1
|
Oluwole I, Tan JBC, DeSouza S, Hutchinson M, Leigh RM, Cha M, Rodriguez A, Hou G, Rao SS, Narang A, Chou FS. The association between bronchopulmonary dysplasia grade and risks of adverse neurodevelopmental outcomes among preterm infants born at less than 30 weeks of gestation. J Matern Fetal Neonatal Med 2023; 36:2167074. [PMID: 36642443 DOI: 10.1080/14767058.2023.2167074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a multifactorial disease with neurodevelopmental implications. This study aims to quantify the risks of adverse neurodevelopmental outcomes for each BPD grade among preterm infants born at less than 30 weeks' gestation. METHODS We retrospectively studied infants who received care in our institution until at least 36 weeks postmenstrual age and had a formal neurodevelopmental assessment in our infant follow-up clinic using the Bayley Scales for Infant and Toddler Development (BSID). We assessed the association between BPD grade and adverse neurodevelopmental outcomes using descriptive statistics and regression models. RESULTS Two hundred and fifty infants, including 89 (35.6%), 87 (34.8%), 65 (20.6%), and 9 (3.6%) with No BPD, Grade 1, Grade 2, and Grade 3 BPD, were included in the study. Small for gestational age, late pulmonary hypertension, dexamethasone administration, and adverse neurodevelopmental outcomes were more common as BPD grade increased. In a logistic regression analysis, Grades 2 and 3, but not Grade 1, BPD were associated with increased odds of a composite adverse neurodevelopmental outcome by 2.7 and 7.2 folds, respectively. A BSID domain-specific analysis showed that higher grades were associated with lower scores in the cognitive, gross motor, and fine motor domains. CONCLUSIONS Grades 2 and 3 BPD, but not Grade 1, correlate with risks of adverse neurodevelopmental outcomes at a grade-dependent manner in our single-center cohort retrospective study. Further validation using a multi-center large cohort is warranted.
Collapse
Affiliation(s)
- Izabela Oluwole
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - John B C Tan
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Huckleberry Labs, Inc, Irvine, CA, USA
| | - Shirin DeSouza
- Division of General Pediatrics and Pediatric Hospital Medicine, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | - Rebekah M Leigh
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Minha Cha
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | - Gina Hou
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Srinandini S Rao
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Arvind Narang
- Business intelligence and Data Governance, Loma Linda University Health, Loma Linda, CA, USA
| | - Fu-Sheng Chou
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Clinician Investigator Program, Southern California Permanente Medical Group, Pasadena, CA, USA.,Department of Neonatal-Perinatal Medicine, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| |
Collapse
|
2
|
Xie L, Luo X, Li B, Du L, Wang Z, Liu Y, Chen J, Duan S, Yan L, Gao W. Impact of Changes in Early Respiratory Support Management on Respiratory Outcomes of Preterm Infants. Respir Care 2022; 67:1310-1319. [PMID: 35764345 PMCID: PMC9994321 DOI: 10.4187/respcare.09963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the period immediately after birth, preterm infants are highly susceptible to lung injury. Ventilator-induced lung injury has been recognized as a major contributing factor for bronchopulmonary dysplasia (BPD) in preterm infants. Noninvasive respiratory support (NIRS) could decrease lung injury, and early respiratory support management might affect pulmonary outcomes. We conducted a study to evaluate the changes in early respiratory support management and their impact on respiratory outcome and complications of preterm infants in 3 different time periods over the last 13 years. METHODS This study was a retrospective, single-center cohort study. We retrospectively reviewed the medical records of preterm infants < 32 weeks of gestational age born in our hospital from 2007-2020. The study period was divided into three 3-y discrete periods: 2007-2009 (period A), 2013-2015 (period B), and 2018-2020 (period C). Changes in early respiratory support management were assessed in the 3 periods. The outcomes measured included mortality, BPD, other major neonatal complications, initial respiratory support, and duration of mechanical ventilation. RESULTS In all, 1,880 clinical records were assessed in our study, with 358 in period A, 825 in period B, and 697 in period C. The use of antenatal corticosteroids increased over time (56.1% in period A, 56.7% in period B, and 74.0% in period C (P < .001). The need for surfactant decreased from 65.6% in period A to 40.7% in period B and 45.9% in period C. Increased utilization of NIRS was associated with decreased invasive mechanical ventilation within 24 h after birth. NIRS only during the hospital stay increased from 22.9% in period A to 36.8% and 45.1% in the latter 2 periods (P < .001). Oxygen therapy duration decreased from 24.3 d in period A to 14.4 d in period B and 17.2 d in period C (P < .001). The overall incidence of BPD was 32.4% in the first period, 23.9% in the second period, and 25.4% in the third period (P < .001). The moderate-to-severe forms of BPD decreased from 12.8% in period A to 7.9% in period B and 7.6% in period C (P = .009). Other neonatal complications, such as pneumothorax, pulmonary hemorrhage, persistent pulmonary hypertension of the newborn, surgical necrotizing enterocolitis, intraventricular hemorrhage grade III/IV, and periventricular leukomalacia, were unchanged among the 3 periods. CONCLUSIONS From 2007-2020, respiratory management was characterized by a marked reduction in invasive mechanical ventilation and an increase in the use of NIRS. Changes in early respiratory support management resulted in improved respiratory outcomes with a decrease in the overall incidence of BPD. It is likely that our aim to reduce lung injury by improving our respiratory management has contributed to a favorable outcome.
