compartment during pregnancy. Ureaplasma spp. are the most common organisms isolated from women with chorioamnionitis. Ureaplasma spp. are associated with increased risk for preterm labor and morbidity in the preterm neonate. However, there is some controversy regarding the importance of Ureaplasma in the pathogenesis of bronchopulmonary dysplasia (BPD). This article will review the microbiology of Ureaplasma, host innate immune responses, and the pathology of lung injury in animal models of Ureaplasma chorioamnionitis. We will review epidemiological studies of Ureaplasma and BPD in preterm infants and efficacy of antibiotics in preventing preterm labor and BPD.
Collapse
Affiliation(s)
- Suhas G. Kallapur
- Divisions of Neonatology and Pulmonary Biology, the Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, University of Cincinnati, OH, USA
| | - Boris W. Kramer
- Department of Pediatrics, School for Oncology and Developmental Biology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alan H. Jobe
- Divisions of Neonatology and Pulmonary Biology, the Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, University of Cincinnati, OH, USA
| |
Collapse
|
41
|
Bancalari EH, Jobe AH. Reply to Hjalmarson and Sandberg. J Pediatr 2013; 162:656-7. [PMID: 23324521 DOI: 10.1016/j.jpeds.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
42
|
Kang JH, Lee JJ, Cho SI, Choi Y, Jo HS, Lee KH. Association of Interleukin-1α-889, β-31, β-511 Polymorphism with Risk of Bronchopulmonary Dysplasia. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.4.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jeong Hee Kang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung Jin Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung-Il Cho
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - YouJin Choi
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Heui Seung Jo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kyu Hyung Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| |
Collapse
|
43
|
Choi CW, Kim BI. Epidemiology, Clinical Characteristics, and Pathophysiology of Bronchopulmonary Dysplasia. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.3.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
44
|
The respiratory course of extremely preterm infants: a dilemma for diagnosis and terminology. J Pediatr 2012; 161:585-8. [PMID: 22785261 DOI: 10.1016/j.jpeds.2012.05.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/17/2012] [Accepted: 05/23/2012] [Indexed: 11/21/2022]
|
45
|
Abstract
Although significant advances in respiratory care have been made in neonatal medicine, bronchopulmonary dysplasia (BPD) remains the most common serious pulmonary morbidity in premature infants. The development of BPD is the result of the complex interactions between multiple perinatal and postnatal factors. Early identification of infants at the most risk of developing BPD through the use of estimators and models may allow a targeted approach at reducing BPD in the future.
Collapse
Affiliation(s)
- Andrea Trembath
- Rainbow Babies & Children's Hospital, 11000 Euclid Avenue, RBC Suite 3100, Cleveland, OH 44106, USA.
| | | |
Collapse
|
46
|
Hjalmarson O, Brynjarsson H, Nilsson S, Sandberg KL. Spectrum of chronic lung disease in a population of newborns with extremely low gestational age. Acta Paediatr 2012; 101:912-8. [PMID: 22716028 DOI: 10.1111/j.1651-2227.2012.02753.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine how the ability to oxygenate the blood develops after birth in infants of extremely low gestational age (ELGANs) and to find risk factors for chronic lung disease. METHOD A prospective, population-based, cohort study was undertaken in one tertiary-care centre. The alveolar-arterial oxygen pressure difference (AaDO(2)) was monitored. RESULTS Of 41 survivors, 21 had a period of normal lung function in the first week of life, after which oxygenation deteriorated. Low gestational age and low Apgar score at 5 min were found to be strong and independent predictors of AaDO(2) in the first month of life. Mechanical ventilation did not appear as a risk factor. Lung function at 36 weeks of gestation and duration of oxygen treatment could be better predicted by the severity of lung disease in the first month than by gestational age at birth. CONCLUSIONS Difficulty in oxygenation was a general observation in ELGANs and not only a particular subset. Gestational age and Apgar score were independent predictors of the degree of difficulty over the first month of life. As oxygenation failure often developed after a few days, the process may be possible to treat or prevent once the pathogenesis is known.
