1
|
Pijnenburg MW. Next steps in treatment of prematurity-associated respiratory disease. THE LANCET. CHILD & ADOLESCENT HEALTH 2023:S2352-4642(23)00139-6. [PMID: 37385268 DOI: 10.1016/s2352-4642(23)00139-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Marielle W Pijnenburg
- Erasmus Medical Center, Sophia Children's Hospital, University Medical Centre Rotterdam, Department of Paediatrics, Division of Respiratory Medicine and Allergology, 3015 CN Rotterdam, Netherlands.
| |
Collapse
|
2
|
Urs RC, Evans DJ, Bradshaw TK, Gibbons JTD, Smith EF, Foong RE, Wilson AC, Simpson SJ. Inhaled corticosteroids to improve lung function in children (aged 6-12 years) who were born very preterm (PICSI): a randomised, double-blind, placebo-controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2023:S2352-4642(23)00128-1. [PMID: 37385269 DOI: 10.1016/s2352-4642(23)00128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Despite the substantial burden of lung disease throughout childhood in children who were born very preterm, there are no evidence-based interventions to improve lung health beyond the neonatal period. We tested the hypothesis that inhaled corticosteroid improves lung function in this population. METHODS PICSI was a randomised, double-blind, placebo-controlled trial at Perth Children's Hospital (Perth, WA, Australia) to assess whether fluticasone propionate, an inhaled corticosteroid, improves lung function in children who had been born very preterm (<32 weeks of gestation). Eligible children were aged 6-12 years and did not have severe congenital abnormalities, cardiopulmonary defects, neurodevelopmental impairment, diabetes, or any glucocorticoid use within the preceding 3 months. Participants were randomly assigned (1:1) to receive 125 μg fluticasone propionate or placebo twice daily for 12 weeks. Participants were stratified for sex, age, bronchopulmonary dysplasia diagnosis, and recent respiratory symptoms using the biased-coin minimisation technique. The primary outcome was change in pre-bronchodilator forced expiratory volume in 1 s (FEV1) after 12 weeks of treatment. Data were analysed by intention-to-treat (ie, all participants who were randomly assigned and took at least the tolerance dose of the drug). All participants were included in the safety analyses. This trial is registered at the Australian and New Zealand Clinical Trials Registry, number 12618000781246. FINDINGS Between Oct 23, 2018, and Feb 4, 2022, 170 participants were randomly assigned and received at least the tolerance dose (83 received placebo and 87 received inhaled corticosteroid). 92 (54%) participants were male and 78 (46%) were female. 31 participants discontinued treatment before 12 weeks (14 in the placebo group and 17 in the inhaled corticosteroid group), mostly due to the impact of the COVID-19 pandemic. When analysed by intention-to-treat, the change in pre-bronchodilator FEV1 Z score over 12 weeks was -0·11 (95% CI -0·21 to 0·00) in the placebo group and 0·20 (0·11 to 0·30) in the inhaled corticosteroid group (imputed mean difference 0·30, 0·15-0·45). Three of 83 participants in the inhaled corticosteroid group had adverse events requiring treatment discontinuation (exacerbation of asthma-like symptoms). One of 87 participants in the placebo group had an adverse event requiring treatment discontinuation (inability to tolerate the treatment with dizziness, headaches, stomach pains, and worsening of a skin condition). INTERPRETATION As a group, children born very preterm have only modestly improved lung function when treated with inhaled corticosteroid for 12 weeks. Future studies should consider individual phenotypes of lung disease after preterm birth and other agents to improve management of prematurity-associated lung disease. FUNDING Australian National Health and Medical Research Council, Telethon Kids Institute, and Curtin University.
Collapse
Affiliation(s)
- Rhea C Urs
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Denby J Evans
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; School of Population Science, Curtin University, Perth, WA, Australia
| | - Tiffany K Bradshaw
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
| | - James T D Gibbons
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Elizabeth F Smith
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Rachel E Foong
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Andrew C Wilson
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Shannon J Simpson
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| |
Collapse
|
3
|
Kosik K, Sowińska A, Seremak-Mrozikiewicz A, Abu-Amara JA, Al-Saad SR, Karbowski LM, Gryczka K, Kurzawińska G, Szymankiewicz-Bręborowicz M, Drews K, Szpecht D. Polymorphisms of fibronectin-1 (rs3796123; rs1968510; rs10202709; rs6725958; and rs35343655) are not associated with bronchopulmonary dysplasia in preterm infants. Mol Cell Biochem 2022; 477:1645-1652. [PMID: 35230604 DOI: 10.1007/s11010-022-04397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mainly affects premature newborns. Many different factors, increasingly genetic, are involved in the pathogenesis of BPD. The aim of the study is to investigate the possible influence of fibronectin SNP on the occurrence of BPD. The study included 108 infants born between 24 and 32 weeks of gestation. BPD was diagnosed based on the National Institutes of Health Consensus definition. The 5 FN1 gene polymorphisms assessed in the study were the following: rs3796123; rs1968510; rs10202709; rs6725958; and rs35343655. BPD developed in 30 (27.8%) out of the 108 preterm infants. Incidence of BPD was higher in infants with lower APGAR scores and low birthweight. Investigation did not confirm any significant prevalence for BPD development in any genotypes and alleles of FN1. Further studies should be performed to confirm the role of genetic factors in etiology and pathogenesis of BPD.