Collapse
Affiliation(s)
- Lulu Xie
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xianqiong Luo
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Bing Li
- Department of Statistics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Lanlan Du
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhu Wang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ying Liu
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jia Chen
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shunyan Duan
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Longli Yan
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Weiwei Gao
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China.
| |
Collapse
|
3
|
Lim G, Kim YJ, Chung S, Park YM, Kim KS, Park HW. Association of Maternal Hypertensive Disorders During Pregnancy With Severe Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. J Korean Med Sci 2022; 37:e127. [PMID: 35470601 PMCID: PMC9039196 DOI: 10.3346/jkms.2022.37.e127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This meta-analysis was performed to examine the association between maternal hypertension during pregnancy (HDP) and neonatal bronchopulmonary dysplasia (BPD). METHODS We systematically searched PubMed, EMBASE, the Cochrane Library, and the KoreaMed database for relevant studies. We used the Newcastle-Ottawa Scale for quality assessment of all included studies. The meta-analysis was performed using Comprehensive Meta-Analysis software (version 3.3). RESULTS We included 35 studies that fulfilled the inclusion criteria; the total number of infants evaluated came to 97,399 through review process. Maternal HDP was not significantly associated with any definition of BPD, i.e., oxygen dependency at 36 weeks of gestation (odds ratio [OR], 1.162; 95% confidence interval [CI], 0.991-1.362; P = 0.064) in pooled analysis of 29 studies or oxygen dependency at 28 days of age (OR, 1.084; 95% CI, 0.660-1.780; P = 0.751) in pooled analysis of 8 studies. Maternal HDP was significantly associated only with severe BPD (OR, 2.341; 95% CI, 1.726-3.174; P < 0.001). BPD was not associated with HDP in the overall analysis (OR, 1.131; 95% CI, 0.977-1.309; P = 0.100) or subgroup analysis according to the definition of HDP. CONCLUSION Maternal HDP was not associated with neonatal BPD defined by the duration of oxygen dependency (at either 36 weeks of gestation or 28 days of life) but was associated with severe BPD.
Collapse
Affiliation(s)
- Gina Lim
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yoo Jinie Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Konkuk University School of Medicine, Seoul, Korea
| | - Yong Mean Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Konkuk University School of Medicine, Seoul, Korea
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Konkuk University School of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Li J, Xu H. Comparisons of two definitions of bronchopulmonary dysplasia for the premature infants. Pediatr Pulmonol 2022; 57:217-223. [PMID: 34687285 DOI: 10.1002/ppul.25739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Bronchopulmonary dysplasia (BPD) is a very common respiratory disease in premature infants, but there is still a different understanding of the definition of BPD. Therefore, this study is intended to compare are main clinical results and health economic expenditures under different BPD definitions. METHODS This study included premature infants who came into the neonatal intensive care unit (NICU) from January 2018 to January 2020, who were not more than 32 weeks of premenstrual age. The main clinical consequences and health economic expenditures were analyzed by the National Institute of Health and Human Development definition (Workshop) and Jensen definition. RESULTS Total 303 survivors were evaluated at 36 weeks. BPD was performed in 47.5% and 37.6% of infants, respectively, with Workshop's and Jensen's definitions. The percentage of unclassified BPD infants was 0.9% in Workshop's and 3.3% in Jensen's definitions. Further discussing the health economic burden and found that Jensen's definitions had a significantly correlated with NICU charges than the Workshop's definitions. CONCLUSION Comparing the Workshop definition of BPD, the Jensens definition was better correlated to health expenditure.