Collapse
Affiliation(s)
- O Hjalmarson
- Department of Paediatrics, The Sahlgrenska Academy at University of Gothenburg, Sweden.
| | | | | | | |
Collapse
|
47
|
Tang JR, Karumanchi SA, Seedorf G, Markham N, Abman SH. Excess soluble vascular endothelial growth factor receptor-1 in amniotic fluid impairs lung growth in rats: linking preeclampsia with bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2012; 302:L36-46. [PMID: 22003089 PMCID: PMC3349373 DOI: 10.1152/ajplung.00294.2011] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 10/09/2011] [Indexed: 01/27/2023] Open
Abstract
Epidemiological studies have shown that maternal preeclampsia (PE) increases the risk of bronchopulmonary dysplasia (BPD), but the underlying mechanism is unknown. Soluble vascular endothelial growth factor receptor-1 (soluble VEGFR1, known as soluble fms-like tyrosine kinase 1, or sFlt-1), an endogenous antagonist of vascular endothelial growth factor (VEGF), is markedly elevated in amniotic fluid and maternal blood in PE. Therefore, we hypothesized that antenatal exposure to excess sFlt-1 disrupts lung development through impaired VEGF signaling in utero, providing a mechanistic link between PE and BPD. To determine whether increased sFlt-1 in amniotic fluid is sufficient to cause sustained abnormalities of lung structure during infancy, sFlt-1 or saline was injected into amniotic sacs of pregnant Sprague-Dawley rats at 20 days of gestation (term, 22 days). After birth, pups were observed through 14 days of age for study. We found that intra-amniotic sFlt-1 treatment decreased alveolar number, reduced pulmonary vessel density, and caused right and left ventricular hypertrophy in 14-day-old rats. In addition, intra-amniotic sFlt-1 treatment suppressed activation of lung VEGF receptor-2 and increased apoptosis in endothelial and mesenchymal cells in the newborn lung. We conclude that exposure to excess sFlt-1 in amniotic fluid during late gestation causes sustained reductions in alveolarization and pulmonary vascular growth during infancy, accompanied by biventricular hypertrophy suggesting pulmonary and systemic hypertension. We speculate that impaired VEGF signaling in utero due to exposure of high amniotic fluid levels of sFlt-1 in PE disrupts lung growth and contributes to the increased risk of BPD in infants born to mothers with PE.
Collapse
Affiliation(s)
- Jen-Ruey Tang
- Pediatric Heart Lung Center, Dept. of Pediatrics, Univ. of Colorado Health Sciences Center, P15-4460A, Mail Stop 8614, 12700 East 19th Ave., Aurora, CO 80045, USA.
| | | | | | | | | |
Collapse
|
48
|
Hyödynmaa E, Korhonen P, Ahonen S, Luukkaala T, Tammela O. Frequency and clinical correlates of radiographic patterns of bronchopulmonary dysplasia in very low birth weight infants by term age. Eur J Pediatr 2012; 171:95-102. [PMID: 21597910 DOI: 10.1007/s00431-011-1486-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/03/2011] [Indexed: 11/29/2022]
Abstract
UNLABELLED Our aim was to study the frequency and clinical correlates of two radiographic patterns of bronchopulmonary dysplasia (BPD), the cystic BPD (cBPD) and the leaky lung syndrome (LLS). Radiographic findings of BPD from sixth day of life until term in a cohort of 82 very low birth weight (VLBW) infants were evaluated and scored independently by a neonatologist and a paediatric radiologist. Data on prenatal factors and events during the first hospitalisation were collected prospectively. Forty-four (53.7%) infants showed radiographic evidence of BPD, 19 (23.2%) cBPD and 25 (30.5%) LLS. In multivariate analysis, the best predictors for radiographic BPD were oxygen dependency at 28 days (odds ratio (OR) 10.2 [95% confidence interval (CI) 2.49-41.4]), more than 2 days on ventilator (OR 10.4 [95% CI 1.8-61.5]) and volume expanders in the first 2 h (OR 7.36 [95% CI 1.32-41.2]). During the first week of life, infants with radiographic BPD received less energy per kilogram (p < 0.001) and more daily fluids per kilogram of body weight (p = 0.013). Sixty-two percent of the infants with radiographic BPD were not oxygen dependent at 36 weeks postmenstrual age (PMA). Seventeen (89.5%) of the 19 infants who needed oxygen supplementation at 36 weeks PMA also had abnormal chest X-rays. CONCLUSIONS Radiographic BPD findings appeared to be common in VLBW infants. In addition to the well-known respiratory risk factors (oxygen and ventilator therapy), poor nutrition and excessive fluid administration in early life seem to be significantly associated with radiological findings of lung injury in these patients.