Collapse
Affiliation(s)
- Katarzyna Kosik
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | | | | | - Katarzyna Gryczka
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Grażyna Kurzawińska
- Department of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Krzysztof Drews
- Department of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
4
|
Plasma Adipokines Profile in Prepubertal Children with a History of Prematurity or Extrauterine Growth Restriction. Nutrients 2020; 12:nu12041201. [PMID: 32344627 PMCID: PMC7231070 DOI: 10.3390/nu12041201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
Adipose tissue programming could be developed in very preterm infants with extrauterine growth restriction (EUGR), with an adverse impact on long-term metabolic status, as was studied in intrauterine growth restriction patterns. The aim of this cohort study was to evaluate the difference in levels of plasma adipokines in children with a history of EUGR. A total of 211 school age prepubertal children were examined: 38 with a history of prematurity and EUGR (EUGR), 50 with a history of prematurity with adequate growth (PREM), and 123 healthy children born at term. Anthropometric parameters, blood pressure, metabolic markers and adipokines (adiponectin, resistin, leptin) were measured. Children with a history of EUGR showed lower values of adiponectin (μg/mL) compared with the other two groups: (EUGR: 10.6 vs. PREM: 17.7, p < 0.001; vs. CONTROL: 25.7, p = 0.004) and higher levels of resistin (ng/mL) (EUGR: 19.2 vs. PREM: 16.3, p =0.007; vs. CONTROL: 7.1, p < 0.001. The PREM group showed the highest values of leptin (ng/mL), compared with the others: PREM: 4.9 vs. EUGR: 2.1, p = 0.048; vs. CONTROL: 3.2, p = 0.029). In conclusion, EUGR in premature children could lead to a distinctive adipokines profile, likely associated with an early programming of the adipose tissue, and likely to increase the risk of adverse health outcomes later in life.
Collapse
|
5
|
González-Luis GE, van Westering-Kroon E, Villamor-Martinez E, Huizing MJ, Kilani MA, Kramer BW, Villamor E. Tobacco Smoking During Pregnancy Is Associated With Increased Risk of Moderate/Severe Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:160. [PMID: 32411634 PMCID: PMC7198744 DOI: 10.3389/fped.2020.00160] [Citation(s) in RCA: 8] [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: 12/03/2019] [Accepted: 03/20/2020] [Indexed: 12/30/2022] Open
Abstract
Epidemiological evidence and animal studies support that intrauterine exposure to tobacco smoke disturbs lung development and has a negative effect in the pulmonary health of the offspring. Individual studies suggest an association between fetal exposure to maternal smoking and risk of developing bronchopulmonary dysplasia (BPD). However, this association has not yet been systematically investigated. We aimed to conduct a systematic review of studies reporting on tobacco smoking during pregnancy as potential risk factor for BPD. PubMed/MEDLINE and EMBASE databases were searched. BPD was defined as requirement of supplemental oxygen on postnatal day 28 (BPD28; all BPD), at the postmenstrual age (PMA) of 36 weeks (BPD36; moderate/severe BPD), or as requirement of more than 30% oxygen and/or positive pressure at 36 weeks PMA (severe BPD). Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. Of 2,894 potentially relevant studies, 33 met the inclusion criteria. The included studies evaluated 171,772 infants and included 30,445 cases of exposure to maternal smoking and 25,340 cases of BPD of any severity. Meta-analysis showed a significant association between tobacco smoking during pregnancy and BPD36 (17 studies, RR 1.126, 95% CI 1.008-1.259, p = 0.036), but could not demonstrate a significant association between tobacco smoking during pregnancy and BPD28 (16 studies, RR 1.021, 95% CI 0.924-1.129, p = 0.681), or severe BPD (3 studies, RR 1.143, 95% CI 0.528-2.478, p = 0.734). In conclusion, our data suggest that tobacco smoking during pregnancy increases the risk of moderate/severe BPD. Our results highlight the detrimental effects of tobacco smoking and reinforce the hypothesis of the involvement of prenatal insults in the etiopathogenesis of BPD.