Collapse
Affiliation(s)
- Jiahui Li
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Haiyan Xu
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.,Department of Pediatrics, Shandong Provincial Qianfoshan Hospital, Jinan, China
| |
Collapse
|
5
|
Karkoutli AA, Brumund MR, Evans AK. Bronchopulmonary dysplasia requiring tracheostomy: A review of management and outcomes. Int J Pediatr Otorhinolaryngol 2020; 139:110449. [PMID: 33157458 DOI: 10.1016/j.ijporl.2020.110449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/10/2020] [Indexed: 12/27/2022]
Abstract
Bronchopulmonary Dysplasia (BPD) is a pulmonary disease affecting newborns, commonly those with prematurity or low birth weight. Its pathogenesis involves underdevelopment of lung tissue with subsequent limitations in ventilation and oxygenation, resulting in impaired postnatal alveolarization. Despite advances in care with improved survival, BPD remains a prevalent comorbidity of prematurity. In severe cases, management may involve mechanical ventilation via tracheostomy. BPD's demand for multidisciplinary care compounds the challenges in management of this condition. Here, we review existing literature: the history of disease, criteria for diagnosis, pathogenesis, and modes of treatment with a focus on the severe subtype: that which is associated with pulmonary hypertension (PAH) for which tracheostomy is often required to facilitate long-term mechanical ventilation. We review the current recommendations for tracheostomy and decannulation.
Collapse
Affiliation(s)
- Adam Ahmad Karkoutli
- Louisiana State University Health Sciences Center, School of Medicine, 533 Bolivar Street, New Orleans, LA, 70112, USA
| | - Michael R Brumund
- Pediatric Cardiology, Louisiana State University Health Sciences Center, Department of Pediatrics, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA; Children's Hospital New Orleans, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA
| | - Adele K Evans
- Pediatric Otolaryngology, Louisiana State University Health Sciences Center, Department of Otolaryngology - Head and Neck Surgery, 533 Bolivar Street, Suite 566, New Orleans, LA, 70112, USA; Children's Hospital New Orleans, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA.
| |
Collapse
|
6
|
Ma D, Gao W, Liu J, Kong D, Zhang Y, Qian M. Mechanism of oxidative stress and Keap-1/Nrf2 signaling pathway in bronchopulmonary dysplasia. Medicine (Baltimore) 2020; 99:e20433. [PMID: 32590729 PMCID: PMC7328910 DOI: 10.1097/md.0000000000020433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease common in premature infants and is one of the leading causes of disability and death in newborns. The Keap-1/Nrf2 signaling pathway plays an important role in antioxidant and anti-inflammatory.Ten clean-grade, healthy pregnant Sprague-Dawley rats (purchased from Experimental Animal Center of Peking university, China) naturally gave birth to 55 neonatal rats from which 40 were selected and randomly divided into a hyperoxia group and a control group (N = 20, each). Thirty-two BPD patient samples are from Neonatal Department of the second Hospital of Jilin University from November 30, 2016 to May 1 2019.In present study, we observed that lung tissues of the control group did not undergo obvious pathological changes, whereas in the hyperoxia group, lung tissues had disordered structures. With increased time of hyperoxia exposure, the alveolar wall became attenuated. Under hypoxia conditions, the activity of oxidative stress-related enzymes (CAT, GSH-Px, SOD) in lung samples was significantly lower than that before treatment. The expression level of Keap1 mRNA and protein in the hyperoxia group was slightly lower than that of control group. The expression of Nrf2 and HO-1 mRNA and protein in the hyperoxia group was significantly higher than that of control group. For the infants with BPD, we found that the activity of SOD, GSH-Px, and CAT was significantly different from those of control group.We constructed a premature BPD animal model and found the abnormal of oxidative stress in different groups and the expression levels of Keap1/Nrf2 signaling pathway-related molecules, and we validated the results in premature infants with BPD.
Collapse
|
7
|
Jung YH, Choi CW, Kim BI. Strategies to improve outcomes of bronchopulmonary dysplasia. KOREAN JOURNAL OF PEDIATRICS 2019; 62:380-381. [PMID: 31623418 PMCID: PMC6801197 DOI: 10.3345/kjp.2019.00661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Young Hwa Jung
- Division of Neonatology, Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Won Choi
- Division of Neonatology, Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beyong Il Kim
- Division of Neonatology, Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|