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Panneflek TJR, Kuypers KLAM, Polglase GR, Derleth DP, Dekker J, Hooper SB, van den Akker T, Pas ABT. The influence of chorioamnionitis on respiratory drive and spontaneous breathing of premature infants at birth: a narrative review. Eur J Pediatr 2024; 183:2539-2547. [PMID: 38558311 PMCID: PMC11098929 DOI: 10.1007/s00431-024-05508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
Most very premature infants breathe at birth but require respiratory support in order to stimulate and support their breathing. A significant proportion of premature infants are affected by chorioamnionitis, defined as an umbrella term for antenatal inflammation of the foetal membranes and umbilical vessels. Chorioamnionitis produces inflammatory mediators that potentially depress the respiratory drive generated in the brainstem. Such respiratory depression could maintain itself by delaying lung aeration, hampering respiratory support at birth and putting infants at risk of hypoxic injury. This inflammatory-mediated respiratory depression may contribute to an association between chorioamnionitis and increased requirement of neonatal resuscitation in premature infants at birth. This narrative review summarises mechanisms on how respiratory drive and spontaneous breathing could be influenced by chorioamnionitis and provides possible interventions to stimulate spontaneous breathing. Conclusion: Chorioamnionitis could possibly depress respiratory drive and spontaneous breathing in premature infants at birth. Interventions to stimulate spontaneous breathing could therefore be valuable. What is Known: • A large proportion of premature infants are affected by chorioamnionitis, antenatal inflammation of the foetal membranes and umbilical vessels. What is New: • Premature infants affected by chorioamnionitis might be exposed to higher concentrations of respiratory drive inhibitors which could depress breathing at birth. • Premature infants affected by chorioamnionitis seem to be associated with a higher and more extensive requirement of resuscitation at birth.
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Affiliation(s)
- Timothy J R Panneflek
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, Netherlands.
| | - Kristel L A M Kuypers
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, Netherlands
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Douglas P Derleth
- Department of Paediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Janneke Dekker
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, Netherlands
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, Netherlands
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Wang D, Huang S, Cao J, Feng Z, Jiang Q, Zhang W, Chen J, Kutty S, Liu C, Liao W, Zhang L, Zhu G, Guo W, Yang J, Liu L, Yang J, Li Q. A comprehensive study on machine learning models combining with oversampling for bronchopulmonary dysplasia-associated pulmonary hypertension in very preterm infants. Respir Res 2024; 25:199. [PMID: 38720331 PMCID: PMC11077703 DOI: 10.1186/s12931-024-02797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) remains a devastating clinical complication seriously affecting the therapeutic outcome of preterm infants. Hence, early prevention and timely diagnosis prior to pathological change is the key to reducing morbidity and improving prognosis. Our primary objective is to utilize machine learning techniques to build predictive models that could accurately identify BPD infants at risk of developing PH. METHODS The data utilized in this study were collected from neonatology departments of four tertiary-level hospitals in China. To address the issue of imbalanced data, oversampling algorithms synthetic minority over-sampling technique (SMOTE) was applied to improve the model. RESULTS Seven hundred sixty one clinical records were collected in our study. Following data pre-processing and feature selection, 5 of the 46 features were used to build models, including duration of invasive respiratory support (day), the severity of BPD, ventilator-associated pneumonia, pulmonary hemorrhage, and early-onset PH. Four machine learning models were applied to predictive learning, and after comprehensive selection a model was ultimately selected. The model achieved 93.8% sensitivity, 85.0% accuracy, and 0.933 AUC. A score of the logistic regression formula greater than 0 was identified as a warning sign of BPD-PH. CONCLUSIONS We comprehensively compared different machine learning models and ultimately obtained a good prognosis model which was sufficient to support pediatric clinicians to make early diagnosis and formulate a better treatment plan for pediatric patients with BPD-PH.
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Affiliation(s)
- Dan Wang
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Cardiology, Hunan Children's Hospital, Changsha, China
| | - Shuwei Huang
- School of Software, Tsinghua University, Beijing, China
| | - Jingke Cao
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhichun Feng
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qiannan Jiang
- Department of Neonatology, Qingdao Women and Children's Hospital, Qingdao, China
| | - Wanxian Zhang
- Department of Neonatology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Jia Chen
- Department of Neonatology, Guangdong Women and Children Hospital, Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Shelby Kutty
- Pediatric and Congenital Cardiology, Taussig Heart Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Changgen Liu
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wenyu Liao
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Le Zhang
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Guli Zhu
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Wenhao Guo
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Jie Yang
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lin Liu
- School of Software, Tsinghua University, Beijing, China.
| | - Jingwei Yang
- Department of Statistics and Data Science, BNU-HKBU United International College, Zhuhai, China.
| | - Qiuping Li
- Newborn Intensive Care Unit, Faculty of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beiing, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Dewi DJ, Rachmawati EZK, Wahyuni LK, Hsu WC, Tamin S, Yunizaf R, Prihartono J, Iskandar RATP. Risk of dysphagia in a population of infants born pre-term: characteristic risk factors in a tertiary NICU. J Pediatr (Rio J) 2024; 100:169-176. [PMID: 37848170 PMCID: PMC10943319 DOI: 10.1016/j.jped.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. METHOD A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. RESULTS The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). CONCLUSION Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.
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Affiliation(s)
- Dwi Juliana Dewi
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Jakarta, Indonesia.
| | | | - Luh Karunia Wahyuni
- Universitas Indonesia, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Jakarta, Indonesia
| | - Wei-Chung Hsu
- National Taiwan University Hospital, Department of Otolaryngology, Head and Neck Surgery, Taipei, Taiwan
| | - Susyana Tamin
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Jakarta, Indonesia
| | - Rahmanofa Yunizaf
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Jakarta, Indonesia
| | - Joedo Prihartono
- Universitas Indonesia, Faculty of Medicine, Department of Community Medicine, Jakarta, Indonesia
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Medeiros KJ, Morais CA, Winterton D, Rub DM, De Santis Santiago R, Shekhar N, Chipman D, Monaghan TT, Bittner EA, Carroll R, Berra L. Delivering Low Tidal Volume With Anesthesia and ICU Ventilators in a Neonatal Lung Model. Respir Care 2023; 68:384-391. [PMID: 36750259 PMCID: PMC10027158 DOI: 10.4187/respcare.10354] [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] [Indexed: 02/09/2023]
Abstract
BACKGROUND Mechanical ventilation of the neonate requires ventilators than can deliver precise and accurate tidal volume (VT) and PEEP to avoid lung injury. Due to small neonatal VT and the disproportionate effect of endotracheal tube leak in these patients, accomplishing precise and accurate VT delivery is difficult. Whereas neonatal ICU ventilators are validated in this population, thorough studies testing the performance of anesthesia ventilators in delivering small VT in neonates are lacking. METHODS Three anesthesia ventilators, Dräger Apollo, GE Avance, and Getinge Flow-i; and 2 ICU ventilators, Medtronic PB980 and Nihon Kohden NKV-550, were tested under volume control mode at VT of 5, 20, 40, and 60 mL. Three combinations of lung compliance and airway resistance were tested using a Servo ASL 5000 lung simulator. RESULTS In a scenario without leak, the measured VT was greater than the set VT by > 10% in the Apollo (21.0% [18.8-26.0]); measured VT was less than the set VT by > 10% in the Flow-i (-19% [-20.8 to -18.7]). The Avance, PB980, and NKV-550 presented a volume error < 10% (-9.50% [-10.8 to -4.4], -5.8% [-11.8 to -3.5], and 5.4% [-4.5 to 18.9], respectively). Considering all combinations of set VT, leaks, and respiratory mechanics, none of the anesthesia ventilators were able to deliver a median measured VT within a 10% error. The bias between measured VT and set VT varied widely among ventilators (from 4.27 mL to -10.59 mL). Additionally, in the Apollo ventilator, PEEP was underdelivered with the largest leak value. CONCLUSIONS Our results suggest that in comparison with the 2 neonatal ICU ventilators tested, the anesthesia ventilators did not greatly differ in terms of VT delivery in the presence of a gas leak.