Collapse
Affiliation(s)
- Gema E González-Luis
- Department of Pediatrics, Hospital Universitario Materno-Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Elke van Westering-Kroon
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Eduardo Villamor-Martinez
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Maurice J Huizing
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Mohammed A Kilani
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Boris W Kramer
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Eduardo Villamor
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| |
Collapse
|
6
|
Course CW, Kotecha S, Kotecha SJ. Fractional exhaled nitric oxide in preterm-born subjects: A systematic review and meta-analysis. Pediatr Pulmonol 2019; 54:595-601. [PMID: 30694610 PMCID: PMC6519366 DOI: 10.1002/ppul.24270] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Decreased lung function is common in preterm-born survivors. Increased fractional exhaled nitric oxide (FeNO) appears to be a reliable test for eosinophillic airway inflammation especially in asthma. We, systematically, reviewed the literature to compare FeNO levels in preterm-born children and adults who did or did not have chronic lung disease of prematurity (CLD) in infancy with term-born controls. METHODS We searched eight databases up to February 2018. Studies comparing FeNO levels in preterm-born subjects (<37 weeks' gestation) in childhood and adulthood with and without (CLD) with term-born subjects were identified and extracted by two reviewers. Data were analysed using Review Manager v5.3. RESULTS From 6042 article titles, 183 full articles were screened for inclusion. Nineteen studies met the inclusion criteria. Seventeen studies compared FeNO levels in preterm- and term-born children and adults; 11 studies (preterm n = 640 and term n = 4005) were included in a meta-analysis. The mean FeNO concentration difference between the preterm-born and term-born group was -0.74 (95% CI -1.88 to 0.41) ppb. For the six studies reporting data on CLD (preterm n = 204 and term n = 211) the mean difference for FeNO levels was -2.82 (95% CI -5.87 to 0.22) ppb between the preterm-born CLD and term-born groups. CONCLUSIONS Our data suggest that preterm born children with and without CLD have similar FeNO levels to term-born children suggesting an alternative mechanism to eosinophilic inflammation for symptoms of wheezing and airway obstruction observed in preterm-born subjects.
Collapse
Affiliation(s)
- Christopher W Course
- Welsh Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
7
|
Urs R, Kotecha S, Hall GL, Simpson SJ. Persistent and progressive long-term lung disease in survivors of preterm birth. Paediatr Respir Rev 2018; 28:87-94. [PMID: 29752125 DOI: 10.1016/j.prrv.2018.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 02/05/2023]
Abstract
Preterm birth accounts for approximately 11% of births globally, with rates increasing across many countries. Concurrent advances in neonatal care have led to increased survival of infants of lower gestational age (GA). However, infants born <32 weeks of GA experience adverse respiratory outcomes, manifesting with increased respiratory symptoms, hospitalisation and health care utilisation into early childhood. The development of bronchopulmonary dysplasia (BPD) - the chronic lung disease of prematurity - further increases the risk of poor respiratory outcomes throughout childhood, into adolescence and adulthood. Indeed, survivors of preterm birth have shown increased respiratory symptoms, altered lung structure, persistent and even declining lung function throughout childhood. The mechanisms behind this persistent and sometimes progressive lung disease are unclear, and the implications place those born preterm at increased risk of respiratory morbidity into adulthood. This review aims to summarise what is known about the long-term pulmonary outcomes of contemporary preterm birth, examine the possible mechanisms of long-term respiratory morbidity in those born preterm and discuss addressing the unknowns and potentials for targeted treatments.
Collapse
Affiliation(s)
- Rhea Urs
- Telethon Kids Institute, Perth, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | |
Collapse
|
8
|
Malleske DT, Chorna O, Maitre NL. Pulmonary sequelae and functional limitations in children and adults with bronchopulmonary dysplasia. Paediatr Respir Rev 2018; 26:55-59. [PMID: 29031795 DOI: 10.1016/j.prrv.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
Abstract
Preterm infants with bronchopulmonary dysplasia (BPD) often suffer from life-long pulmonary impairments in pulmonary physical function. This review summarizes our current understanding of the chronic pulmonary impairments and physical functional limitations associated with BPD from preterm birth to adulthood. It also identifies opportunities for intervention in children and adults living with chronic lung disease (CLD) after preterm birth.