Collapse
Affiliation(s)
- Elina Hyödynmaa
- Paediatric Research Centre, University of Tampere, Tampere, Finland
| | | | | | | | | |
Collapse
|
49
|
Joung KE, Kim HS, Lee J, Shim GH, Choi CW, Kim EK, Kim BI, Choi JH. Correlation of urinary inflammatory and oxidative stress markers in very low birth weight infants with subsequent development of bronchopulmonary dysplasia. Free Radic Res 2011; 45:1024-32. [PMID: 21651454 DOI: 10.3109/10715762.2011.588229] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Currently, bronchopulmonary dysplasia (BPD) occurs almost exclusively in pre-term infants. In addition to prematurity, other factors like oxygen toxicity and inflammation can contribute to the pathogenesis. This study aimed to compare urinary inflammatory and oxidative stress markers between the no/mild BPD group and moderate/severe BPD group and between BPD cases with significant early lung disease like respiratory distress syndrome (RDS) ('classic' BPD) and with minimal early lung disease ('atypical' BPD). A total of 60 patients who were a gestational age < 30 weeks or a birth weight < 1250 g were included. Urine samples were obtained on the 1(st), 3(rd) and 7(th) day of life and measured the levels of leukotriene E(4) (LTE(4)) and 8-hydroxydeoxyguanosine (8-OHdG). The 8-OHdG values on the 3(rd) day showed significant correlation to duration of mechanical ventilation. The 8-OHdG levels on the 7(th) day were the independent risk factor for developing moderate/severe BPD. In 'classic' BPD, the 8-OHdG values on the 3(rd) day were higher than those of 'atypical' BPD. In 'atypical' BPD, the LTE(4) values on the 7(th) day were higher than the values in 'classic' BPD. These results suggest that oxidative DNA damage could be the crucial mechanism in the pathogenesis of current BPD and the ongoing inflammatory process could be an important mechanism in 'atypical' BPD.
Collapse
Affiliation(s)
- Kyoung Eun Joung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
PURPOSE OF REVIEW Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infancy affecting mostly premature infants with significant morbidity and mortality. Improved survival of very immature infants has led to increased numbers of infants with this disorder. Acute and chronic lung injury and impaired postnatal lung growth are thought to be responsible for the development of BPD. Whereas changes in clinical practice have improved the clinical course and outcomes for infants with BPD, over the past decade, the overall incidence of BPD has not changed. This review will describe the prenatal and postnatal factors that contribute to the pathogenesis of BPD as well as current and experimental therapies for treatment of BPD. RECENT FINDINGS The factors that contribute to the pathogenesis of BPD are well described; however, recent studies have better defined how these factors modulate lung growth. Inflammation, proinflammatory cytokines and altered angiogenic gene signaling contribute to lung injury and impair prenatal and postnatal lung growth resulting in BPD; however, to date no therapy has been identified that potently and consistently prevents or reverses their effects on lung growth. We will discuss the cell signaling pathways affected in BPD and current therapies available for modulating these pathways. SUMMARY Despite current advances in neonatal care, BPD remains a heavy burden on healthcare resources. New treatments directed at either reducing lung injury or improving lung growth are under study.
Collapse
|