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Affiliation(s)
- Kyle J Medeiros
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caio A Morais
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Brazil
| | - Dario Winterton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David M Rub
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Roberta De Santis Santiago
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nitika Shekhar
- Respiratory Care Department, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Chipman
- Respiratory Care Department, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas T Monaghan
- Department of Biomedical Engineering, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Carroll
- Division of Pediatric Critical Care, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and Respiratory Care Department, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Menshykova AO, Dobryanskyy DO. Duration of mechanical ventilation and clinical outcomes in very low birth weight infants: A single center 10-years cohort study. J Neonatal Perinatal Med 2023; 16:673-680. [PMID: 38043024 DOI: 10.3233/npm-230142] [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] [Indexed: 12/04/2023]
Abstract
BACKGROUND Despite the important role of MV in reducing mortality in very preterm infants, its use is often associated with complications. The study was aimed to determine the duration of mechanical ventilation (MV), which significantly increased the risk of adverse outcomes in very low birth weight (VLBW) infants. METHODS Data obtained from a prospectively created computer database were used in a retrospective cohort study. The database included information about 1980 VLBW infants <32 weeks of gestation who were cared for at the tertiary care center between January 2010 and December 2020. RESULTS Out of 1980 VLBW infants, 1086 (55%) were ventilated sometime during the hospital stay. 678 (62.43%) of ventilated babies survived until discharge. With ROC analysis, it was identified that MV duration of 60.5 hours had 79.3% sensitivity and 64.6% specificity for the prediction of BPD with the AUC of 0.784 (95% CI 0.733-0.827; p < 0.0001). The duration of MV above 60.5 hours was a significant risk factor for bronchopulmonary dysplasia (aOR 6.005, 95% CI 3.626-9.946), death (aOR 3.610, 95% CI 2.470-5.276), bronchopulmonary dysplasia/death (aOR 4.561, 95% CI 3.328-6.252), sepsis (aOR 1.634, 95% CI 1.168-2.286), necrotizing enterocolitis (aOR 2.606, 95% CI 1.364-4.980), and periventricular leukomalacia (aOR 2.191, 95% CI 1.241-3.867). CONCLUSIONS Duration of MV longer than 60.5 hours is an independent risk factor for adverse outcomes in VLBW infants. It is essential to increase and optimize efforts to avoid MV or extubate very preterm infants as soon as possible, before reaching the established threshold duration of invasive respiratory support.
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Affiliation(s)
- A O Menshykova
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - D O Dobryanskyy
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Peduce MA, Dannenberg VC, Rovedder PME, Carvalho PRA. Effects of critical illness on the functional status of children with a history of prematurity. Rev Bras Ter Intensiva 2022; 34:469-476. [PMID: 36888827 PMCID: PMC9987008 DOI: 10.5935/0103-507x.20220429-pt] [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: 10/26/2021] [Accepted: 08/27/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the effects of critical illness on the functional status of children aged zero to 4 years with or without a history of prematurity after discharge from the pediatric intensive care unit. METHODS This was a secondary cross-sectional study nested in an observational cohort of survivors from a pediatric intensive care unit. Functional assessment was performed using the Functional Status Scale within 48 hours after discharge from the pediatric intensive care unit. RESULTS A total of 126 patients participated in the study, 75 of whom were premature, and 51 of whom were born at term. Comparing the baseline and functional status at pediatric intensive care unit discharge, both groups showed significant differences (p < 0.001). Preterm patients exhibited greater functional decline at discharge from the pediatric intensive care unit (61%). Among patients born at term, there was a significant correlation between the Pediatric Index of Mortality, duration of sedation, duration of mechanical ventilation and length of hospital stay with the functional outcomes (p = 0.05). CONCLUSION Most patients showed a functional decline at discharge from the pediatric intensive care unit. Although preterm patients had a greater functional decline at discharge, sedation and mechanical ventilation duration influenced functional status among patients born at term.
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Affiliation(s)
- Millene Albeche Peduce
- Postgraduate Program in Child and Adolescent Health, Universidade
Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Vanessa Campes Dannenberg
- Postgraduate Program in Child and Adolescent Health, Universidade
Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | - Paulo Roberto Antonacci Carvalho
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital
de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto
Alegre (RS), Brazil
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Muacevic A, Adler JR. Less Invasive Surfactant Administration: A Review of Current Evidence of Clinical Outcomes With Beractant. Cureus 2022; 14:e30223. [PMID: 36381708 PMCID: PMC9651081 DOI: 10.7759/cureus.30223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 01/25/2023] Open
Abstract
Evidence supporting clinical recommendations or approval for less invasive surfactant administration (LISA) has primarily examined heterogeneous or small-volume (e.g., 1.25-2.5 mL/kg) animal-derived surfactant regimens. To address the evidence gap for larger-volume (e.g., 4-5 mL/kg) animal-derived surfactants, the aim of this review was to evaluate and summarize LISA literature for widely used larger-volume beractant. Surfactant treatment and the LISA technique were initially summarized. The available literature on beractant with LISA was thoroughly assessed and reviewed, including a recent systematic analysis, studies from regions where access or preferences may influence reliance on larger-volume surfactants, and investigations of short- and long-term outcomes. The available literature indicated improved short-term outcomes, including less need for mechanical ventilation, death, or bronchopulmonary dysplasia, and no negative long-term developmental outcomes when beractant was administered via LISA compared with older, more invasive techniques. The rates of short-term outcomes were similar to those previously observed in examinations of LISA with small-volume surfactants, including in populations reflecting very preterm infants. As uptake of LISA is expected to increase, future research directions for larger-volume surfactants include cost-effectiveness evaluations and robust examinations of repeat dosing and surfactant reflux to further inform clinical practice. This review provides a detailed assessment of the literature describing surfactant and LISA, with a focus on studies of beractant. Collectively, the available evidence supports the use of beractant with LISA based both on short-term and long-term outcomes relative to more invasive techniques and comparability of outcomes with small-volume surfactants and may be valuable in guiding clinical decision-making.
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Bisquera A, Harris C, Lunt A, Zivanovic S, Marlow N, Calvert S, Greenough A, Peacock JL. Longitudinal changes in lung function in very prematurely born young people receiving high-frequency oscillation or conventional ventilation from birth. Pediatr Pulmonol 2022; 57:1489-1496. [PMID: 35388626 PMCID: PMC9321071 DOI: 10.1002/ppul.25918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine changes in lung function over time in extremely prematurely born adolescents. WORKING HYPOTHESIS Changes in lung function during adolescence would vary by ventilation mode immediately after birth. STUDY DESIGN Longitudinal follow-up study. PATIENT SUBJECT SELECTION Participants from the United Kingdom Oscillation Study who were randomized at birth to high-frequency oscillation (HFO) or conventional ventilation (CV) were assessed at 11-14 years (n = 319) and at 16-19 years (n = 159). METHODOLOGY Forced expiratory flow (FEF), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and lung volumes including functional residual capacity (FRC) were reported as z-scores. The diffusion capacity of the lungs for carbon monoxide (DLCO) was measured. Lung function trajectories were compared by mode of ventilation using mixed models. Changes in z-scores were scaled to 5-year average follow-up. RESULTS There were significant changes in the mean FEF75, FEF50, FEF25, FEV1, FVC, and DLCO z-scores within the CV and HFO cohorts, but no significant differences in the changes between the two groups. The mean FRC z-score increased in both groups, with an average change of greater than one z-score. The mean FEV1/FVC z-score increased significantly in the CV group, but not in the HFO group (difference in slopes: p = 0.02). Across the population, deterioration in lung function was associated with male sex, white ethnicity, lower gestational age at birth, postnatal corticosteroids, oxygen dependency at 36 weeks postmenstrual age, and lower birth weight, but not ventilation mode. CONCLUSIONS There was little evidence that the mode of ventilation affected changes in lung function over time.
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Affiliation(s)
- Alessandra Bisquera
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Alan Lunt
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Sanja Zivanovic
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Neil Marlow
- Department of Neonatal Medicine, Elizabeth Garrett Anderson UCL Institute for Women's Health, University College, London, UK
| | - Sandy Calvert
- Department of Child Health, St George's Hospital, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.,NIHR Biomedical Research Centre based at Guy's and St Thomas', NHS Foundation Trust and King's College London, London, UK
| | - Janet L Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK.,Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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Söderström F, Ågren J, Sindelar R. Early extubation is associated with shorter duration of mechanical ventilation and lower incidence of bronchopulmonary dysplasia. Early Hum Dev 2021; 163:105467. [PMID: 34543945 DOI: 10.1016/j.earlhumdev.2021.105467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Respiratory care of extremely preterm infants remains a challenge. The majority require invasive mechanical ventilation (MV), which is a contributing factor in developing bronchopulmonary dysplasia (BPD). It is important to keep MV to a minimum but there have been concerns that attempting extubation too early increases the risk for atelectasis, re-intubation, and further lung trauma. The aim of this study was to compare two different approaches to extubation. METHODS Single-center, retrospective cohort study including infants born at 22 + 0-25 + 6 weeks during 2005-2009 and 2011-2015, before and after implementing guidelines recommending delayed extubation. Primary outcomes were BPD, duration of MV and length of hospital stay. RESULTS Eighty-eight infants in the early era and 102 infants in the late era were included. Infants in the first period were younger at first extubation attempt, and a higher number of infants were extubated within 24 h, 72 h, and one week after birth. The number of infants re-intubated and postnatal age at re-intubation did not differ between the groups. The incidence of severe BPD was 28% in the early period compared to 48% in the later (p < 0.01). Infants in the late period had longer duration of MV (17 vs 27 days, p < 0.01) but similar length of hospital stay (118 vs 123, p = 0.21). CONCLUSION After implementing guidelines recommending delayed extubation, the incidence of severe BPD was higher and the duration of MV was longer. This supports the strategy to attempt extubation early even in extremely preterm infants.