Collapse
Affiliation(s)
- Daniel T Malleske
- Division of Neonatology, Nationwide Children's Hospital/The Ohio State University College of Medicine, United States.
| | - Olena Chorna
- Center for Perinatal Research, Nationwide Children's Hospital, United States
| | - Nathalie L Maitre
- Division of Neonatology, Nationwide Children's Hospital/The Ohio State University College of Medicine, United States; Center for Perinatal Research, Nationwide Children's Hospital, United States
| |
Collapse
|
9
|
Bronchopulmonary dysplasia as a risk factor for asthma in school children and adolescents: A systematic review. Allergol Immunopathol (Madr) 2018; 46:87-98. [PMID: 28668285 DOI: 10.1016/j.aller.2017.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/18/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mainly affects extremely pre-term infants, and remains the most common complication of prematurity. Several studies have shown that prematurity predisposes to the development of asthma in school children and adolescents. Nevertheless, it is not clear to what extent a history of BPD involves an additional risk. METHODS A systematic review of studies assessing the association between BPD and asthma in school-children and adolescents was made. A literature search was carried out in the MEDLINE and EMBASE databases to retrieve articles published between 1 January 2000 and 31 August 2016. RESULTS A total of 17 studies comprising 7433 patients were included in the review. There was considerable heterogeneity in the definitions of BPD and asthma among studies. Overall, the prevalence of asthma was higher in children and adolescents with a history of prematurity and BPD compared with those who did not develop BPD. However, in only one of the studies did this difference reach statistical significance. The main limitation of this review was potential bias due to the lack of adjustment for confounding factors between exposure (BPD) and outcome (asthma) in most of the studies. CONCLUSION Based on the studies reviewed, it cannot be argued that BPD, as an independent factor of prematurity, increases the risk of asthma defined by clinical parameters in school-children and adolescents. Further studies of greater methodological quality and homogeneous diagnostic criteria of BPD and asthma are needed for improved assessment of this association.
Collapse
|
10
|
Lehtinen A, Korhonen P, Hyödynmaa E, Koivisto AM, Peltola T, Hämäläinen M, Moilanen E, Tammela O. Adipokines played a limited role in predicting temporary growth differences between very low birthweight infants with and without bronchopulmonary dysplasia. Acta Paediatr 2017. [PMID: 28639282 DOI: 10.1111/apa.13942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study explored whether growth was poorer among very low birthweight (VLBW) infants with bronchopulmonary dysplasia (BPD) and assessed adipokine levels as predictors of early growth. METHODS We studied 53 VLBW infants born in Tampere University Hospital up to 12 months of corrected age (CA). The median gestational age of the 21 infants with BPD and 32 infants without BPD was 29 weeks, and the median birthweights were 930 (635-1470) and 1185 (650-1470) grams. Growth parameters, macronutrients intake and plasma levels of adipokines were measured. RESULTS Bronchopulmonary dysplasia infants were lighter than controls until 36 weeks of CA, with catch-up growth achieved by three months of CA. Adipsin levels were lower in BPD infants at 28 days of postnatal age. High leptin levels seemed protective for low weight for height at nine months of CA. The duration of ventilator therapy predicted low weight for height, length for age and body mass index and BPD predicted low length for age at 12 months of CA. CONCLUSIONS Catch-up growth in VLBW infants with BPD was achieved by three months of CA, but adipokines played a limited role in predicting growth. Shortening ventilator therapy could help growth in VLBW infants.
Collapse
Affiliation(s)
- A Lehtinen
- Faculty of Medicine; University of Tampere; Tampere Finland
| | - P Korhonen
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - E Hyödynmaa
- Department of Paediatrics; Central Finland Central Hospital; Jyväskylä Finland
| | - AM Koivisto
- School of Health Sciences; University of Tampere; Tampere Finland
| | - T Peltola
- Medical Nutrition Unit; Tampere University Hospital; Tampere Finland
| | - M Hämäläinen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - E Moilanen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - O Tammela
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| |
Collapse
|
11
|
Nordlund B, James A, Ebersjö C, Hedlin G, Broström EB. Differences and similarities between bronchopulmonary dysplasia and asthma in schoolchildren. Pediatr Pulmonol 2017. [PMID: 28636794 DOI: 10.1002/ppul.23741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The long-term respiratory characteristics of ex-preterm children with bronchopulmonary dysplasia (BPD) are not established. The objective of this study was to describe hallmarks of BPD at school age in comparison to children with atopic asthma. METHODS This study was a cross-sectional descriptive comparative study in a hospital-based setting. Thirty schoolchildren diagnosed with BPD (10.4 years/born at 26.6 weeks' gestation) and 30 age- and sex-matched children with asthma and sensitized to airborne allergens (IgE >0.35 kUA /L) were analyzed. Measurements included fraction of exhaled nitric oxide (FENO, ppb), dynamic and static lung function, and bronchial provocation with methacholine (PD:20) and mannitol (PD:15), as well as an evaluation of respiratory symptoms using the asthma control test (C-ACT). RESULTS Lung function measures (FEV1% 77 vs 84, FEV1/FVC% 85 vs 91, FEF50% 61 vs 80) and carbon monoxide diffusion capacity (DLCO%, 81 vs 88) were all reduced in children with BPD compared to asthma (P values <0.042). FENO values were also significantly lower in children with BPD (12 vs 23, P = 0.019). The proportion of positive methacholine tests (74% vs 93%, P = 0.14) was comparable between BPD and asthma. However, less responsiveness towards mannitol (19% vs 61%, P = 0.007) and fewer self-reported symptoms (C-ACT, median 26 vs 24, P = 0.003) were found in the BPD group. CONCLUSION Respiratory hallmarks of BPD at school-age were reduced lung function, limited responsiveness towards indirectly acting mannitol but hyper-responsiveness towards direct acting methacholine and impairment in diffusion capacity. Children with BPD displayed less evidence of airway inflammation compared with atopic asthma.
Collapse
Affiliation(s)
- Björn Nordlund
- Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna James
- Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christina Ebersjö
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva B Broström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
12
|
Suursalmi P, Ojala T, Poutanen T, Eerola A, Korhonen P, Kopeli T, Tammela O. Velocity vector imaging shows normal cardiac systolic function in survivors of severe bronchopulmonary dysplasia at six to 16 years of age. Acta Paediatr 2017; 106:1136-1141. [PMID: 28370347 DOI: 10.1111/apa.13860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 01/02/2023]
Abstract
AIM This study evaluated global myocardial function and associations between cardiac function and lung function in very low birth weight (VLBW) children, with and without severe radiographic bronchopulmonary dysplasia (BPD), at six to 14 years of age. METHODS We studied 34 VLBW and 19 term-born controls, and the VLBW group was further divided into a BPD group with severe radiographic BPD and those without radiographic BPD in infancy. Detailed right and left ventricular myocardial functions were analysed by velocity vector imaging, and the left ventricular mass was calculated. The associations between cardiac function and lung function were assessed by impulse oscillometry. RESULTS The right and left ventricular myocardial systolic functions and the left ventricular mass were similar in the three groups. Lung function was not associated with cardiac systolic function. Neonatal exposure to dexamethasone treatment was negatively associated with right ventricular function, as measured by the automated fractional area change, with an odds ratio of 7.9 and 95% confidence interval of 1.9-33.5 (p = 0.005). CONCLUSION Lung function measurements were not associated with cardiac systolic function in preterm infants at six to 14 years of age. Neonatal exposure to dexamethasone, used for weaning from the ventilator, was negatively associated with right ventricular function.
Collapse
Affiliation(s)
- Piia Suursalmi
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Tiina Ojala
- Department of Pediatric Cardiology; Children's Hospital; University Hospital of Helsinki and University of Helsinki; Helsinki Finland
| | - Tuija Poutanen
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
| | - Anneli Eerola
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
| | - Päivi Korhonen
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Tarja Kopeli
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Department of Pediatrics; Päijät-Häme Central Hospital; Lahti Finland
| | - Outi Tammela
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| |
Collapse
|
13
|
Suursalmi P, Eerola A, Poutanen T, Korhonen P, Kopeli T, Tammela O. Very low birthweight bronchopulmonary dysplasia survivors had similar cardiac outcomes to controls at six years to 14 years of age. Acta Paediatr 2017; 106:261-267. [PMID: 27792267 DOI: 10.1111/apa.13647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/16/2016] [Accepted: 10/25/2016] [Indexed: 01/04/2023]
Abstract
AIM This study evaluated cardiac function and its associations with lung function and neonatal pulmonary morbidity in very low birthweight (VLBW) children, with and without severe radiographic bronchopulmonary dysplasia (radBPD), at school age. METHODS We examined 18 VLBW children with radBPD, 17 VLBW children without radBPD and 18 healthy term-born children using conventional echocardiography, tissue Doppler imaging, speckle tracking echocardiography and real-time three-dimensional echocardiography at six years to 14 years of age. Lung function was studied by impulse oscillometry. Plasma N-terminal-proBNP concentrations were measured. RESULTS Cardiac function and N-terminal-proBNP concentrations did not differ between the groups. No associations were found between cardiac function and neonatal dexamethasone, oxygen or ventilator therapies. In VLBW children, poorer reactance correlated with larger left ventricle (LV) end-systolic (Spearman's ρ = -0.45) and end-diastolic (ρ = -0.50) volumes and higher resistance correlated with higher LV dyssynchrony indexes, with ρ ranging from 0.37 to 0.48. Greater bronchodilation responses correlated with lower early diastolic myocardial relaxation velocities, with ρ ranging from 0.39 to 0.42. CONCLUSION BPD survivors had normal cardiac function at the age of six years to 14 years. No associations were found between neonatal pulmonary morbidity and cardiac parameters. Poorer lung function correlated modestly with LV echocardiographic parameters in VLBW children.