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Affiliation(s)
- Fanny Söderström
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Johan Ågren
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - Richard Sindelar
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
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10
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Ramos ACR, Castro PS, Souza RG, Carneiro JA, Pinho LD, Caldeira AP. Factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to determine the prevalence and factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units, in the city of Montes Claros, northern Minas Gerais. Methods: cross-sectional study, with data collection from medical records of a follow-up clinic, interviews with mothers and, eventually, search in hospital records. Bivariate analyzes were carried out between sociodemographic and clinical characteristics and recurrent wheezing. Variables associated up to the level of 20% were analyzed by binary logistic regression, and associations defined by the Odds Ratio and respective 95% confidence intervals. Only variables associated with a 5% significance level were maintained in the final model of logistic regression. Results: among 277 infants studied, about one fifth (21.3%) were extremely low birth weight preterm and more than half (60.7%) had birth weight below 1500 grams. The prevalence of recurrent wheezing was 14.4% (CI95% = 10.3-18.4). Mechanical ventilation (OR = 2.12; CI95% = 1.09-4.76; p = 0.030) and oxygen therapy time ≥ 15 days (OR = 2.49; CI95%= 1.12-5.00; p = 0.010) were the risk factors for the event. Conclusions: there is a high prevalence of recurrent wheezing in the evaluated group and the associated variables reiterate the risk of prolonged oxygen therapy and mechanical ventilation for premature newborns.
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11
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Brasher M, Raffay TM, Cunningham MD, Abu Jawdeh EG. Aerosolized Surfactant for Preterm Infants with Respiratory Distress Syndrome. CHILDREN-BASEL 2021; 8:children8060493. [PMID: 34200535 PMCID: PMC8228799 DOI: 10.3390/children8060493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Currently, the administration of surfactant to preterm infants with respiratory distress syndrome (RDS) mainly relies on intratracheal instillation; however, there is increasing evidence of aerosolized surfactant being an effective non-invasive strategy. We present a historical narrative spanning sixty years of development of aerosolization systems. We also offer an overview of the pertinent mechanisms needed to create and manage the ideal aerosolization system, with a focus on delivery, distribution, deposition, and dispersion in the context of the human lung. More studies are needed to optimize treatment with aerosolized surfactants, including determination of ideal dosages, nebulizer types, non-invasive interfaces, and breath synchronization. However, the field is rapidly evolving, and widespread clinical use may be achieved in the near future.
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Affiliation(s)
- Mandy Brasher
- Department of Pediatrics/Neonatology, College of Medicine, University of Kentucky, Lexington, KY 40506, USA;
- Correspondence: (M.B.); (E.G.A.J.); Tel.: +1-859-323-6117 (E.G.A.J.); Fax: +1-859-257-6066 (E.G.A.J.)
| | - Thomas M. Raffay
- Department of Pediatrics/Neonatology, College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - M. Douglas Cunningham
- Department of Pediatrics/Neonatology, College of Medicine, University of Kentucky, Lexington, KY 40506, USA;
| | - Elie G. Abu Jawdeh
- Department of Pediatrics/Neonatology, College of Medicine, University of Kentucky, Lexington, KY 40506, USA;
- Correspondence: (M.B.); (E.G.A.J.); Tel.: +1-859-323-6117 (E.G.A.J.); Fax: +1-859-257-6066 (E.G.A.J.)
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12
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Darby JRT, Berry MJ, Quinn M, Holman SL, Bradshaw EL, Jesse SM, Haller C, Seed M, Morrison JL. Haemodynamics and cerebral oxygenation of neonatal piglets in the immediate ex utero period supported by mechanical ventilation or ex utero oxygenator. J Physiol 2021; 599:2751-2761. [PMID: 33745149 DOI: 10.1113/jp280803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
KEY POINTS The margin of human viability has extended to the extremes of gestational age (<24 weeks) when the lungs are immature and ventilator-induced lung injury is common. Artificial placenta technology aims to extend gestation ex utero in order to allow the lungs additional time to develop prior to entering an air-breathing environment. We compared the haemodynamics and cerebral oxygenation of piglets in the immediate period post-oxygenator (OXY) transition against both paired in utero measures and uniquely against piglets transitioned onto mechanical ventilation (VENT). Post-transition, OXY piglets became hypotensive with reduced carotid blood flow in comparison with both paired in utero measures and VENT piglets. The addition of a pump to the oxygenator circuit may be required to ensure haemodynamic stability in the immediate post-transition period. ABSTRACT Gestational age at birth is a major predictor of wellbeing; the lower the gestational age, the greater the risk of mortality and morbidity. At the margins of human viability (<24 weeks gestation) immature lungs combined with the need for early ventilatory support means lung injury and respiratory morbidity is common. The abrupt haemodynamic changes consequent on birth may also contribute to preterm-associated brain injury, including intraventricular haemorrhage. Artificial placenta technology aims to support oxygenation, haemodynamic stability and ongoing fetal development ex utero until mature enough to safely transition to a true ex utero environment. We aimed to characterize the impact of birth transition onto either an oxygenator circuit or positive pressure ventilation on haemodynamic and cerebral oxygenation of the neonatal piglet. At 112 days gestation (term = 115 days), fetal pigs underwent instrumentation surgery and transitioned onto either an oxygenator (OXY, n = 5) or ventilatory support (VENT, n = 8). Blood pressure (BP), carotid blood flow and cerebral oxygenation in VENT piglets rose from in utero levels to be significantly higher than OXY piglets post-transition. OXY piglet BP, carotid blood flow and carotid oxygen delivery (DO2 ) decreased from in utero levels post-transition; however, cerebral regional oxygen saturation (rSO2 ) was maintained at fetal-like levels. OXY piglets became hypoxaemic and retained CO2 . Whether OXY piglets are able to maintain cerebral rSO2 under these conditions for a prolonged period is yet to be determined. Improvements to OXY piglet oxygenation may lie in maintaining piglet BP at in utero levels and enhancing oxygenator circuit flow.
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Affiliation(s)
- Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Mary J Berry
- Centre for Translational Physiology, University of Otago, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Megan Quinn
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Stacey L Holman
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Emma L Bradshaw
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah M Jesse
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Christoph Haller
- Univeristy of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike Seed
- Univeristy of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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13
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Bhattacharjee I, Das A, Collin M, Aly H. Predicting outcomes of mechanically ventilated premature infants using respiratory severity score. J Matern Fetal Neonatal Med 2020; 35:4620-4627. [PMID: 33280479 DOI: 10.1080/14767058.2020.1858277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) infants have significant morbidities and higher mortality. The major morbidities are bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP). Release of proinflammatory cytokines has been implicated in the development of systemic inflammation that contributes to BPD aND ROP. Also, cumulative oxygen exposure in the first 3 days of life and use of mechanical ventilation was associated with 3-fold increase in severe IVH. Therefore, early ventilation and oxygenation may contribute significantly to morbidities in ELBW infants. Respiratory severity score (RSS), a product of Mean airway pressure (MAP) and FiO2, is a steady-state noninvasive assessment tool useful in infants to monitor the severity of respiratory failure. We used RSS, in the first 3 days of life of ELBW infants, to predict neonatal morbidities and mortality. STUDY DESIGN In a single-center retrospective cohort study in an urban setting, convenience sampling of ELBW infants meeting the study criteria who were mechanically ventilated at birth for the first 3 days of life were included. Time-weighted average RSS was plotted on receiver-operating characteristic (ROC) curve in the first 3 days of life to predict outcomes. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios were calculated. RESULTS A total of 69 infants qualified for the study. RSS in the first 3 days significantly predicted the composite outcome of death, ROP, IVH or BPD with an area under the curve (AUC) of 0.82 (p < 0.001). Individually, RSS predicted death, severe ROP and IVH with an AUC of 0.86, 0.77 and 0.71 respectively; but did not predict severe BPD (AUC 0.61). RSS was more sensitive and specific than each of its component; FiO2 and MAP. Weighted RSS in the first 3 days had high-negative predictive value of 98.1% for death between 7 days and 36 weeks, 94.6% for ROP and 91.7% for IVH. CONCLUSIONS This study is the first to show that RSS in the first 3 days of life is a good predictor of composite neonatal outcomes: severe IVH, BPD, ROP, or mortality. Early RSS had a high positive predictive value for the composite outcome of morbidities/mortality and a high specificity for mortality, ROP, and IVH individually.
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Affiliation(s)
| | - Anirudha Das
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Marc Collin
- Department of Neonatology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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14
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Rocha G. Pulmonary pneumatoceles in neonates. Pediatr Pulmonol 2020; 55:2532-2541. [PMID: 32691976 DOI: 10.1002/ppul.24969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
Pulmonary pneumatoceles were relatively common in neonates in the pre-surfactant era. In the current era of surfactant, noninvasive and gentle invasive ventilation there is a paucity of data on clinical characteristics and outcomes of pneumatoceles in neonates. The lesion generally resolves spontaneously, but a few cases follow a complicated course with formation of extensive and expanding lesions. To better understand the pathophysiology, clinical significance, natural history, complications, treatment options and prognosis of pulmonary pneumatoceles in neonates, an extensive research was performed on the databases of medical literature. The information collected in this review is important for the clinicians in decision-making, especially in the most difficult cases.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
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15
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Escobar V, Soares DS, Kreling J, Ferrari LSL, Felcar JM, Camillo CAM, Probst VS. Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study. BMC Pediatr 2020; 20:241. [PMID: 32438923 PMCID: PMC7240994 DOI: 10.1186/s12887-020-02129-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022] Open
Abstract
Background The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. Methods Fifty-three PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n = 16) by Chi-square test. Results Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p = 0,047), longer time under MV (43 vs 19 days, p < 0,001), more individuals with PH (12 vs 3, p = 0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p = 0,003), longer hospital length of stay (109 vs 81,5 days, p < 0,001), greater PMA (41 vs 38 weeks, p < 0,001) and weight (2620 vs 2031 g, p < 0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p = 0,043). Among all variables included in logistic regression, only PH and MV < 36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n = 6) and 0% in mild BPD group (p = 0,0001). Conclusion Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.