Collapse
Affiliation(s)
- Piia Suursalmi
- Department of Pediatrics Tampere University Hospital Tampere Finland
- Tampere Center for Child Health Research Tampere University Hospital and University of Tampere Tampere Finland
| | - Anneli Eerola
- Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Tuija Poutanen
- Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Päivi Korhonen
- Department of Pediatrics Tampere University Hospital Tampere Finland
- Tampere Center for Child Health Research Tampere University Hospital and University of Tampere Tampere Finland
| | - Tarja Kopeli
- Department of Pediatrics Tampere University Hospital Tampere Finland
- Department of Pediatrics Päijät‐Häme Central Hospital Lahti Finland
| | - Outi Tammela
- Department of Pediatrics Tampere University Hospital Tampere Finland
- Tampere Center for Child Health Research Tampere University Hospital and University of Tampere Tampere Finland
| |
Collapse
|
14
|
Ronkainen E, Kaukola T, Marttila R, Hallman M, Dunder T. School-age children enjoyed good respiratory health and fewer allergies despite having lung disease after preterm birth. Acta Paediatr 2016; 105:1298-1304. [PMID: 27411109 DOI: 10.1111/apa.13526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/18/2016] [Accepted: 07/11/2016] [Indexed: 01/05/2023]
Abstract
AIM This study explored the under-researched area of whether preterm birth or bronchopulmonary dysplasia (BPD) affected hospitalisation rates, allergies or health-related quality of life (HRQoL). METHODS We studied 88 schoolchildren born preterm at a mean gestational age of 28.8 weeks (range 24.1-31.9) and matched term-born controls at the mean age of 11 years (range 8-14). Hospitalisations after the first discharge were recorded, skin prick allergy tests were performed and HRQoL was assessed with a parental questionnaire. RESULTS Preterm children were hospitalised more than controls (64% versus 39%, p = 0.001), mostly before two years of age. The adjusted odds ratios (OR) for two-year-old preterm-born children being hospitalised for wheezing was 8.2 (95% CI 2.0-34.1). BPD affected 56% of the preterm children, but did not influence hospitalisations, and the positive skin prick rate was similar between the preterm and term-born children (35% versus 48%, p = 0.126). Preterm BPD children had fewer positive skin prick tests than those without BPD. HRQoL was lower in preterm than term children (81.25 ± 10.84 versus 86.80 ± 9.60, p = 0.001). CONCLUSION Most health problems experienced by preterm-born schoolchildren occurred before two years of age and were mainly wheezing disorders. BPD decreased atopy but had no influence on hospitalisation rates.
Collapse
Affiliation(s)
- Eveliina Ronkainen
- PEDEGO Research Unit; Medical Research Center Oulu and Department of Children and Adolescents; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Tuula Kaukola
- Division of Neonatal Medicine; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
| | - Riitta Marttila
- Division of Neonatal Medicine; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
| | - Mikko Hallman
- PEDEGO Research Unit; Medical Research Center Oulu and Department of Children and Adolescents; Oulu University Hospital and University of Oulu; Oulu Finland
- Division of Neonatal Medicine; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
| | - Teija Dunder
- Division of Allergology and Pulmonology; Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
| |
Collapse
|
15
|
Shahzad T, Radajewski S, Chao CM, Bellusci S, Ehrhardt H. Pathogenesis of bronchopulmonary dysplasia: when inflammation meets organ development. Mol Cell Pediatr 2016; 3:23. [PMID: 27357257 PMCID: PMC4927524 DOI: 10.1186/s40348-016-0051-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/20/2016] [Indexed: 01/12/2023] Open
Abstract
Bronchopulmonary dysplasia is a chronic lung disease of preterm infants. It is caused by the disturbance of physiologic lung development mainly in the saccular stage with lifelong restrictions of pulmonary function and an increased risk of abnormal somatic and psychomotor development. The contributors to this disease’s entity are multifactorial with pre- and postnatal origin. Central to the pathogenesis of bronchopulmonary is the induction of a massive pulmonary inflammatory response due to mechanical ventilation and oxygen toxicity. The extent of the pro-inflammatory reaction and the disturbance of further alveolar growth and vasculogenesis vary largely and can be modified by prenatal infections, antenatal steroids, and surfactant application. This minireview summarizes the important recent research findings on the pulmonary inflammatory reaction obtained in patient cohorts and in experimental models. Unfortunately, recent changes in clinical practice based on these findings had only limited impact on the incidence of bronchopulmonary dysplasia.