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Affiliation(s)
- Victoria Escobar
- Neonatal Intensive Unit, University Hospital, Londrina State University (UEL), Londrina, PR, Brazil.,Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, Londrina State University (UEL), Londrina, PR, Brazil
| | - Darllyana S Soares
- Neonatal Intensive Unit, University Hospital, Londrina State University (UEL), Londrina, PR, Brazil.,Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, Londrina State University (UEL), Londrina, PR, Brazil
| | - Jane Kreling
- Neonatal Intensive Unit, University Hospital, Londrina State University (UEL), Londrina, PR, Brazil
| | - Ligia S L Ferrari
- Neonatal Intensive Unit, University Hospital, Londrina State University (UEL), Londrina, PR, Brazil.,Pediatric Surgery and Pediatric Department, Center of Health Sciences, Londrina State University (UEL), Londrina, PR, Brazil
| | - Josiane M Felcar
- Physiotherapy Department, Center of Health Sciences, Londrina State University, 60 Robert Koch Av, Londrina, Parana, 86038-350, Brazil.,Pitagoras Unopar University, Londrina, PR, Brazil
| | - Carlos A M Camillo
- Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, Londrina State University (UEL), Londrina, PR, Brazil.,Physiotherapy Department, Center of Health Sciences, Londrina State University, 60 Robert Koch Av, Londrina, Parana, 86038-350, Brazil.,Pitagoras Unopar University, Londrina, PR, Brazil
| | - Vanessa S Probst
- Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, Londrina State University (UEL), Londrina, PR, Brazil. .,Physiotherapy Department, Center of Health Sciences, Londrina State University, 60 Robert Koch Av, Londrina, Parana, 86038-350, Brazil.
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16
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Correger E, Marcos J, Laguens G, Stringa P, Cardinal-Fernández P, Blanch L. Pretreatment with adalimumab reduces ventilator-induced lung injury in an experimental model. Rev Bras Ter Intensiva 2020; 32:58-65. [PMID: 32401991 PMCID: PMC7206963 DOI: 10.5935/0103-507x.20200010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/29/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To determine whether adalimumab administration before mechanical ventilation reduces ventilator-induced lung injury (VILI). Methods Eighteen rats randomized into 3 groups underwent mechanical ventilation for 3 hours with a fraction of inspired oxygen = 0.40% including a low tidal volume group (n = 6), where tidal volume = 8mL/kg and positive end-expiratory pressure = 5cmH2O; a high tidal volume group (n = 6), where tidal volume = 35mL/kg and positive end-expiratory pressure = 0; and a pretreated + high tidal volume group (n = 6) where adalimumab (100ug/kg) was administered intraperitoneally 24 hours before mechanical ventilation + tidal volume = 35mL/kg and positive end-expiratory pressure = 0. ANOVA was used to compare histological damage (ATS 2010 Lung Injury Scoring System), pulmonary edema, lung compliance, arterial partial pressure of oxygen, and mean arterial pressure among the groups. Results After 3 hours of ventilation, the mean histological lung injury score was higher in the high tidal volume group than in the low tidal volume group (0.030 versus 0.0051, respectively, p = 0.003). The high tidal volume group showed diminished lung compliance at 3 hours (p = 0.04) and hypoxemia (p = 0,018 versus control). Pretreated HVt group had an improved histological score, mainly due to a significant reduction in leukocyte infiltration (p = 0.003). Conclusion Histological examination after 3 hours of injurious ventilation revealed ventilator-induced lung injury in the absence of measurable changes in lung mechanics or oxygenation; administering adalimumab before mechanical ventilation reduced lung edema and histological damage.
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Affiliation(s)
- Enrique Correger
- Grupo de Trabalho em Fisiopatologia Pulmonar Experimental, Faculdade de Medicina, Universidad Nacional de La Plata, La Plata, Argentina
| | - Josefina Marcos
- Grupo de Trabalho em Fisiopatologia Pulmonar Experimental, Faculdade de Medicina, Universidad Nacional de La Plata, La Plata, Argentina
| | - Graciela Laguens
- Cadeira de Patologia, Faculdade de Medicina, Universidad Nacional de La Plata, La Plata, Argentina
| | - Pablo Stringa
- Grupo de Trabalho em Fisiopatologia Pulmonar Experimental, Faculdade de Medicina, Universidad Nacional de La Plata, La Plata, Argentina
| | | | - Lluis Blanch
- Centro de Cuidados Intensivos, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
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17
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Das P, Curstedt T, Agarwal B, Prahaladan VM, Ramirez J, Bhandari S, Syed MA, Salomone F, Casiraghi C, Pelizzi N, Bhandari V. Small Molecule Inhibitor Adjuvant Surfactant Therapy Attenuates Ventilator- and Hyperoxia-Induced Lung Injury in Preterm Rabbits. Front Physiol 2020; 11:266. [PMID: 32327998 PMCID: PMC7160647 DOI: 10.3389/fphys.2020.00266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Invasive mechanical ventilation (IMV) has become one of the mainstays of therapy in NICUs worldwide, as a result of which premature babies with extremely low birth weight have been able to survive. Although lifesaving, IMV can result in lung inflammation and injury. Surfactant therapy is considered a standard of care in preterm infants with immature lungs. Recently, small molecule inhibitors like siRNAs and miRNAs have been used for therapeutic purposes. Ddit3 (CHOP), Ang2 and miR34a are known to be upregulated in experimental lung injury. We wanted to test whether inhibitors for these molecules (CHOP siRNA, Ang2 siRNA, and miR34a antagomir) if used alone or with a combination with surfactant (Curosurf®) would help in reducing ventilation and hyperoxia-induced injury in an experimental lung injury model. Methods Preterm rabbits born by cesarean section were intratracheally instilled with the three small molecule inhibitors with or without Curosurf® prior to IMV and hyperoxia exposure. Prior to testing the inhibitors in rabbits, these small molecule inhibitors were transfected in mouse lung epithelial cells (MLE12 and AECII) and delivered to neonatal mouse pups intranasally as a proof of concept that surfactant (Curosurf®) could be used as an effective vehicle for administration of such drugs. Survival, pulmonary function tests, histopathology, immunostaining, quantitative PCR and western blotting were done to see the adjuvant effect of surfactant with these three small molecule inhibitors. Results Our data shows that Curosurf® can facilitate transfection of small molecules in MLE12 cells with the same and/or increased efficiency as Lipofectamine. Surfactant given alone or as an adjuvant with small molecule inhibitors increases survival, decreases IMV and hyperoxia-induced inflammation, improves pulmonary function and lung injury scores in preterm rabbit kits. Conclusion Our study shows that Curosurf® can be used successfully as an adjuvant therapy with small molecule inhibitors for CHOP/Ang2/miR34a. In this study, of the three inhibitors used, miR34a inhibitor seemed to be the most promising compound to combat IMV and hyperoxia-induced lung injury in preterm rabbits.
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Affiliation(s)
- Pragnya Das
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States
| | - Tore Curstedt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Varsha M Prahaladan
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States
| | - John Ramirez
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Shreya Bhandari
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States
| | - Mansoor A Syed
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | | | | | | | - Vineet Bhandari
- Department of Pediatrics, Drexel University, Philadelphia, PA, United States.,Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
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18
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Cao ZL, Pan JJ, Shen X, Zhou XY, Cheng R, Zhou XG, Yang Y. Less invasive surfactant administration in preterm infants with respiratory distress syndrome-an updated meta-analysis. J Chin Med Assoc 2020; 83:170-179. [PMID: 31834026 DOI: 10.1097/jcma.0000000000000228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Less invasive surfactant administration (LISA) seems to have a good application prospect both in experimental models and patients with respiratory distress syndrome (RDS). Data regarding the effect of LISA procedure on RDS are conflicting. METHODS A search was conducted by two investigators involved in this research in PubMed, Embase, and Cochrane databases for studies in English and in Wanfang, VIP, and Cnki databases for Chinese studies (all last launched on December 18, 2018). Odds ratio and weighted mean difference were calculated using a random-effects or fixed-effects model, depending on the data type and heterogeneity of the included studies. RESULTS The comparison of effectiveness on RDS: (1) with respect to mechanical ventilation (<72 hours) and mechanical ventilation (all time periods). Data showed significant differences between LISA/control groups. (2) With respect to days of mechanical ventilation, data showed no significant differences between LISA/control groups. (3) With respect to bronchopulmonary dysplasia, the analysis showed that there was significant difference between LISA group and control group. (4) Regarding days of supplementary oxygen therapy and hospital stay, no significant differences were found. The comparison of possible complications of RDS: (1) data for mortality, pneumothorax and pulmonary hemorrhage showed no differences in the two groups. (2) Data for retinopathy of preterm comparison showed significant difference between the two groups. (3) Regarding intraventricular hemorrhage/periventricular leukomalacia, significant differences were found between the two groups. CONCLUSION Based on the above evidences, LISA is an effective and safe treatment for preterm infants with RDS.
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Affiliation(s)
- Zhao-Lan Cao
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jing-Jing Pan
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xian Shen
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Yu Zhou
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Cheng
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Guang Zhou
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Yang
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
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19
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Yeganeh B, Lee J, Bilodeau C, Lok I, Ermini L, Ackerley C, Caniggia I, Tibboel J, Kroon A, Post M. Acid Sphingomyelinase Inhibition Attenuates Cell Death in Mechanically Ventilated Newborn Rat Lung. Am J Respir Crit Care Med 2020; 199:760-772. [PMID: 30326731 DOI: 10.1164/rccm.201803-0583oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Premature infants subjected to mechanical ventilation (MV) are prone to lung injury that may result in bronchopulmonary dysplasia. MV causes epithelial cell death and halts alveolar development. The exact mechanism of MV-induced epithelial cell death is unknown. OBJECTIVES To determine the contribution of autophagy to MV-induced epithelial cell death in newborn rat lungs. METHODS Newborn rat lungs and fetal rat lung epithelial (FRLE) cells were exposed to MV and cyclic stretch, respectively, and were then analyzed by immunoblotting and mass spectrometry for autophagy, apoptosis, and bioactive sphingolipids. MEASUREMENTS AND MAIN RESULTS Both MV and stretch first induce autophagy (ATG 5-12 [autophagy related 5-12] and LC3B-II [microtubule-associated proteins 1A/1B light chain 3B-II] formation) followed by extrinsic apoptosis (cleaved CASP8/3 [caspase-8/3] and PARP [poly(ADP-ribose) polymerase] formation). Stretch-induced apoptosis was attenuated by inhibiting autophagy. Coimmunoprecipitation revealed that stretch promoted an interaction between LC3B and the FAS (first apoptosis signal) cell death receptor in FRLE cells. Ceramide levels, in particular C16 ceramide, were rapidly elevated in response to ventilation and stretch, and C16 ceramide treatment of FRLE cells induced autophagy and apoptosis in a temporal pattern similar to that seen with MV and stretch. SMPD1 (sphingomyelin phosphodiesterase 1) was activated by ventilation and stretch, and its inhibition prevented ceramide production, LC3B-II formation, LC3B/first apoptosis signal interaction, caspase-3 activation, and, ultimately, FLRE cell death. SMPD1 inhibition also attenuated ventilation-induced autophagy and apoptosis in newborn rats. CONCLUSIONS Ventilation-induced ceramides promote autophagy-mediated cell death, and identifies SMPD1 as a potential therapeutic target for the treatment of ventilation-induced lung injury in newborns.
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Affiliation(s)
- Behzad Yeganeh
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joyce Lee
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada.,2 Institute of Medical Science and
| | - Claudia Bilodeau
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada.,3 Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Irene Lok
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leonardo Ermini
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cameron Ackerley
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Isabella Caniggia
- 4 Mount Sinai Hospital, the Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada; and
| | - Jeroen Tibboel
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada.,5 Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, the Netherlands
| | - Andre Kroon
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada.,5 Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, the Netherlands
| | - Martin Post
- 1 Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada.,2 Institute of Medical Science and
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20
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Lookzadeh MH, Bakhshayesh H, Shadkam MN, Sheikhpour E. The effect of Sustained Lung Inflation on Outcomes of Acute Respiratory Distress Syndrome in Preterm Infants Born in Shahid Sadoughi Hospital during 2018. MAEDICA 2019; 14:264-269. [PMID: 31798743 PMCID: PMC6861724 DOI: 10.26574/maedica.2019.14.3.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Respiratory distress syndrome is the chief reason of death in infants. Sustained lung inflation (SLI) may improve respiratory outcomes and reduce the demand for mechanical ventilation (MV). Given that only few studies have been done in this field so far, the current study aimed to evaluate the effect of SLI on outcomes of acute respiratory distress syndrome in preterm infants. Materials and methods:This randomized trial was conducted on preterm infants with respiratory distress syndrome in Shahid Sadoughi Hospital, Yazd, Iran, during 2018. Data were extracted from medical records. Infants born at 25-30 weeks of gestation were randomized into two groups with an equal number of subjects (n=30) in each one. In group 1 (cases), patients received SLI (25 cm H2O for 15 seconds) and nasal continuous positive airway pressure (nCPAP) (5 cm H2O) after oropharynx and nasal suction. In group 2 (controls), patients received only nCPAP (5 cm H2O). Both nCPAP and SLI and were delivered through a T-piece ventilator and neonatal mask. Results:In the current study, no serious differences were seen between case and control groups in terms of either quantitative parameters, including MV duration, Apgar score in the first minute, duration of oxygen therapy, gestational age, birth weight, nCPAP duration, and duration of hospitalization in NICU (P>0.05), or qualitative variables, including sex, pneumothorax rate, rate of intraventricular hemorrhage, need for mechanical ventilation during the first 72 hours of life, surfactant need, and mortality rate (p>0.05), except in cases of complications (p=0.019). Conclusions:According to the results of the current study, neither nCPAP alone, nor SLI and nCPAP had any effect on the duration, or need, or type of mechanical ventilation, while the incidence of complications in the nCPAP alone group (control group) was higher than that of combined nCPAP + SLI group (case group). It is suggested that future studies should be conducted on a larger sample size.
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Affiliation(s)
| | - Hanieh Bakhshayesh
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmood Noori Shadkam
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elnaz Sheikhpour
- Hematology and Oncology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Lee BK, Shin SH, Jung YH, Kim EK, Kim HS. Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants. BMC Pediatr 2019; 19:298. [PMID: 31462232 PMCID: PMC6712684 DOI: 10.1186/s12887-019-1683-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Various types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored. We aimed to compare noninvasive neurally adjusted ventilatory assist (NIV-NAVA) and nasal continuous positive airway pressure (NCPAP) for the postextubation stabilization of preterm infants. METHODS This retrospective study was divided into two distinct periods, between July 2012 and June 2013 and between July 2013 and June 2014, because NIV-NAVA was applied beginning in July 2013. Preterm infants of less than 30 weeks GA who had been intubated with mechanical ventilation for longer than 24 h and were weaned to NCPAP or NIV-NAVA after extubation were enrolled. Ventilatory variables and extubation failure were compared after weaning to NCPAP or NIV-NAVA. Extubation failure was defined when infants were reintubated within 72 h of extubation. RESULTS There were 14 infants who were weaned to NCPAP during Period I, and 2 infants and 16 infants were weaned to NCPAP and NIV-NAVA, respectively, during Period II. At the time of extubation, there were no differences in the respiratory severity score (NIV-NAVA 1.65 vs. NCPAP 1.95), oxygen saturation index (1.70 vs. 2.09) and steroid use before extubation. Several ventilation parameters at extubation, such as the mean airway pressure, positive end-expiratory pressure, peak inspiratory pressure, and FiO2, were similar between the two groups. SpO2 and pCO2 preceding extubation were comparable. Extubation failure within 72 h after extubation was observed in 6.3% of the NIV-NAVA group and 37.5% of the NCPAP group (P = 0.041). CONCLUSIONS The data in the present showed promising implications for using NIV-NAVA over NCPAP to facilitate extubation.
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Affiliation(s)
- Byoung Kook Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769 South Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769 South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-769 South Korea
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22
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Márquez Isidro E, Sánchez Luna M, Ramos-Navarro C. Long-term outcomes of preterm infants treated with less invasive surfactant technique (LISA). J Matern Fetal Neonatal Med 2019; 34:1919-1924. [PMID: 31405313 DOI: 10.1080/14767058.2019.1651276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study is to compare the clinical outcomes at 24 months postmenstrual age of two populations receiving beractant replacement therapy using less invasive surfactant administration (LISA) versus intubation, administration of surfactant, and early extubation (INSURE). Hospital admission requirements, psychomotor development, and respiratory and neurological outcomes were studied. STUDY DESIGN This was a single-center, retrospective, and descriptive study with a sample of 60 patients (30 for each group) on nasal continuous positive airway pressure during the first 3 days of life, requiring surfactant administration. RESULTS We found no significant differences between both groups on psychomotor development and respiratory and neurological outcomes. CONCLUSION Compared to INSURE technique, the administration of surfactant by LISA is feasible and safe and reduces invasive mechanical ventilation exposure with no differences in the follow-up neurodevelopmental and respiratory outcomes at 24 postmenstrual age.
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23
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Looi K, Evans DJ, Garratt LW, Ang S, Hillas JK, Kicic A, Simpson SJ. Preterm birth: Born too soon for the developing airway epithelium? Paediatr Respir Rev 2019; 31:82-88. [PMID: 31103368 DOI: 10.1016/j.prrv.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/31/2018] [Accepted: 11/23/2018] [Indexed: 12/17/2022]
Abstract
Birth prior to term interrupts the normal development of the respiratory system and consequently results in poor respiratory outcomes that persist throughout childhood. The mechanisms underpinning these poor respiratory outcomes are not well understood, but intrinsic abnormalities within the airway epithelium may be a contributing factor. Current evidence suggests that the airway epithelium is both structurally and functionally abnormal after preterm birth, with reports of epithelial thickening and goblet cell hyperplasia in addition to increased inflammation and apoptosis in the neonatal intensive care unit. However, studies focusing on the airway epithelium are limited and many questions remain unanswered; including whether abnormalities are a direct result of interrupted development, a consequence of exposure to inflammatory stimuli in the perinatal period or a combination of the two. In addition, the difficulty of accessing airway tissue has resulted in the majority of evidence being collected in the pre-surfactant era which may not reflect contemporary preterm birth. This review examines the consequences of preterm birth on the airway epithelium and explores the clinical relevance of currently available models whilst highlighting the need to develop a clinically relevant in vitro model to help further our understanding of the airway epithelium in preterm birth.