Collapse
Affiliation(s)
- Tayyab Shahzad
- 1Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University, Feulgenstrasse 12, D-35392 Gießen, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Lung Research Center (DZL), Giessen, Germany.,University of Giessen Lung Center, Excellence Cluster Cardio-Pulmonary Systems, Member of the German Lung Center, Department of Internal Medicine II, Aulweg 130, 35392, Giessen, Germany
| | - Sarah Radajewski
- 1Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University, Feulgenstrasse 12, D-35392 Gießen, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Lung Research Center (DZL), Giessen, Germany.,University of Giessen Lung Center, Excellence Cluster Cardio-Pulmonary Systems, Member of the German Lung Center, Department of Internal Medicine II, Aulweg 130, 35392, Giessen, Germany
| | - Cho-Ming Chao
- 1Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University, Feulgenstrasse 12, D-35392 Gießen, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Lung Research Center (DZL), Giessen, Germany.,University of Giessen Lung Center, Excellence Cluster Cardio-Pulmonary Systems, Member of the German Lung Center, Department of Internal Medicine II, Aulweg 130, 35392, Giessen, Germany
| | - Saverio Bellusci
- University of Giessen Lung Center, Excellence Cluster Cardio-Pulmonary Systems, Member of the German Lung Center, Department of Internal Medicine II, Aulweg 130, 35392, Giessen, Germany
| | - Harald Ehrhardt
- 1Department of General Pediatrics and Neonatology, Center for Pediatrics and Youth Medicine, Justus-Liebig-University, Feulgenstrasse 12, D-35392 Gießen, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Lung Research Center (DZL), Giessen, Germany. .,University of Giessen Lung Center, Excellence Cluster Cardio-Pulmonary Systems, Member of the German Lung Center, Department of Internal Medicine II, Aulweg 130, 35392, Giessen, Germany.
| |
Collapse
|
16
|
Suursalmi P, Korhonen P, Kopeli T, Nieminen R, Luukkaala T, Moilanen E, Tammela O. Severe Bronchopulmonary Dysplasia, Growth, Nutrition, and Adipokines at School Age. Glob Pediatr Health 2016; 3:2333794X16637290. [PMID: 27336010 PMCID: PMC4905159 DOI: 10.1177/2333794x16637290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 12/25/2022] Open
Abstract
This study evaluated nutrition and growth in relation to plasma adipokine levels in 21 very-low-birth-weight (VLBW) children with radiographic bronchopulmonary dysplasia (BPD), 19 VLBW controls, and 19 term controls with a median age of 11.3 years. We took anthropometric measurements; assessed plasma levels of adipsin, resistin, adiponectin, and leptin; and analyzed the children’s 3-day food records. Children with BPD had a smaller age-adjusted head circumference and more microcephaly but no other significant growth differences. Daily recommended nutritional intake levels were poorly met but did not differ between the groups. Leptin levels correlated positively with the body mass index standard deviation score in VLBW children. No other associations between adipokine concentrations and growth were found. There were negative correlations between leptin concentrations and fat intake, resistin levels and carbohydrate intake, and adiponectin, adipsin, and leptin levels and energy intake.
Collapse
Affiliation(s)
- Piia Suursalmi
- Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland
| | - Päivi Korhonen
- Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland
| | | | - Riina Nieminen
- Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland
| | | | - Eeva Moilanen
- Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland
| | - Outi Tammela
- Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland
| |
Collapse
|
17
|
Islam JY, Keller RL, Aschner JL, Hartert TV, Moore PE. Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia. Am J Respir Crit Care Med 2015; 192:134-56. [PMID: 26038806 DOI: 10.1164/rccm.201412-2142pp] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease associated with premature birth that primarily affects infants born at less than 28 weeks' gestational age. BPD is the most common serious complication experienced by premature infants, with more than 8,000 newly diagnosed infants annually in the United States alone. In light of the increasing numbers of preterm survivors with BPD, improving the current state of knowledge of long-term respiratory morbidity for infants with BPD is a priority. We undertook a comprehensive review of the published literature to analyze and consolidate current knowledge of the effects of BPD that are recognized at specific stages of life, including infancy, childhood, and adulthood. In this review, we discuss both the short-term and long-term respiratory outcomes of individuals diagnosed as infants with the disease and highlight the gaps in knowledge needed to improve early and lifelong management of these patients.