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Affiliation(s)
- Kevin Looi
- Telethon Kids Institute, Nedlands 6009, Western Australia, Australia
| | - Denby J Evans
- Telethon Kids Institute, Nedlands 6009, Western Australia, Australia
| | - Luke W Garratt
- Telethon Kids Institute, Nedlands 6009, Western Australia, Australia
| | - Sherlynn Ang
- Telethon Kids Institute, Nedlands 6009, Western Australia, Australia
| | - Jessica K Hillas
- Telethon Kids Institute, Nedlands 6009, Western Australia, Australia
| | - Anthony Kicic
- Telethon Kids Institute, Nedlands 6009, Western Australia, Australia; Occupation and Environment, School of Public Health, Curtin University, Bentley 6845, Western Australia, Australia; Centre for Cell Therapy and Regenerative Medicine, University of Western Australia, Nedlands 6009, Western Australia, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA 6009, Australia; UWA Centre for Child Health Research & School of Biomedical Sciences, Nedlands 6009, Western Australia, Australia
| | - Shannon J Simpson
- Telethon Kids Institute, Nedlands 6009, Western Australia, Australia.
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Early Intratracheal Administration of Corticosteroid and Pulmonary Surfactant for Preventing Bronchopulmonary Dysplasia in Preterm Infants with Neonatal Respiratory Distress Syndrome: A Meta-analysis. Curr Med Sci 2019; 39:493-499. [DOI: 10.1007/s11596-019-2064-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/07/2019] [Indexed: 10/26/2022]
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25
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Pereira-Fantini PM, Byars SG, McCall KE, Perkins EJ, Oakley RB, Dellacà RL, Dargaville PA, Davis PG, Ignjatovic V, Tingay DG. Plasma proteomics reveals gestational age-specific responses to mechanical ventilation and identifies the mechanistic pathways that initiate preterm lung injury. Sci Rep 2018; 8:12616. [PMID: 30135517 PMCID: PMC6105628 DOI: 10.1038/s41598-018-30868-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
The preterm lung is particularly vulnerable to ventilator-induced lung injury (VILI) as a result of mechanical ventilation. However the developmental and pathological cellular mechanisms influencing the changing patterns of VILI have not been comprehensively delineated, preventing the advancement of targeted lung protective therapies. This study aimed to use SWATH-MS to comprehensively map the plasma proteome alterations associated with the initiation of VILI following 60 minutes of standardized mechanical ventilation from birth in three distinctly different developmental lung states; the extremely preterm, preterm and term lung using the ventilated lamb model. Across these gestations, 34 proteins were differentially altered in matched plasma samples taken at birth and 60 minutes. Multivariate analysis of the plasma proteomes confirmed a gestation-specific response to mechanical ventilation with 79% of differentially-expressed proteins altered in a single gestation group only. Six cellular and molecular functions and two physiological functions were uniquely enriched in either the extremely preterm or preterm group. Correlation analysis supported gestation-specific protein-function associations within each group. In identifying the gestation-specific proteome and functional responses to ventilation we provide the founding evidence required for the potential development of individualized respiratory support approaches tailored to both the developmental and pathological state of the lung.
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Affiliation(s)
- Prue M Pereira-Fantini
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia. .,Department of Paediatrics, University of Melbourne, Parkville, Australia.
| | - Sean G Byars
- Department of Pathology, University of Melbourne, Parkville, Australia.,Centre for Systems Genomics, University of Melbourne, Parkville, Australia
| | - Karen E McCall
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia.,University College Dublin, Dublin, Ireland
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
| | - Regina B Oakley
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia
| | - R L Dellacà
- Laboratorio di Tecnologie Biomediche, Dipartimento di Elettronica, Informazione e Ingegneria Biomedica-DEIB, Politecnico di Milano University, Milano, Italy
| | - Peter A Dargaville
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Peter G Davis
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia.,The Royal Women's Hospital, Parkville, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Parkville, Australia.,Haematology Research, Murdoch Childrens Research Institute, Parkville, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Neonatology, Royal Children's Hospital, Parkville, Australia
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Silva LV, Araújo LBD, Azevedo VMGDO. Assessment of the neuropsychomotor development in the first year of life of premature infants with and without bronchopulmonary dysplasia. Rev Bras Ter Intensiva 2018; 30:174-180. [PMID: 29995082 PMCID: PMC6031416 DOI: 10.5935/0103-507x.20180023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/25/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the neuropsychomotor development in the first year of life of
premature infants with and without bronchopulmonary dysplasia. Methods A cross-sectional retrospective study was conducted between January 1, 2014,
and December 30, 2015, with premature infants weighing < 1,500g at birth
and diagnosed with bronchopulmonary dysplasia at the corrected ages of 6 and
9 months, assessed using the DENVER II Developmental Screening Test.
Quantitative variables were described as the means, medians and standard
deviations. Variables with normal distribution were tested using Student's
t test; otherwise, the Mann-Whitney test was used,
considering significance at p-value < 0.05. Qualitative variables were
expressed as frequencies and percentages. Logistic regression was used with
odds ratio analysis to evaluate the effects of other variables as risk
factors for changes in neuropsychomotor development. Results Infants with bronchopulmonary dysplasia showed greater developmental delay
compared with those without bronchopulmonary dysplasia (p-value = 0.001).
The factors associated with a higher incidence of changes in
neuropsychomotor development, in addition to bronchopulmonary dysplasia,
were antenatal steroid, gender, birth weight, 5-minute Apgar score, Score
for Neonatal Acute Physiology-Perinatal Extension, duration of oxygen
therapy, duration of mechanical ventilation and length of hospital stay.
Other variables may also have influenced the result, such as drug use by
mothers of infants with bronchopulmonary dysplasia. Conclusion Bronchopulmonary dysplasia associated with other pre- and postnatal factors
may be considered a risk factor for delayed neuropsychomotor development in
the first year of life in premature infants born weighing less than
1,500g.
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Affiliation(s)
- Letycia Vieira Silva
- Residência Multiprofissional e em Área Profissional da Saúde, Hospital de Clínicas, Faculdade de Medicina, Universidade Federal de Uberlândia - Uberlândia (MG), Brasil
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27
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Smitthimedhin A, Whitehead MT, Bigdeli M, Nino G, Perez G, Otero HJ. MRI determination of volumes for the upper airway and pharyngeal lymphoid tissue in preterm and term infants. Clin Imaging 2018; 50:51-56. [DOI: 10.1016/j.clinimag.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/28/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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28
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Shu XX, Chen C, Tang J, Wang H. [Clinical effect of bubble nasal continuous positive airway pressure versus conventional nasal continuous positive airway pressure in respiratory support for preterm infants with neonatal respiratory distress syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:433-437. [PMID: 29972114 PMCID: PMC7389941 DOI: 10.7499/j.issn.1008-8830.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the clinical effect and safety of bubble nasal continuous positive airway pressure (BNCPAP) versus conventional nasal continuous positive airway pressure (nCPAP) in respiratory support for preterm infants with neonatal respiratory distress syndrome (NRDS). METHODS A retrospective analysis was performed for the clinical data of 130 preterm infants with NRDS. Among them, 69 underwent BNCPAP and 61 underwent nCPAP. The two groups were compared in terms of mortality rate, duration of respiratory support, use of pulmonary surfactant (PS), and treatment failure rate, and the incidence rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), as well as the changes in blood gas pH, partial pressure of oxygen, and partial pressure of carbon dioxide. The safety was evaluated for both groups. RESULTS There were no significant differences between the BNCPAP group and the nCPAP group in sex distribution, gestational age, birth weight, Apgar score at 1 and 5 minutes after birth, delivery mode, and the severity of NRDS (P>0.05). No infants in the BNCPAP group died, and one infant in the nCPAP group died; there was no significant difference in the mortality rate between the two groups (P>0.05). There were also no significant differences between the two groups in the duration of noninvasive ventilation, treatment failure rate, the incidence rates of BPD and ROP, and the percentage of infants with a need for use or reuse of PS (P>0.05). After 8-12 hours of ventilation, there were no significant differences between the two groups in the changes in blood gas pH and oxygenation index (P>0.05), while the BNCPAP group had a significantly greater reduction in partial pressure of carbon dioxide than the nCPAP group (P<0.05). There were no significant differences between the two groups in the incidence rates of pneumothorax, nasal septal injury, and nasal mucosal injury (P>0.05). CONCLUSIONS BNCPAP and nCPAP have similar clinical effect and safety in respiratory support for preterm infants with NRDS.
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Affiliation(s)
- Xian-Xiao Shu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
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Goel N, Chakraborty M, Watkins WJ, Banerjee S. Predicting Extubation Outcomes-A Model Incorporating Heart Rate Characteristics Index. J Pediatr 2018; 195:53-58.e1. [PMID: 29329913 DOI: 10.1016/j.jpeds.2017.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/09/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics index (HRCi) can be combined with a clinical model for predicting extubation outcomes in neonates. STUDY DESIGN HRCi and clinical data for all intended intubation-extubation events (episodes) were retrospectively analyzed between June 2014 and January 2015. Each episode started 6 hours pre-extubation or at the time of primary intubation if ventilation duration was shorter than 6 hours (baseline). The episodes ended at 72 hours postextubation for successful extubations or at reintubation for failed extubations. Mean of 6 hourly epoch HRCi-scores (baseline) or fold-changes (postextubation) were analyzed. Results are expressed as medians (IQR) for continuous data and proportions for categorical data. Multivariable logistic regression mixed model was used for statistical analysis. RESULTS Sixty-six infants contributed to 96 episodes (18 failed extubations, 78 successful extubations) in the study. Failed extubations had significantly longer duration of ventilation (65.3 hours, 19.94-158.2 vs 38.4, 16.5-71.3) and more culture positive sepsis (33.3% vs 3.8%) than successful extubations. Baseline HRCi scores (1.68, 1.29-2.45 vs 0.95, 0.54-1.86) and postextubation epoch-1 fold changes (1.25, 0.94-1.55 vs 0.94, 0.82-1.11) were higher in failed extubations compared with successful extubations. Multivariable linear mixed-effects regression was used to create prediction models for success of extubation, using relevant variables. CONCLUSIONS The baseline and postextubation HRCi were significantly higher in neonates with extubation failure compared with those who succeeded. Models using HRCi and clinical variables to predict extubation success may add to the confidence of clinicians considering extubation.
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Affiliation(s)
- Nitin Goel
- Neonatal Intensive Care Unit, Singleton Hospital, Swansea, United Kingdom.
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, United Kingdom; Department of Postgraduate Medicine and Dentistry, Cardiff University, Cardiff, United Kingdom
| | - William John Watkins
- Department of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Sujoy Banerjee
- Neonatal Intensive Care Unit, Singleton Hospital, Swansea, United Kingdom
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Olivier F, Nadeau S, Bélanger S, Julien AS, Massé E, Ali N, Caouette G, Piedboeuf B. Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: A multicentre randomized control trial. Paediatr Child Health 2017; 22:120-124. [PMID: 29479196 PMCID: PMC5804903 DOI: 10.1093/pch/pxx033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Minimally invasive surfactant therapy (MIST) is a new strategy to avoid mechanical ventilation (MV) in respiratory distress syndrome. The primary aim of this study was to test MIST as a means of avoiding MV exposure and pneumothorax occurrence in moderate and late preterm infants (32 to 36 weeks' gestational age). METHODS This was a randomized controlled trial including three Canadian centres. Patients were randomized to standard management or to the intervention if they required nasal continuous positive airway pressure of 6 cm H2O and 35% FiO2 in the first 24 hours of life. Patients from the intervention group received MIST immediately after inclusion. The primary outcome was either need for MV or development of a pneumothorax requiring a chest tube. To ensure that clinicians were not biased toward delaying intubation in the intervention group, clinical failure criteria were also used as a primary outcome. The primary outcome was analyzed using bivariate and multivariate logistic regressions. RESULTS Among 45 randomized patients, 24 were assigned to MIST and 21 to standard management. Eight infants (33%) from the intervention group met the primary outcome criteria versus 19 (90%) in the control group (absolute risk reduction 0.57, 95% confidence interval 0.54 to 0.60). One patient in each group reached the primary outcome because of pneumothorax occurrence. The other patients were exposed to MV. None of the patients reached the clinical failure criteria. CONCLUSION MIST for respiratory distress syndrome management in moderate and late preterm infants was associated with a significant reduction of MV exposure and pneumothorax occurrence.
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Affiliation(s)
- François Olivier
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Sophie Nadeau
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Sylvie Bélanger
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Anne-Sophie Julien
- Plateforme de la recherche clinique, Centre de recherche du CHU de Québec - Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Québec
| | - Nabeel Ali
- Department of Pediatrics, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec
| | - Georges Caouette
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Bruno Piedboeuf
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
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31
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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
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Kollisch-Singule M, Jain SV, Satalin J, Andrews P, Searles Q, Liu Z, Zhou Y, Wang G, Meier AH, Gatto LA, Nieman GF, Habashi NM. Limiting ventilator-associated lung injury in a preterm porcine neonatal model. J Pediatr Surg 2017; 52:50-55. [PMID: 27837992 DOI: 10.1016/j.jpedsurg.2016.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/20/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Preterm infants are prone to respiratory distress syndrome (RDS), with severe cases requiring mechanical ventilation for support. However, there are no clear guidelines regarding the optimal ventilation strategy. We hypothesized that airway pressure release ventilation (APRV) would mitigate lung injury in a preterm porcine neonatal model. METHODS Preterm piglets were delivered on gestational day 98 (85% of 115day term), instrumented, and randomized to volume guarantee (VG; n=10) with low tidal volumes (5.5cm3kg-1) and PEEP 4cmH2O or APRV (n=10) with initial ventilator settings: PHigh 18cmH2O, PLow 0cmH2O, THigh 1.30s, TLow 0.15s. Ventilator setting changes were made in response to clinical parameters in both groups. Animals were monitored continuously for 24hours. RESULTS The mortality rates between the two groups were not significantly different (p>0.05). The VG group had relatively increased oxygen requirements (FiO2 50%±9%) compared with the APRV group (FiO2 28%±5%; p>0.05) and a decrease in PaO2/FiO2 ratio (VG 162±33mmHg; APRV 251±45mmHg; p<0.05). The compliance of the VG group (0.51±0.07L·cmH2O-1) was significantly less than the APRV group (0.90±0.06L·cmH2O-1; p<0.05). CONCLUSION This study demonstrates that APRV improves oxygenation and compliance as compared with VG. This preliminary work suggests further study into the clinical uses of APRV in the neonate is warranted. LEVEL OF EVIDENCE Not Applicable (Basic Science Animal Study).
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Affiliation(s)
| | - Sumeet V Jain
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Joshua Satalin
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Penny Andrews
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA.
| | - Quinn Searles
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Zhiyong Liu
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Yan Zhou
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Guirong Wang
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Andreas H Meier
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Louis A Gatto
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA; Department of Biological Sciences, SUNY Cortland, 22 Graham Ave, Cortland, NY, 13045, USA.
| | - Gary F Nieman
- Department of Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
| | - Nader M Habashi
- Department of Trauma Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA.
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Wei QZ, Su P, Han JT, Zhang X, Duan YH. [Effect of early caffeine treatment on the need for respirator therapy in preterm infants with respiratory distress syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:1227-1231. [PMID: 27974112 PMCID: PMC7403083 DOI: 10.7499/j.issn.1008-8830.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the efficacy of early caffeine treatment in preterm infants with respiratory distress syndrome (RDS). METHODS A prospective controlled clinical trial was performed. A total of 59 preterm infants with RDS were enrolled and divided into a caffeine group (30 infants) and a control group (29 infants). Caffeine was administered in the caffeine group and control group at the same dosage at 12-24 hours after birth and before extubation respectively. The respirator parameters and the incidence rates of ventilator-associated pneumonia (VAP) and apnea were compared between the two groups. RESULTS Compared with the control group, the caffeine group had significantly lower peak inspiratory pressure, peak fraction of inspired oxygen, and incidence rate of VAP (p<0.05), as well as significantly shorter intubation time, NCPAP time, and total duration of oxygen supply (p<0.05). In addition, the caffeine group had a significantly longer time to first onset of apnea after extubation (p<0.05) and significantly fewer times of onset of apnea 1-2 days after extubation (p<0.01), as compared with the control group. CONCLUSIONS Early caffeine treatment can reduce the need for assisted ventilation in preterm infants with RDS, help with early extubation and ventilator weaning, reduce the oxygen time in the late stage, reduce the incidence of VAP, and prevent the development of apnea after extubation.
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Affiliation(s)
- Qiao-Zhen Wei
- Department of Neonatology, Yulin First People's Hospital/Sixth Hospital Affiliated to Guangxi Medical University, Yulin, Guangxi 537000, China.