Collapse
Affiliation(s)
- Jessica Y Islam
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Roberta L Keller
- 2 Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, California; and
| | - Judy L Aschner
- 3 Department of Pediatrics and.,4 Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, New York
| | - Tina V Hartert
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Paul E Moore
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and.,5 Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
18
|
Malinovschi A, Ludviksdottir D, Tufvesson E, Rolla G, Bjermer L, Alving K, Diamant Z. Application of nitric oxide measurements in clinical conditions beyond asthma. Eur Clin Respir J 2015; 2:28517. [PMID: 26672962 PMCID: PMC4653314 DOI: 10.3402/ecrj.v2.28517] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/05/2015] [Indexed: 02/01/2023] Open
Abstract
Fractional exhaled nitric oxide (FeNO) is a convenient, non-invasive method for the assessment of active, mainly Th2-driven, airway inflammation, which is sensitive to treatment with standard anti-inflammatory therapy. Consequently, FeNO serves as a valued tool to aid diagnosis and monitoring in several asthma phenotypes. More recently, FeNO has been evaluated in several other respiratory, infectious, and/or immunological conditions. In this short review, we provide an overview of several clinical studies and discuss the status of potential applications of NO measurements in clinical conditions beyond asthma.
Collapse
Affiliation(s)
- Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden;
| | - Dora Ludviksdottir
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ellen Tufvesson
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Lund University, Lund, Sweden
| | - Giovanni Rolla
- Department of Medical Sciences, Allergology and Clinical Immunology, University of Torino, Torino, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Lund University, Lund, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Lund University, Lund, Sweden.,Department of Clinical Pharmacy & Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands.,Department of General Practice, University Medical Centre Groningen, Groningen, The Netherlands.,QPS Netherlands, Groningen, The Netherlands
| |
Collapse
|
19
|
Suursalmi P, Kopeli T, Korhonen P, Lehtimäki L, Nieminen R, Luukkaala T, Moilanen E, Korppi M, Paassilta M, Tammela O. Very low birthweight bronchopulmonary dysplasia survivors show no substantial association between lung function and current inflammatory markers. Acta Paediatr 2015; 104:264-8. [PMID: 25348705 DOI: 10.1111/apa.12837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/08/2014] [Accepted: 10/22/2014] [Indexed: 01/17/2023]
Abstract
AIM The role of inflammation in the bronchopulmonary dysplasia (BPD) survivors is indistinct. We evaluated lung function in relation to inflammatory markers in plasma, exhaled breath condensate and exhaled air in school-aged very low birthweight (VLBW) survivors with and without radiographic BPD. METHODS Pre- and postbronchodilator impulse oscillometry were performed by 21 six to 14-year-old VLBW children with radiographic BPD, 19 VLBW children without radiographic BPD and 19 age-matched nonasthmatic term controls. Eosinophilic cationic protein, interleukins 6 and 8, adiponectin, adipsin, leptin and resistin in plasma, leukotriene B4 and 8-isoprostane in exhaled breath condensate, and bronchial and alveolar nitric oxide output were measured. RESULTS Abnormal lung function was found in 12.5% of the former VLBW children. Airway resistance at 5 Hz was highest in the radiographic BPD, but bronchodilator responses were most prominent in the non-BPD group. Plasma adiponectin had a modest positive correlation with obstruction and with bronchodilator responses, and alveolar nitric oxide and plasma interleukin 6 with bronchodilator responses. CONCLUSION Very low birthweight children with radiographic BPD had poorest lung function. The most pronounced bronchodilator responses were found in VLBW children without radiographic BPD. Current detected inflammatory markers had only a minor association with lung function in school-aged BPD survivors.
Collapse
Affiliation(s)
- Piia Suursalmi
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Tarja Kopeli
- Department of Pediatrics; Päijät-Häme Central Hospital; Lahti Finland
| | - Päivi Korhonen
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Lauri Lehtimäki
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
- Allergy Centre; Tampere University Hospital; Tampere Finland
| | - Riina Nieminen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - Tiina Luukkaala
- Science Center; Pirkanmaa Hospital District and School of Health Sciences; University of Tampere; Tampere Finland
| | - Eeva Moilanen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - Matti Korppi
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | | | - Outi Tammela
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| |
Collapse
|