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Metelo-Coimbra C, Roncon-Albuquerque R. Artificial placenta: Recent advances and potential clinical applications. Pediatr Pulmonol 2016; 51:643-9. [PMID: 26915478 DOI: 10.1002/ppul.23401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/02/2015] [Accepted: 01/21/2016] [Indexed: 12/12/2022]
Abstract
Lung immaturity remains a major cause of morbidity and mortality in extremely premature infants. Positive-pressure mechanical ventilation, the method of choice for respiratory support in premature infants, frequently promotes by itself lung injury and a negative impact in the circulatory function. Extracorporeal lung support has been proposed for more than 50 years as a potential alternative to mechanical ventilation in the treatment of severe respiratory failure of extremely premature infants. Recent advances in this field included the development of miniaturized centrifugal pumps and polymethylpentene oxygenators, as well as the successful use of pump-assisted veno-venous extracorporeal gas exchange systems in experimental artificial placenta models. This review, which includes studies published from 1958 to 2015, presents an update on the artificial placenta concept and its potential clinical applications. Special focus will be devoted to the milestones achieved so far and to the limitations that must be overcome before its clinical application. Notwithstanding, the artificial placenta stands as a promising alternative to mechanical ventilation in extremely premature infants. Pediatr Pulmonol. 2016;51:643-649. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Catarina Metelo-Coimbra
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto, Porto, Portugal
| | - Roberto Roncon-Albuquerque
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto, Porto, Portugal.,Department of Emergency and Intensive Care Medicine, Hospital de S.João, Porto, Portugal
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Ke H, Li ZK, Yu XP, Guo JZ. [Efficacy of different preparations of budesonide combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome: a comparative analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:400-404. [PMID: 27165587 PMCID: PMC7390364 DOI: 10.7499/j.issn.1008-8830.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/01/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To study the efficacy of different preparations of budesonide combined with pulmonary surfactant (PS) in improving blood gas levels and preventing bronchopulmonary dysplasia (BPD) in preterm infants with neonatal respiratory distress syndrome (NRDS). METHODS A total of 184 preterm infants who developed NRDS within 4 hours after birth were randomly administered with PS + continuous inhalation of budesonide aerosol (continuous aerosol group), PS+budesonide solution (solution group), PS + single inhalation of budesonide aerosol (single aerosol group), and PS alone, with 46 neonates in each group. The changes in arterial blood gas levels, rate of invasive mechanical ventilation after treatment, time of assisted ventilation, rate of repeated use of PS, and the incidence of BPD were compared between the four groups. RESULTS On the 2nd to 4th day after treatment, pH, PCO2, and oxygenation index (FiO2/PaO2) showed significant differences among the four groups, and the continuous aerosol group showed the most improvements of all indicators, followed by the solution group, single aerosol group, and PS alone group. The continuous aerosol group had a significantly shorter time of assisted ventilation than the other three groups (P<0.05). The solution group had a significantly shorter time of assisted ventilation than the single aerosol and PS alone groups (P<0.05). The rate of invasive mechanical ventilation after treatment, rate of repeated use of PS, and incidence of BPD showed significant differences among the four groups (P<0.05), and the continuous aerosol group had the lowest rates, followed by the solution group. CONCLUSIONS A combination of PS and continuous inhalation of budesonide aerosol has a better efficacy in the treatment of NRDS than a combination of PS and budesonide solution. The difference in reducing the incidence of BDP between the two administration methods awaits further investigation with a larger sample size.
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Affiliation(s)
- Hua Ke
- Department of Neonatology, Northwest Women and Children's Hospital, Xi'an 710061, China.
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Chiuchetta FS, Munhoz TN, Santos IS, Menezes AMB, Albernaz E, Barros FC, Matijasevich A. Neonatal ventilatory support and respiratory diseases in children up to six years of age: the 2004 Pelotas (Brazil) Birth Cohort study. CAD SAUDE PUBLICA 2016; 31:1403-15. [PMID: 26248096 DOI: 10.1590/0102-311x00087614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
Abstract
The study's objective was to evaluate the association between neonatal ventilatory support and the subsequent occurrence of respiratory diseases in children up to six years of age. This was a population-based birth cohort study. The main exposure was ventilatory support at birth, defined as the use of nasal continuous positive airway pressure (NCPAP) and/or mechanical ventilation (MV) for more than three hours from the time of hospitalization at birth until the first 28 days of life. Outcomes were: chest wheezing in the twelve months prior to the follow-up interview, medical diagnosis of asthma any time in the child´s life, and occurrence of pneumonia up to six years of age. Crude and adjusted analyses for potential confounding variables were performed using Poisson regression. 3,624 children were analyzed. NCPAP plus MV or MV alone was associated with higher frequency of medical diagnosis of asthma, even after adjusting for maternal and child characteristics (PR = 2.24; 95%CI: 1.27-3.99). The results highlight medium-term respiratory complications associated with neonatal ventilatory support.
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Affiliation(s)
| | | | - Iná S Santos
- Universidade Federal de Pelotas, Pelotas, Brasil
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Ramos-Navarro C, Sánchez-Luna M, Zeballos-Sarrato S, González-Pacheco N. Less invasive beractant administration in preterm infants: a pilot study. Clinics (Sao Paulo) 2016; 71:128-34. [PMID: 27074172 PMCID: PMC4785853 DOI: 10.6061/clinics/2016(03)02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess the efficacy and feasibility of a new, less invasive surfactant administration technique for beractant replacement using a specifically designed cannula in preterm infants born at <32 weeks of gestation and to compare short- and long-term outcomes between this approach and standard treatment, consisting of intubation, administration of surfactant and early extubation to nasal continuous positive airway pressure. METHOD This was a single-center, prospective, open-label, non-randomized, controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the standard approach. Beractant (4 ml/kg) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30% FiO2. Clinicaltrials.gov: NCT02611284. RESULTS In the group with less invasive surfactant administration, beractant was successfully administered in all patients. Thirteen patients (43.3%) in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life, compared with 22 (73%) in the control group (p<0.036). The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups (46% vs. 40%, respectively). There were no differences in other outcomes. CONCLUSION The administration of beractant (4 ml/kg) using a less invasive surfactant administration technique with a specifically designed cannula for administration is feasible. Moreover, early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation, surfactant administration and early extubation.
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Balany J, Bhandari V. Understanding the Impact of Infection, Inflammation, and Their Persistence in the Pathogenesis of Bronchopulmonary Dysplasia. Front Med (Lausanne) 2015; 2:90. [PMID: 26734611 PMCID: PMC4685088 DOI: 10.3389/fmed.2015.00090] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/03/2015] [Indexed: 12/11/2022] Open
Abstract
The concerted interaction of genetic and environmental factors acts on the preterm human immature lung with inflammation being the common denominator leading to the multifactorial origin of the most common chronic lung disease in infants – bronchopulmonary dysplasia (BPD). Adverse perinatal exposure to infection/inflammation with added insults like invasive mecha nical ventilation, exposure to hyperoxia, and sepsis causes persistent immune dysregulation. In this review article, we have attempted to analyze and consolidate current knowledge about the role played by persistent prenatal and postnatal inflammation in the pathogenesis of BPD. While some parameters of the early inflammatory response (neutrophils, cytokines, etc.) may not be detectable after days to weeks of exposure to noxious stimuli, they have already initiated the signaling pathways of the inflammatory process/immune cascade and have affected permanent defects structurally and functionally in the BPD lungs. Hence, translational research aimed at prevention/amelioration of BPD needs to focus on dampening the inflammatory response at an early stage to prevent the cascade of events leading to lung injury with impaired healing resulting in the pathologic pulmonary phenotype of alveolar simplification and dysregulated vascularization characteristic of BPD.
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Affiliation(s)
- Jherna Balany
- Section of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine , Philadelphia, PA , USA
| | - Vineet Bhandari
- Section of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine , Philadelphia, PA , USA
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Barton SK, Tolcos M, Miller SL, Roehr CC, Schmölzer GM, Davis PG, Moss TJM, LaRosa DA, Hooper SB, Polglase GR. Unraveling the Links Between the Initiation of Ventilation and Brain Injury in Preterm Infants. Front Pediatr 2015; 3:97. [PMID: 26618148 PMCID: PMC4639621 DOI: 10.3389/fped.2015.00097] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Abstract
The initiation of ventilation in the delivery room is one of the most important but least controlled interventions a preterm infant will face. Tidal volumes (V T) used in the neonatal intensive care unit are carefully measured and adjusted. However, the V Ts that an infant receives during resuscitation are usually unmonitored and highly variable. Inappropriate V Ts delivered to preterm infants during respiratory support substantially increase the risk of injury and inflammation to the lungs and brain. These may cause cerebral blood flow instability and initiate a cerebral inflammatory cascade. The two pathways increase the risk of brain injury and potential life-long adverse neurodevelopmental outcomes. The employment of new technologies, including respiratory function monitors, can improve and guide the optimal delivery of V Ts and reduce confounders, such as leak. Better respiratory support in the delivery room has the potential to improve both respiratory and neurological outcomes in this vulnerable population.
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Affiliation(s)
- Samantha K Barton
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia
| | - Mary Tolcos
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia ; Department of Obstetrics and Gynecology, Monash University , Melbourne, VIC , Australia
| | - Suzie L Miller
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia ; Department of Obstetrics and Gynecology, Monash University , Melbourne, VIC , Australia
| | - Charles C Roehr
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia ; Newborn Services, John Radcliffe Hospital, Oxford University Hospitals , Oxford , UK
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta , Edmonton, AB , Canada ; Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services , Edmonton, AB , Canada
| | - Peter G Davis
- Neonatal Services, Newborn Research Centre, The Royal Women's Hospital , Melbourne, VIC , Australia
| | - Timothy J M Moss
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia ; Department of Obstetrics and Gynecology, Monash University , Melbourne, VIC , Australia
| | - Domenic A LaRosa
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia ; Department of Obstetrics and Gynecology, Monash University , Melbourne, VIC , Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne, VIC , Australia ; Department of Obstetrics and Gynecology, Monash University , Melbourne, VIC , Australia
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